What is a Medicare Part A Plan?

Hospital Benefits

While Part A does provide hospital care benefits, there are two stipulations for you to receive coverage. First, you need to be admitted for inpatient care by a doctor’s recommendation. Second, the hospital in question must accept Medicare. Finally, you may receive coverage if the hospital’s Utilization Review Committee approves your coverage.

If you meet these requirements, you will have coverage for meals, shared hospital rooms, and general nursing care. Additionally, you will have coverage for the drugs required for your treatment, and other necessarily hospital services and supplies.

Skilled Nursing Facility Coverage

These benefits cover the cost of care given by skilled nurses. These services include injections and tests necessary for your recovery. Similar to hospital benefits, you must meet certain requirements in order to receive coverage for SNF.

These requirements include having enough hospital days left in your benefits pool, as well as qualifying for a hospital stay. Beyond that, your doctor must approve your hospital care can be administered by skilled nursing staff. Furthermore, the SNF must be approved by Medicare.

Another requirement is that your condition must be a hospital-related condition and treated during your stay. What you should know, is that these stipulations include conditions that you develop during your 3-day inpatient stay, even if you were admitted for a different condition.

Benefits

Similar to your hospital benefits, this coverage will give you access to semi-private rooms, meals, medications, and necessary medical supplies. In addition, SNF coverage applies to physical therapy, occupational therapy, and speech-language pathology. There are a few other benefits of your plan that will be detailed in when you purchase your plan.

Long-term Hospital Care Benefits

Abbreviated to LTHC, these benefits cover many of the same services as regular hospital care. You can also receive coverage for acute care and ventilators. If you still need care after your LTHC benefits run out, you may be eligible for Skilled Nursing Facility Care.

The costs for LTHC coverage scales much like that of hospital care benefits. You will have a deductible and coinsurance that will increase the more days you use.

Usually, Part A is the premium free part of Original Medicare, due to retirement benefits. However, if you choose to buy a Part A plan, you will have a premium determined by the number of quarters you paid Medicare taxes.

Hospital Costs

Part A plans have both deductibles and coinsurance costs for inpatient hospital care. Usually, plans will cover the first 60 days of inpatient hospital care without requiring coinsurance. However, after the 60-day mark of your benefits, you will have to start paying coinsurance charges. After 91 days of benefits, the cost of coinsurance will increase.

Once you start paying coinsurance after this mark, you will have a certain amount of “lifetime reserve” days. After these reserve days have been used, you will have to cover the rest of your costs out of pocket.

The difference between Original Medicare and Medicare Advantage is who provides them. Original Medicare is provided by the government, while Medicare Advantage plans are sold by private insurance companies.

Advantage Plans, also called Medicare Part C, are a bundle of Medicare Parts A and B, and sometimes Part D, which provides prescription drug coverage.

Usually, you cannot get Medicare before you turn 65 and you will have to find another healthcare option. However, if you have a qualifying disability or End-Stage Renal Disorder you can get Part A coverage.

When you start receiving Medicare on a disability is determined works the same way it does for people who turn 65. If you have been receiving Social Security benefits for 24 months, you will be automatically enrolled in Medicare Part A and Part B. You will start receiving these benefits during the 25th month of your disability benefits.

If it looks like you will qualify for coverage, you will receive the Medicare red, white, and blue card three months before your coverage begins.

Can I get a Medicare Advantage Plan if I’m under 65?

If you qualify for Original Medicare under 65, then you can buy Medicare Advantage plans.

Dealing with all the ins and outs of Medicare can be overwhelming. At Buffalo Health Advisors, you can find someone to talk to who will help you find the best plan for you.

When you sit down with one of our health insurance agents, we will identify your health care needs and then talk to insurance companies on your behalf.

Learn About Other Advantage Plans

• Preferred Provider Organization (PPO)
• Private Fee-for-Service (PFFS)
• Health Maintenance Organizations (HMO)
• Medical Medicare Savings Account (MSA)
• Medicare Supplement Insurance (Medigap)
• Special Needs Plan (SNP)

Let Us Help You Find The Right Plan

At Buffalo Health Advisors, we believe in providing solutions to individuals as they transition to Medicare plans. Not only can Medicare Advantage work to protect your health, choosing the right plan can go a long way toward protecting your wealth. This plan is critical if you plan on living with a fixed income during your retirement years.

Learn more about your options at no additional cost! Call or stop by our Nashville, TN office to discuss your Medicare plan options with one of our experienced health insurance agents.