Medicare Part A
From the Show: Stoughton Hospital Health Talk
Summary:
Air Date: 12/21/21
Duration: 10 Minutes
In this episode, Ben Rothering gives us information about Medicare Part A. Mr. Rothering talks about who may qualify for this part, the costs, and what it covers.
Transcription:
Scott Webb (Host): Welcome to Stoughton Health Talk. I'm Scott Webb. And this is part two of a five-part series on Medicare. For anybody who is eligible for Medicare or perhaps already on it, you probably know that it can be a bit confusing. And joining me for this series to help answer the most common questions folks have about Medicare enrollment and the various parts A through D, is Ben Rothering.
He's a Licensed Insurance Salesman who specializes in helping guide people through the Medicare process. So Ben, it's great to have you back on, in this five-part series we're doing for Stoughton on Medicare and the respective parts. Last time we talked about, you know, sort of the 101 of Medicare, and we really went through enrollment and when folks need to do that and how they can do it by going to ssa.gov, that's the best way to get rolling.
So in this episode, we want to talk part A and I have to confess, I told you before we got rolling before our last episode, I don't know a lot about Medicare. I'm only 53. My mom has talked to me about it. I didn't listen as closely as I should have. So I'm really listening to you, Ben, and I know that we've got parts, A, B, C, D. Today, we'll talk about A. So let's do that. Let's dig in. What is Medicare part A and who is it for?
Ben Rothering BS Education (Guest): Thanks for having me again. Part A is all about your in-patient or your hospital insurance. Part A is gonna kick in when you are admitted to the hospital. And I stress the word admitted because that's a very important thing to remember if you're spending some time in the hospital, whether you are admitted or if they are just keeping you or holding you for observation, that's a very different thing. Not saying that you're not going to be covered, but it depends on if A or B are going to cover it. Right? So part A comes in when you are admitted to the hospital.
And part A, the different parts of it and the benefits of it are all about, you know, hospital, inpatient, skilled nursing facility care, in-patient blood work like transfusions, home health care and hospice for the terminally ill. Now part A works on what's called a benefit period of 60 days.
So if you are admitted to the hospital, that is going to initiate a 60 day benefit period, and Medicare is going to cover a hundred percent in those first 60 days after the part A deductible has been paid. Okay. So the part A deductible has to be paid. These numbers that Medicare has, they change on a yearly basis.
But once that part A deductible is paid, then, you know, if you're still in the hospital within 60 days, Medicare, they'll cover a hundred percent for the rest of those 60 days. And then they have daily hospital copays as we go further, if you spend more time in the hospital beyond 60 days, beyond 90 days and so on.
Okay. Now when we get into skilled nursing facility care. This has a 20 day benefit period. So, now we have to make sure that we meet Medicare's requirements. When someone is on Medicare, they become the primary. So, they make all the rules and regulations, and we got to make sure that Medicare is going to be there so that you will always have coverage.
So Medicare's requirements at a skilled nursing facility, if you know that you have to spend some time there beyond being in the hospital, Medicare will cover the first 20 days, a hundred percent, if you were in the hospital for a minimum of three days, and then you always want to make sure that you are at a Medicare approved facility. That's very important. No matter where you go, when you're on Medicare, you always want to make sure that you go to a facility that accepts and bills, Medicare. Okay. So as long as we follow their rules, they'll pick up the first 20 days at a skilled nursing facility. And then from days 21 to a hundred, they leave a little bit behind.
If you just have Medicare, you would end up having to pay. Or if you have something else, like a supplement or something that can help you out, we can do that as well. Blood work, Medicare, when we talk inpatient blood work like transfusions, Medicare will pay everything after the first three pints of blood. Okay. So they don't pay the first three pints, but they'll pay everything after that.
For home health care, Medicare is going to cover everything that they feel is medically necessary. So, whether it's skilled care and medical supplies, as long as it is proven that it is medically necessary for you to have this, then Medicare is going to help pick up home health care and hospice for the terminally ill.
So, here, the medical care that relates to a terminal diagnosis, whether you're getting it at a facility or you have, you know, medical professionals coming in to visit you at your home, in your final days or weeks or months, the medical care that relates to that terminal diagnosis is pretty well taken care of with the part A benefits of Medicare.
Host: The respective parts A, B, and so on; is that a thing where folks, you know, when they sign up for Medicare that you choose, I want part A, I want part B that kind of thing? And do people pick and choose between the respective parts, maybe also in light of supplemental coverage that they have?Can you explain that both to me and to listeners?
