It is important for any person to understand the basics of health insurance in the USA. This knowledge helps people save money and understand what medical services can be acquired for free. One of the key points for American citizens is the Medicare program. Understanding the main principles of Medicare coverage will help people decide if they need it or not. It is reasonable to think of health when you are young. Now you may not need high-cost procedures and medical care, but one day you can feel worse. In such a case, many people don’t know where to go and what to do. Medicare can help with this.
For more information, clients can connect the Medicare directly or through the agents. No matter what way of communication the patient is choosing, he will get precise information about the plans available and potential costs for care.
The government provides Medicare part A to a particular group of people. A person can rely on this program in case of reaching a certain age, having a disability or some other special illness. The program is provided to American citizens within 5 years who are older than 65 or getting disability benefits. The majority of people who have the right to get Medicare part A are enlisted in it automatically.
There are two main ways of getting a Medicare part. Most people don’t need to pay premiums for the coverage. If a spouse worked at least ten years, the coverage would be provided to a member for free. If these terms are not fulfilled, a person will have to pay a monthly premium.
What does it mean to have Medicare Part A?
Medicare Part A is a kind of insurance coverage. It is connected mostly with the stay of the patient in the hospital, i.e. inpatient care. Nevertheless, there are lots of other cases that are included in the Medicare Part A package. It is usually provided via the Centres for Medicare and Medicaid Services. There are several aspects that are included in part A of the program:
- Critical access hospitals.
- Inpatient care;
- Nursing homes;
- Skilled nursing facility.
The services that aren’t included are long term care and children’s care. At the same time, some requirements help people get the hospice care and home health care.
The parts of Medicare Part A
Patients must realize what is included in Part A. In general, it means hospital insurance. It has several services provided to the patients by the medical companies, who are the parts of the Medicare system. All these medical services will be observed in detail below.
One of the most serious procedures for the patient is blood transfusion. It is important as the hospital must find the blood within a limited period. In general, it doesn’t cause any problems. Most medical institutions get the blood from blood banks that are part of Medicare program. Other hospitals will have to buy units of blood for the patient. That is the main difference in how Medicare works with blood transfusion.
If the patient is on an inpatient stay, he won’t need to pay for the blood provided for transfusion. In case, if the hospital has to pay for the blood (it means paying for the first three units), it is another situation. The patient pays for three units of blood, and the rest part is subsidized by Medicare coverage.
Hospital stay is one of the main parts that is covered by the Medicare program. It is included in part A. Except for a traditional stay in the hospital, it also includes feeding the patient, providing a semi-private room, general nursing services and other elements of care.
If the patient is a member of the program of Medicare Part A, he can rely on the medical service during the hospital stay in most medical institutions. Critical access hospitals are included this program with hospital stays. It is also fair for long-term care hospitals and acute care hospitals. The list is not full. For any special case, the patient can consult the official representative of the Medicare program. One important thing should be mentioned about psychiatric hospitals. The program here covers care only up to 190 days.
There are some terms that must be performed for providing the services in the abovementioned institutions. First of all, the doctor must prove the inpatient care of the patient for two nights at least. The patient is considered to be inpatient. The patient needs care that can be provided only in the hospital. The Utilization Review Committee confirms the necessity of the inpatient stay in the hospital. In all these cases, a skilled nursing facility will be provided.
Nursing home or skilled nursing facility
The Part A of the care comprises help in a skilled nursing facility if the situation faces any of the terms:
- The patient has an impatient hospital stay not less than 3 days. It includes admission to the nursing facility and doesn’t include any time on the day of discharge.
- There must be a certification provided by Medicare to use the skilled nursing facility.
- Skilled nursing care is prescribed by the doctor every day. The care must be provided only by skilled nursing staff.
- The patient didn’t use all the days of the benefit period.
- The patient needs a nursing service in case he gets the condition that was developed during the inpatient stay in the hospital.
Nursing home or skilled nursing facility stays must be related to the diagnosis set in the hospital. It means that the patient must experience a condition that requires a medical stay in a nursing home or skilled nursing facility. It must be confirmed as the necessity for the patient’s recovery. These features may include a semi-private room, meals, skilled nursing services and care.
The main aspect of the coverage is the period of its activity. It is limited to 100 days. It separates as 20/80. The first 20 days must be fully paid, the rest of the period is known as a copayment. Any patient must be aware that Medicare Part A won’t cover a long period of care or daily living.
Some of the hospitals have a special agreement. According to this, these medical institutions (such as critical access hospitals) can swing beds into the skilled nursing facility when it is necessary. The aspects of payment are the same if it is provided inside the skilled nursing facility in critical access hospitals.
Home health service
This part of the program includes home skilled limited care. It is not spread to the whole working day. It includes the following:
- Periodical medical care;
- Home health aide service;
- Disorders in speech;
- Physical therapy, etc.
Besides, it can also include facilities that are medically necessary such as wheelchairs, walkers and some others.
This type of medical care is provided to the patients who have 6 months or less to live according to prognosis. There are a lot of aspects that are included in this type of care. The program will provide painkillers to ease the pain and control the symptoms. It also includes extra medical and support services, consulting in case of death and so on.
The care is given by the Medicare-approved hospice. Medicare also provides necessary care when a caregiver needs time to rest.
What is not covered by Medicare Part A?
Medicare Part A is considered to be the most complete part of the health insurance in the USA. At the same time, it spreads its influences mainly on hospitalization and inpatient stays. There are some aspects that the package leaves for the patients to pay. It includes aspects such as long-term care, usually known as custodial care.
Another point that is not included in most packages is dental care. Some positions can be covered by the insurance policy, but most of the sum must be paid by the patient. The problems of eyesight are not included in Medicare Part A. The consultation with the eye specialist and glasses prescription is not part of medical insurance. Various cosmetic procedures, like cosmetic surgeries, can’t be part of Medicare policy.
One of the problems that cause heated discussions is the prescription of medicine. It is a real problem that is not subsidized by the Medicare Part A policy. Besides, hearing aids and routine food care are out of the question here.
So, Medicare is an important institution in American citizens’ lives. The system of health and body care in the USA is rather complex and difficult to understand even for native Americans. So, having such programs as Medicare is a real saviour for people. The program is necessary when people are unable to cover all the expenses on the health problems.
When people need skilled medical aid, Medicare is ready to cover most of the expenses. If a person has worked for at least 10 years, he can rely on this program.
At the same time, the program has some pros and cons. As for pros:
- A widespread program;
- Covers most of the cases;
- Reliable service on the market;
- Good for rather serious medical cases.
Nevertheless, the system has also some cons. They can be argued, but they still exist:
- Lots of limits (all the terms must be performed to get the coverage);
- Not all medical care is included;
- Can cover medical care only partially.
As Part A is not full coverage, there are some other policies that allow people to get more services from medical institutions. There are also parts B, C and D. They include various aspects. It is a good chance for the patients to get all the necessary medical aid. So, the patient sometimes has to pay a lot of money to get complete medical treatment in the hospital.