Colorado Medicare Classroom Because You Can’t Afford To Fail This Class

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To qualify, one must have worked at least 10 years and paid FICA taxes (now referred to as Medicare tax), or be the spouse of a qualified individual.

If you don’t qualify, you may buy into the program, but it is quite expensive.

Medicare Part A provides benefits for inpatient hospital care, skilled nursing care, hospice care and medically necessary home health care.

Custodial or extended care is not included in Part A coverage.

In 2015, the Part A deductible is $1260.  This deductible is not a calendar year deductible.  It is called a benefit period deductible.  A benefit period is defined as beginning the first day one enters the hospital and ending 60 days after one’s release date (i.e. If an individual enters the hospital on March 1, and is released on March 4, his/her benefit period would end on June 3.  If that person re-enters the hospital within that time frame he/she would not have to pay the deductible again.  However, if he/she entered after June 3, another deductible would be assessed.)

Once someone meets the initial deductible, Medicare pays 100% of their hospital costs for the first 60 days.  

From the 61st through the 90th day, there is a daily co-pay of $315.

From the 91st through the 150th day, the co-pay is $630.  This period is known as the lifetime reserve days and may only be used once during one’s lifetime.

After 150 days in the hospital, Medicare pays nothing.

Most people never stay in the hospital for more than a few days.  In the mid-80s, Medicare began a program called the DRG.  DRG stands for Diagnostic Related Groups.  Medicare pre-determines what it will pay to the hospital based on the individual’s diagnosis, rather than the number of days an individual is hospitalized. Because of this program, hospitals now release people sooner.

An important point to take into account here is that one must be admitted to a hospital as an “inpatient.”  If you are hospitalized for “observation”, Medicare Part A will not cover the stay, and there are different considerations, which can prove costly to an individual.

If a person no longer meets Medicare’s requirements for hospitalization, but is not quite ready to return home, he/she may qualify for Skilled Nursing Facility Care.  

In order to qualify for Skilled Nursing Facility Care, an individual must have been in the hospital (as an inpatient) for at least 3 days, must enter a Skilled Nursing Care Facility within 30 days of the hospital discharge.  The facility must be Medicare approved, and the stay must be for the same reason that the individual was in the hospital. He/she must also show daily signs of improvement.

Provided one meets (and continues to meet) all of the above criteria, Medicare will pay 100% of the cost of the stay for the first 20 days.  From days 21 to 100, Medicare will pay all but $157.50, per day. After 100 days, Medicare pays nothing.

Medicare Part A also provides benefits for blood.  Medicare will pay 100% of the cost after the first three pints (this benefit may also be covered under Medicare Part B).

Medicare Part A will also cover 100% of medically necessary skilled home nursing care services.

Hospice services are also available.  In order to receive hospice benefits, one needs to be certified as terminally ill, by their doctor, with a life expectancy of less than six (6) months.

Medicare Part A