Ben: Absolutely. So part A and part B together are known as original Medicare. Okay. And there's some different scenarios involved. When you turn 65, if you have no other health insurance through, you know, an employer group insurance, you're going to want to pickup Medicare. Part A is going to be premium free for most people. Most people meaning that you or a spouse have worked long enough and you've paid your taxes. As long as you've done that, part A you've earned it already. You've already paid into it. That's going to be premium free. Okay. And as we talk about part B, you know, when we get into that segment, I'll discuss more about the premium that you would have for part B.
Now, if you or a spouse are still planning on working beyond 65, taking out part A, when you turn 65 is still a good thing to do, because again, you've earned it and it can help supplement your group coverage that you have. Okay. Now what I would highly recommend for anybody that is listening, is to definitely contact your human resources department wherever you work, if you have one, because everybody does things a little different. There are some rules based on what companies are going to want you to do if they want you to pick up A and B and part of that is going to depend on how big is that company, right? So if the company is less than 20 employees, more than likely, they're going to want you to pick up A and B of Medicare, and then you can continue with your group as well. And A and B would become the primary there. Where if it is a company that has more than 20 employees, a lot of times what happens, and I say a lot of times, not everytime, a lot of times what happens is someone can take out part A, but don't take part B at that time because you're still paying for group insurance typically. And you wait until that group insurance is going to end before you pick up part B.
Host: Yeah, this is really interesting. And it's so good to have you on. You know, because it sounds a little complicated. Maybe it's not, but it sounds a little complicated to me. There's a lot of i's to dot and t's to cross and dates and so on.
So if folks want to reach you and pay you for your services to help them navigate these waters, how can they do that Ben?
Ben: My cell phone number is a great way to reach me. It is 608-354-3869, or I can be reached through email. And my email is This email address is being protected from spambots. You need JavaScript enabled to view it. . So it's just my last name, This email address is being protected from spambots. You need JavaScript enabled to view it. .
Host: That's perfect. And want to encourage folks, you know, if you started with part A, if you jumped ahead and you didn't listen to part one of our series with Ben, go on back and listen to that part, because in there Ben talks about the enrollment dates and all the particulars related to enrollment. Starts at ssa.gov, but beyond that, a lot of good information there. So, in this episode we talked about part A. Coming up next, when we speak again, Ben, we're going to talk about part B, which you've referenced here, but there's more to know. So everybody hang tight for that. Be sure to listen. And Ben, I'll talk to you soon.
Ben: Sounds great. Thank you.
Host: For more information, head to Stoughtonhealth.com. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate and review this podcast and all the other Stoughton Hospital podcasts. I'm Scott Webb, stay safe and be well.
Scott Webb (Host): Welcome to Stoughton Health Talk. I'm Scott Webb. And this is part two of a five-part series on Medicare. For anybody who is eligible for Medicare or perhaps already on it, you probably know that it can be a bit confusing. And joining me for this series to help answer the most common questions folks have about Medicare enrollment and the various parts A through D, is Ben Rothering.
He's a Licensed Insurance Salesman who specializes in helping guide people through the Medicare process. So Ben, it's great to have you back on, in this five-part series we're doing for Stoughton on Medicare and the respective parts. Last time we talked about, you know, sort of the 101 of Medicare, and we really went through enrollment and when folks need to do that and how they can do it by going to ssa.gov, that's the best way to get rolling.
So in this episode, we want to talk part A and I have to confess, I told you before we got rolling before our last episode, I don't know a lot about Medicare. I'm only 53. My mom has talked to me about it. I didn't listen as closely as I should have. So I'm really listening to you, Ben, and I know that we've got parts, A, B, C, D. Today, we'll talk about A. So let's do that. Let's dig in. What is Medicare part A and who is it for?
Ben Rothering BS Education (Guest): Thanks for having me again. Part A is all about your in-patient or your hospital insurance. Part A is gonna kick in when you are admitted to the hospital. And I stress the word admitted because that's a very important thing to remember if you're spending some time in the hospital, whether you are admitted or if they are just keeping you or holding you for observation, that's a very different thing. Not saying that you're not going to be covered, but it depends on if A or B are going to cover it. Right? So part A comes in when you are admitted to the hospital.
And part A, the different parts of it and the benefits of it are all about, you know, hospital, inpatient, skilled nursing facility care, in-patient blood work like transfusions, home health care and hospice for the terminally ill. Now part A works on what's called a benefit period of 60 days.
So if you are admitted to the hospital, that is going to initiate a 60 day benefit period, and Medicare is going to cover a hundred percent in those first 60 days after the part A deductible has been paid. Okay. So the part A deductible has to be paid. These numbers that Medicare has, they change on a yearly basis.
But once that part A deductible is paid, then, you know, if you're still in the hospital within 60 days, Medicare, they'll cover a hundred percent for the rest of those 60 days. And then they have daily hospital copays as we go further, if you spend more time in the hospital beyond 60 days, beyond 90 days and so on.
