Medicare, Part A...Explained
While Medicare is a government-run program, as a licensed insurance professional (or soon to be licensed professional), you will able to guide clients and then offer products that are sold by private insurance companies such as Medigap plans as a solution to missing coverages.
Two parts make up original Medicare: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Part A covers Medicare inpatient care, including care received while in a hospital, a skilled nursing facility, and, in limited circumstances, at home.
When most people turn 65, they are automatically eligible for Medicare Part A if they have been collecting retirement benefits from the Social Security Administration or the Railroad Retirement Board. If they have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS), they may qualify for Medicare Part A before age 65. Other eligibility requirements include being either a United States citizen or keeping legal permanent residency for at least five consecutive years.
What Does Medicare Part A Cover?
When visiting their doctor advise your clients to ask them or other healthcare providers about the reasons, they need specific services or supplies. They will inform them if Medicare can cover their needs. It may be a situation where something that's usually covered, but the healthcare professional thinks that Medicare may not cover it that situation. The situation will require the patient to read and sign a notice. The notice will state that the patient understands that they may have to pay for the item, service, or supply.
In General, Services Covered under Medicare Part A:
Hospital care (inpatient)
Limited home health services
Skilled nursing facility care (SNF), provided that custodial care not be the only care required
Under each of those services, the following may be covered...
Medicare Part A hospital care coverage:
Critical access hospitals
Acute care hospitals
Long-term care hospitals
Inpatient rehabilitation facilities
Mental health care
Participation in a qualifying clinical research study
Medicare Part A home health care benefits:
Part-time or intermittent skilled nursing care
Speech-language pathology services
Medical social services
Part-time or intermittent home health aide services
Medicare Part A nursing home coverage:
Skilled nursing services
Medical social services
Rehabilitation services, if deemed medically necessary to treat the illness
Medical supplies and equipment used in SNF
Medications received while in SNF care
Ambulance transportation to the closest provider if needed services are not provided at the SNF
Medicare Part A does not cover:
Most dental care
Routine foot care
Hearing aids and exams for fitting them
Eye examinations related to prescribing glasses
Medicare Part A has restrictions for example, regarding hospitalizations lasting 90 days or more at one time. Part A has limits on the number of days it will help pay for. This is true regarding the number of days of care in a skilled nursing facility that Part A will pay for as well. Private Medicare Part A will help pay for an unlimited number of hospice care visits and home health care visits; however, there are several conditions to meet to receive either kind of help. If you are an insurance professional struggling with all the different terms and regulations when it comes to healthcare, insurance school may be the answer. Our online classes may be able to help you.
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