| Thu, Jun 21, 2012 @ 09:00 AM

Medicare Hospital Coverage: Little Things to Help Avoid Big Surprises

Posted by Medicare Made Clear

Medicare Hospital Coverage: Little Things to Help Avoid Big SurprisesMedicare Part A is usually thought of as “hospital insurance.” While this is true, there are other important things Medicare Part A covers. There are also some things it won’t cover. It’s important to understand both and what they mean for your out-of-pocket costs. First you need a good understanding of Medicare Part A.

Medicare Part A – the Basics

Medicare Part A helps pay the costs involved with an inpatient stay in the hospital. But it helps cover other things, as well. These can include:

  • A stay in a skilled nursing facility as a follow-up to a hospital stay.
  • Hospice care for the terminally ill.
  • Some home health care services for those who can’t leave their home.
  • Some blood transfusions.

A Note about “inpatient” hospital stays: just because you stay overnight in a hospital, doesn’t mean Medicare will consider it an “inpatient” stay. To help you understand the difference, check out Medicare.gov’s “Are You a Hospital Inpatient or Outpatient? If You Have Medicare – Ask!

What Part A Won’t Cover

Medicare Part A helps you pay the costs of hospital care when you’re sick. But there are some things it won’t pay for. These might include:

  • Most doctor services you receive in the hospital. Services provided by a doctor are covered by Medicare Part B. This means you’ll pay your Part B deductible first, then generally 20% coinsurance for covered services.
  • Any personal costs. If the hospital charges you for things like entertainment (e.g. TV or cable), telephone calls or other personal items, you’ll have to pay for these yourself.
  • Custodial care. This includes activities of daily life, like eating, bathing or dressing. Custodial care isn’t covered by Medicare Part A—even if you get it in the hospital—because it isn’t considered “skilled” medical care.

Coverage Limits – Long Stay? You Might Pay.

There are limits on the number of days of care Medicare Part A will help pay for. If your stay in the hospital lasts longer than 90 days, you might have to pay for some of your own care. Be sure you understand what lifetime reserve days are and what they mean for your costs. In the same way, there are also limits on the number of days of care in a skilled nursingNursing care that should be provided only by a licensed nurse.  facility Part A will help pay for. Part A will pay for an unlimited number of skilled home health care In Original Medicare, skilled nursing care and therapy, such as speech therapy or physical therapy, provided on a part-time or intermittent basis to those who cannot leave the home.

visits or hospice care visits. You do have to meet certain conditions to receive these kinds of help, though.

Getting Help with Costs – Covering What Part A Doesn’t

One way to deal with the costs that might come from the things Part A doesn’t cover is just to pay those costs out of your own pocket. This is not always possible, though. If you need help paying for what Medicare Part A won’t, you’ve got options.

  • Medicare Advantage plan: Medicare Advantage plans (also called Medicare Part C) offer the same benefits as Medicare Parts A and B, except hospice care (this will still be paid by Part A). Since these are private plans, they might offer more hospital coverage than Part A. This is not always the case, and plans can vary widely depending on who’s offering them. It’s always a good idea to first check which plans are available in your area. Then look at the benefits of a specific plan to see if it would be worth a change.
  • Medicare supplement insurance plans: If you want to keep Medicare Parts A and B, but want a little help paying for some of the out-of-pocket expenses they won’t pay, a Medicare supplement insurance plan might be worth looking into. Each plan is different and not all plans are available in all areas. Learn more here.
  • Extra Help: This is a program that helps people pay for prescription drug premiums and costs. To see if you qualify, call 1-800-MEDICARE (1-800-633-4227; TTY: 1-877-486-2048), 24 hours a day/7 days a week. You can also call the Social Security Administration office at 1-800-772-1213 (TTY: 1-800-325-0778), 7 a.m. – 7 p.m., Monday through Friday, or your state Medical Assistance office.

Your Medicare Coverage tool – A Little Planning Goes a Long Way

It’s not always possible to plan for a hospital stay. When you can, it definitely pays to do your homework. If you have Medicare Parts A & B and want to find out if they will cover a certain test, item or service, visit the Your Medicare Coverage page of Medicare.gov. You simply enter information about your coverage—like your policy ID number—and choose the service you have in mind from a list they give to you. In most cases, the tool will be able to quickly tell you whether or not your test, item or service will be covered. If you have a Medicare Advantage plan, contact the plan to find out if they will cover a specific service. Talk about planning ahead!

The Little Things Matter

When it comes to Medicare Part A, the little things matter. Knowing what Part A will cover is important. Knowing what it won’t cover is, too. Small steps like research and planning now can help avoid big surprises in your Medicare bill later.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


MedicareMadeClear: Medicare Part A – Coverage

Medicare.gov: Medicare Part A

Medicare.gov: Inpatient vs. Outpatient status (PDF)

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