Original Medicare: Part A

“Original” Medicare: that’s what we call it now that other options have become available in recent years, particularly the Medicare Advantage Plans (Part “C”).

Original Medicare is defined as Part A (Hospital) and Part B (Medical) insurance. When signed into law by then President Lynden Johnson in 1964, it was never intended to be an all-inclusive insurance policy for retirees, but just a basic plan to help ease some of their financial burden.

Original Medicare: What is Covered and What You or Your Senior Loved One is Responsible For

As such, the private insurance industry has flourished as they’ve rushed in the “fill in the gaps” with various Medigap policies. Depending on your budget, you can purchase one of these policies to just fill in some of the gaps, or go with a plan that picks up practically everything that Medicare “leaves behind.” This article goes into more detail on what’s covered and what’s not…

Original Medicare covers certain medical services and supplies in hospitals, doctors’ offices, and other health care settings. Let’s take a closer look at what this means for you or your loved one…

Part A – Hospital insurance helps cover the following:

  • Inpatient care in hospitals
  • Inpatient care in a skilled nursing facility (NOT custodial or long‑term care)
  • Hospice services
  • Home health care services
  • Inpatient care in a Religious Nonmedical Health Care Institution

Blood – In most cases, the hospital gets blood from a blood bank at no charge, but if it has to buy blood for you, you must either pay for the first 3 units of blood you get in a calendar year or have the blood donated.

Home Health Services – Medicare covers medically-necessary part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, and/or services for occupational therapy. You pay nothing for covered home health care services.  You pay 20% for durable medical equipment, such as walkers and wheelchairs.

Hospice Care – To qualify one must be certified to be terminally ill with only 6 months or less to live. This can be in your home or other facility such as a nursing home. You pay nothing for hospice care. During this time the beneficiary would pay a copayment of up to $5 per prescription for drugs for pain and symptom management. You pay 5% for inpatient respite care.

Hospital Care (Inpatient) – Medicare covers semi-private rooms, meals, general nursing, and drugs as part of your inpatient treatment, and other hospital services and supplies. If you have Part B, it covers the doctor’s services you get while you’re in a hospital. Following are your responsibilities for 2012:

  • A deductible of $1,156 and no copayment for days 1–60 each benefit period.
  • $289 a day for days 61–90 each benefit period.
  • $578 a day per “lifetime reserve day” after day 90 each benefit period (up to 60 days over lifetime).
  • All costs for each day after the lifetime reserve days.
  • Inpatient mental health care in a psychiatric hospital – limited to 190 days in a lifetime.

Religious Nonmedical Health Care Institution (Inpatient care) – Medicare only covers the nonmedical, non-religious health care items and services (like room and board) in this type of facility.

Skilled Nursing Facility Care – Medicare covers services and supplies after a 3-day minimum medically necessary inpatient hospital stay for a related illness or injury. (Medicare doesn’t cover long-term or custodial care.)

For 2012:

  • You pay nothing for the first 20 days each benefit period.
  • You pay $144.50 per day for days 21–100 each benefit period.
  • You pay all costs for each day after day 100 in a benefit period.

Contact Information

To find out if Medicare covers a service not on this list, visit www.medicare.gov/coverage or call 1-800-MEDICARE (1‑800‑633‑4227). TTY users should call 1‑877‑486‑2048. For more details about Medicare‑covered services, visit www.medicare.gov/publications to view the booklet “Your Medicare Benefits.”

SeniorLiving.Net is a FREE resource for families that are looking for senior care. To learn more about senior living communities in your area, call (877) 345-1706 to speak to a local Care Advisor in your area.

Gary Phillips is a licensed insurance agent based in western North Carolina. He specializes in the senior market and is knowledgeable in multiple insurance lines including Medicare, Medigap, Long-Term Care, Part D Prescription Drugs, Part C Medicare Advantage, Health, Life and Final Expense insurance. He also enjoys writing and helping others. www.bizpartner.homestead.com.

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Original Medicare: Part B

Information contained in this article is presumed accurate at the date of publication (06/2012), but not guaranteed. In addition, Medicare changes rules and costs annually so it’s important to refer to the paragraph above to access the most current data.