12.6.1 Medicare Part A - Hospital Insurance
Medicare Part A is automatically provided when an individual applies for Social Security benefits (as long as the individual is 65 years of age or older). Part A provides specific in-hospital and related benefits funded through a portion of FICA taxes. For the first 60 days of hospitalization, during one benefit period, Part A participants are subject to a deductible of $1,216 in 2014. From the 61st day to the 90th day Medicare pays a reduced amount and the patient is responsible for a daily copayment equal of one-fourth of the initial deductible figure. The Medicare "benefit period" begins the first day of hospitalization.
Part A provides the following services.
- Inpatient hospital services (including semi-private room and board, nursing services, and other inpatient hospital services)
- Inpatient psychiatric care (on a limited basis)
- Post-hospital skilled nursing facility care*
- Hospice care for terminal illness (to the exclusion of all other Medicare benefits, except for physician services)
- Post-hospital home health care services (including nursing care, therapy, and the part-time services of home health aides)
*The first 20 days is covered in full contingent upon the patient being hospitalized prior for three consecutive days. Maximum limit is 100 days in each benefit period, and a copayment is applicable from the 21st to the 100th day of care equal to one-eighth of the initial deductible.
Medicare covers only those services deemed medically necessary and only up to an amount deemed "reasonable" by Medicare.
Lifetime Reserve
Medicare patients have a lifetime reserve of 60 days of hospital coverage. The lifetime reserve is a one-time benefit and does not renew with a new benefit period. If a patient is hospitalized longer than 90 days in one benefit period, he/she can tap into the 60-day reserve. If the patient taps into the reserve days, the patient must pay a higher copayment equal to half of the initial deductible figure. If a patient is hospitalized beyond the 60th lifetime reserve day, the patient then becomes responsible for all hospital charges.