Okay. Now when we get into skilled nursing facility care. This has a 20 day benefit period. So, now we have to make sure that we meet Medicare's requirements. When someone is on Medicare, they become the primary. So, they make all the rules and regulations, and we got to make sure that Medicare is going to be there so that you will always have coverage.
So Medicare's requirements at a skilled nursing facility, if you know that you have to spend some time there beyond being in the hospital, Medicare will cover the first 20 days, a hundred percent, if you were in the hospital for a minimum of three days, and then you always want to make sure that you are at a Medicare approved facility. That's very important. No matter where you go, when you're on Medicare, you always want to make sure that you go to a facility that accepts and bills, Medicare. Okay. So as long as we follow their rules, they'll pick up the first 20 days at a skilled nursing facility. And then from days 21 to a hundred, they leave a little bit behind.
If you just have Medicare, you would end up having to pay. Or if you have something else, like a supplement or something that can help you out, we can do that as well. Blood work, Medicare, when we talk inpatient blood work like transfusions, Medicare will pay everything after the first three pints of blood. Okay. So they don't pay the first three pints, but they'll pay everything after that.
For home health care, Medicare is going to cover everything that they feel is medically necessary. So, whether it's skilled care and medical supplies, as long as it is proven that it is medically necessary for you to have this, then Medicare is going to help pick up home health care and hospice for the terminally ill.
So, here, the medical care that relates to a terminal diagnosis, whether you're getting it at a facility or you have, you know, medical professionals coming in to visit you at your home, in your final days or weeks or months, the medical care that relates to that terminal diagnosis is pretty well taken care of with the part A benefits of Medicare.
Host: The respective parts A, B, and so on; is that a thing where folks, you know, when they sign up for Medicare that you choose, I want part A, I want part B that kind of thing? And do people pick and choose between the respective parts, maybe also in light of supplemental coverage that they have?Can you explain that both to me and to listeners?
Ben: Absolutely. So part A and part B together are known as original Medicare. Okay. And there's some different scenarios involved. When you turn 65, if you have no other health insurance through, you know, an employer group insurance, you're going to want to pickup Medicare. Part A is going to be premium free for most people. Most people meaning that you or a spouse have worked long enough and you've paid your taxes. As long as you've done that, part A you've earned it already. You've already paid into it. That's going to be premium free. Okay. And as we talk about part B, you know, when we get into that segment, I'll discuss more about the premium that you would have for part B.
Now, if you or a spouse are still planning on working beyond 65, taking out part A, when you turn 65 is still a good thing to do, because again, you've earned it and it can help supplement your group coverage that you have. Okay. Now what I would highly recommend for anybody that is listening, is to definitely contact your human resources department wherever you work, if you have one, because everybody does things a little different. There are some rules based on what companies are going to want you to do if they want you to pick up A and B and part of that is going to depend on how big is that company, right? So if the company is less than 20 employees, more than likely, they're going to want you to pick up A and B of Medicare, and then you can continue with your group as well. And A and B would become the primary there. Where if it is a company that has more than 20 employees, a lot of times what happens, and I say a lot of times, not everytime, a lot of times what happens is someone can take out part A, but don't take part B at that time because you're still paying for group insurance typically. And you wait until that group insurance is going to end before you pick up part B.
Host: Yeah, this is really interesting. And it's so good to have you on. You know, because it sounds a little complicated. Maybe it's not, but it sounds a little complicated to me. There's a lot of i's to dot and t's to cross and dates and so on.
So if folks want to reach you and pay you for your services to help them navigate these waters, how can they do that Ben?
Ben: My cell phone number is a great way to reach me. It is 608-354-3869, or I can be reached through email. And my email is This email address is being protected from spambots. You need JavaScript enabled to view it. . So it's just my last name, This email address is being protected from spambots. You need JavaScript enabled to view it. .
Host: That's perfect. And want to encourage folks, you know, if you started with part A, if you jumped ahead and you didn't listen to part one of our series with Ben, go on back and listen to that part, because in there Ben talks about the enrollment dates and all the particulars related to enrollment. Starts at ssa.gov, but beyond that, a lot of good information there. So, in this episode we talked about part A. Coming up next, when we speak again, Ben, we're going to talk about part B, which you've referenced here, but there's more to know. So everybody hang tight for that. Be sure to listen. And Ben, I'll talk to you soon.
Ben: Sounds great. Thank you.
Host: For more information, head to Stoughtonhealth.com. And that concludes this episode of Stoughton Health Talk. Please remember to subscribe, rate and review this podcast and all the other Stoughton Hospital podcasts. I'm Scott Webb, stay safe and be well.
