Medicare Part A: What is Covered and What is Not

Medicare is a government health insurance program for those who are 65 years of age or older, as well as some individuals under 65 with specific disabilities or diseases. Medicare is managed by a federal organization named the Centers for Medicare & Medicaid Services. Medicare has requirements for costs and coverage because it is a federally funded program. This indicates that regardless of the state in which a person resides, their Medicare coverage will be the same. It’s important to fully understand your options for Medicare coverage and to choose your plan carefully. Your out-of-pocket expenses and the locations of your care options may be impacted by how you choose to receive your benefits and from whom. Medicaid is a different federal program that offers health insurance from Medicare. People with low incomes are covered by Medicaid, which is funded and administered by the federal government in collaboration with the states. Keep in mind that Medicare eligibility is not income-based like Medicaid. Dual-eligible people are those who are qualified for both Medicaid and Medicare. Depending on your plan type, your Medicare expenses will differ. It is difficult to understand and tough to sort through. The program has been divided into four simple sections that include everything from hospital treatment to doctor visits to prescription drugs in order to make it simpler. Medicare’s various parts aid in the coverage of particular services. And before you can decide which ones you want to take, you’ll need to understand them. Let’s review Part A of Medicare, see how you can use it to achieve your health objectives, and learn what is and isn’t covered. And before you can decide which ones you want to take, you’ll need to understand them. Let’s review Part A of Medicare, see how you can use it to achieve your health objectives, and learn what is and isn’t covered. What does Medicare Part A cover? You can enroll in Medicare Part A once you turn 65. If you’re already collecting Social Security disability benefits, you’ll be automatically enrolled in Part A. Part A of Medicare covers hospital stays, hospice care, and some skilled nursing care that you might require after being admitted for a stroke, a broken hip, or other incidents that call for rehabilitation in a nursing facility or other facility so you can get back on your feet. Part A enrollment in Medicare happens automatically when you apply for it. Part A isn’t entirely free, though. Every time you are admitted to the hospital under Medicare, a sizable deductible is assessed. Every year it varies, but the deductible for 2023 is $1,600. What is not under Medicare Part A coverage? It’s also essential to understand that not all hospital expenses are covered by Medicare Part A. Part A won’t cover the following items: Outpatient hospital services, such as trips to the emergency room that do not result in overnight stays, are not covered by Medicare Part A. Medicare Part A does not cover the majority of hospital room amenities, private and custodial care, or long-term care; instead, outpatient hospital treatments are covered under Medicare Part B. Long-term care in a nursing home or assisted living facility is not covered by Medicare Part A or any other part of Medicare. As it would wherever you live, Medicare will cover your medical expenses. However, if the only care you require is assistance with daily tasks like bathing, dressing, eating, or using the restroom (also known as “custodial care”), it does not cover lodging or board at these facilities. Remember: Three-day hospital stay requirement. After being released from the hospital, Part A covers brief stays in a skilled nursing facility or rehabilitation facility. But in order to be eligible for this coverage, you must first be formally admitted to the hospital as an inpatient for a minimum of three days. If you are eligible for coverage for skilled care facilities, you pay:

  • Nothing for days 1 to 20
  • For days 21 to 100, $200 per day in 2023
  • Every expense for days 101 and after

Dates to remember You should be aware of important dates on the website, regardless of whether you are looking at Medicare Part A or Part B 

  • A three-month grace period is required prior to your 65th birthday for initial enrollment
  • General Enrollment: January 1 – March 31 for Medicare Part B if not set up during enrollment
  • Open Enrollment: October 15 – December 7 

Additionally, provides useful information about the program and answers most general questions. Remember, we have professionals right here on our team who can speak directly and specifically to you about what is best for your loved one and your family. The opportunity to ease your anxiety and reveal the mysteries of Medicare would be an honor for us.

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