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Part A helps pay the costs for care provided by Medicare approved
hospitals, skilled nursing facilities, home health agencies and hospices.
Benefits are available for 90 days in per benefit period. Depending on
circumstances, a possible 60 additional days are available. These days,
known as Lifetime Reserve Days, is only available one time per individual,
but may be spread across multiple benefit periods.
Benefits period begin the day a beneficiary starts to receive benefits
for a particular condition in a Medicare approved facility. The periods
once the individual has been home and has not received care for 60
consecutive days. There is no limit to the number of benefit periods an
individual can have during a year or a lifetime.
This is an important point considering that Medicare pays all expenses
for the stay in the hospital after a deductible first 60 days of
$792.00 for
each benefit period. This is different than most major medical plans
that charge deductibles on a yearly basis. If the patient is still
receiving care after the first 30 days, Medicare pays expenses only after
a deductible of $198.00 per day. If care continues past 90 day and into
Lifetime Reserve days then Medicare pays after a deductible of
$396.00 per day. All benefits stop after this
period, unless a new benefit period
starts.
If the beneficiary qualifies to receive care in a skilled nursing
facility Medicare pays all expenses for the first 20 days. If the
beneficiary remains qualified and care continues after 20 days, a
deductible of $99.00 per day starts with benefits
stopping entirely after 100 days.
To a limited extent and under certain circumstances, Medicare Part A will
cover some home health care services, but only if the care is skilled in
nature. It also pays for hospice care for eligible terminally ill
patients.
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Medicare Part B helps pay the expenses from outpatient hospital services,
emergency room visits, ambulance transport, physician services such as
test, lab work, outpatient therapy, some preventative care, and some
various other services. To a limited extent Part B pays for some home
health care not cover by Part A.
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