Original Medicare

Original Medicare:
Getting Care in a Hospital, Nursing Home, at Home and with
Hospice
Medicare Part A helps pay for inpatient care in hospitals and skilled nursing
facilities. It also helps cover hospice care and some home health care. You
must meet certain conditions to get these benefits. Medicare does not pay
all of these costs. You, or separate insurance, must pay some of these
costs, too.

Medicare Part A
Most people do not have to pay a monthly fee or premium for Part A. That
is because they or their spouse paid Medicare taxes while they were
working.

Medicare Part A helps pay for the cost of:
  • hospital stays
  • short term skilled nursing home stays, following a hospital stay
  • home health care, following a hospital stay
  • hospice care

Medicare Part A




























Medicare Part A does not pay all of the costs of hospital, skilled nursing
home, home, and hospice care. The following describes what your share of
the costs will be.

Care in a Hospital
Medicare Part A helps pay for hospital stays, including stays in psychiatric
hospitals. Here's how it works:

  • Once you pay your Part A deductible, ($1,024 in 2008), Medicare
    pays the rest of your hospital bill for a stay of up to 60 days in a
    benefit period. A benefit period begins the day you go to the hospital
    and ends when you have been out of the hospital for 60 days in a
    row.

  • If you go into the hospital again before you've been out 60 days, you
    continue in the "old" benefit period. If you go into the hospital again
    after you have been out at least 60 days, you begin a new benefit
    period. You pay a deductible for each new benefit period.
  • If you stay in the hospital more than 60 days, you will pay a bigger
    part of the bill.


How Much You and Medicare Pay for Hospital Care (In 2008)













* Days 91-150 (60 days) are called lifetime reserve days. They can be used
after you have been in the hospital 90 days. You don't need to use these
lifetime reserve days all at once. There are 190 lifetime day reserve days
for stays in a psychiatric hospital.

In the hospital, Medicare Part A helps pay for:

  • semi-private room and meals
  • resident and intern services
  • nursing services
  • medical social services
  • drugs, shots, and blood for use in the hospital
  • equipment, such as wheelchairs, and medical supplies
  • physical therapy
  • planning for follow-up care

In the hospital, Medicare Part A does not pay for:

  • private-duty nursing (you hire your own private nurse)
  • private rooms (unless the doctor says you need a private room for
    your health)
  • television
  • telephone

Care in a Nursing Home
Medicare Part A helps pay for some of your stay in a nursing home. A
skilled nursing facility is a place where you get skilled nursing or
rehabilitative care from licensed health professionals. Help from family
members or care you give yourself is not considered skilled nursing care.

You must meet these conditions for Medicare to help pay for your care in a
nursing home:

  • You need to have been in the hospital for three or more days before
    you go to a skilled nursing home. Your care must begin within 30
    days after you leave the hospital.
  • Your doctor must order daily skilled nursing or rehabilitation services
    that you can get only in a skilled nursing home. "Daily" means seven
    days a week for skilled nursing services and five days a week or
    more for skilled rehabilitation services.
  • You get these skilled services in a nursing home that has been
    approved by Medicare.

If you meet these conditions, Medicare pays for up to 100 days in a benefit
period. A benefit period begins the day you go into the hospital or skilled
nursing home. The benefit period ends when you have been out of the
hospital or skilled nursing home for at least 60 days in a row. You pay a
Part A deductible ($1,024 in 2008) for each new benefit period.

How Much You and Medicare Pay for Skilled Nursing Home
Care (In 2008)








If you need care in a skilled nursing home at a later time, you must again
meet the same conditions for Medicare to help pay for your care.

In a skilled nursing home, Medicare helps pays for:

  • a semi-private room
  • meals
  • skilled nursing and rehabilitative services
  • medical social services
  • prescription drugs, medical supplies and equipment
  • possible ambulance service
  • dietary counseling
  • other services such as lab tests and x-rays

Care at Home
Medicare Part A and Part B both help pay for home health care. Home
health care is skilled nursing, rehabilitative, and other kinds of health care
services that you get in your home to treat an illness or injury. (Medicare
doesn't pay for care to help you with activities of daily living, such as
bathing, dressing, eating or using the toilet.)

You must meet four conditions for Medicare to help pay for your home
health care:

  1. Your doctor must order medical care for you in your home and make
    a plan for that care.
  2. You must need help from a skilled nurse or a physical, occupational,
    or speech therapist on a part-time basis. Medicare does not pay for
    these services round-the-clock (24 hours).
  3. You must be homebound. This means it is very hard for you to leave
    your home because of your illness or injury.
  4. You must get your care from a home health care agency that is
    approved by Medicare.


What Medicare Pays
Medicare will pay for your home care for as long as you meet these
conditions. Your doctor and home health care agency will review your plan
of care at least every 60 days.

Medicare will pay for the following as part of your home health care:

  • part-time skilled nursing care
  • home health aides
  • physical, occupational, or speech therapists
  • medical social services or counseling to help you cope with your
    illness or injury
  • medical equipment and supplies

What You Pay
You do not have to pay anything for these services as long as you meet the
four conditions listed above. However, you must pay 20 percent of the cost
of medical equipment and 100 percent of the costs of outpatient
prescription drugs, unless you have drug coverage from Medicare Part D or
another source.

Hospice Care
Medicare Part A will help pay for your hospice care. Hospice care is a
special way of caring for people who are dying and for their family
members. The focus of hospice care is to help make people as comfortable
as possible at the end of their life rather than try to cure their illness or
injury. While you can receive hospice care in your home, a hospice facility,
a nursing home, or a hospital, most people use hospice care at home.

You must meet these conditions for Medicare to pay for your hospice care:

  • You must have or be able to get Medicare Part A.
  • A doctor must say you are terminally ill.
  • You, or the person who is making your health care decisions, must
    sign and send a form to Medicare to tell them you are choosing
    hospice care.*
  • You must get care from a hospice approved by Medicare.

*Once you choose hospice care, you can't use your Medicare benefits to
cure your terminal illness. You can, however, get care for other health
problems. If for any reason you stop hospice care, you will again get your
health care from Medicare.

For example, Mary is getting hospice care for cancer. She is not using
Medicare to continue chemotherapy or radiation to cure her illness.
Unfortunately, while receiving hospice care, Mary fell and broke her wrist.
Medicare will pay for treating her broken wrist.

What Medicare Pays
You get hospice care for up to two 90-day periods, followed by an unlimited
number of 60 day periods. At the start of each period of care, your doctor
must confirm that you are still terminally ill in order to continue the care.

Medicare pays for the following services as part of your hospice care:

  • doctor and nursing care
  • drugs to help control your pain
  • dietary counseling
  • counseling for you and your family
  • short-term hospital care (including respite care)
  • physical, occupational, and speech therapy
  • medical social services
  • home health aide and homemaker services
  • medical supplies and equipment

What You Pay
You pay up to $5 for each prescription drug. You also pay 5 percent of the
Medicare-approved amount for respite care. Respite care is short-term
care given to you so that your caregiver can get some rest, run errands or
get away for a few days.



AARP Resources
Nursing Home Evaluation Checklist
This checklist will help you choose the right nursing home to meet your
needs and will make comparing the facilities a little easier.

Caring for Those You Care About
AARP offers three one hour online seminars to help with your caregiving
needs.

Health Professionals, Patients, and Caregivers
Regular contact with the medical community and caring for an older parent
go hand-in hand.

Additional Resources
National Association of Home Care
Information about Medicare coverage for home health care.

Hospice Association of America (HAA)
Consumer's guide to hospice care.

National Hospice and Palliative Care Organization
Information about hospice care and the Medicare hospice benefit.
Service
Part A helps pay for:
Hospital Care
Semi-private room, meals, nursing
care, and other hospital services
and supplies.
Nursing Home Care
Semi-private room, meals, skilled
nursing
(Skilled Nursing Facility)
and rehabilitative care, and other
services and supplies. Part A pays
for this care only after you have
been in a hospital for three or more
days. Your care in the facility must
begin within 30 days after you
leave a hospital.
Home Health Care
Part-time skilled nursing care;
physical, occupational, and speech
therapy; some home health aides;
medical social services; medical
equipment (wheelchairs, hospital
beds, walkers, and oxygen); and
other supplies and services.
Hospice Care
Doctor and nursing services; drugs
for pain and to help control your
symptoms; counseling services;
and care in a hospice, hospital,
nursing home, or your home.
Number of Days
You Pay
Medicare Pays
Days 1-60
$1,024 deductible (per
benefit period), then
nothing
The rest
Days 61-90
$256 per day
The rest
Days 91-150*
$512 per day
The rest
All additional days
Everything
Nothing
Number of Days
You Pay
Medicare Pays
Days 1- 20
Nothing
Everything
Days 21-100
$128 per day
The rest
Over 100 days
Everything
Nothing

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