Medicare Part A
The original Medicare Plan (Medicare Part A) provides hospital insurance to people 65 or over and those who meet special criteria and runs on a fee-for-service basis. Doctors are also limited as to what they can charge you for their services. As long as you or your spouse paid your Medicare taxes while you were working, you normally will not have to pay a monthly premium for Part A coverage. Most individuals are automatically enrolled in Part A, however, if you aren’t getting Social Security or RRB benefits (for example because you are still working) you may need to sign up for Part A. You also have the option of adding Part B and Part D.
Even if you did not pay Medicare taxes before retirement, you can still buy Part A if you are over 65 years old and meet US citizenship and residency requirements, or if you are under 65, disabled, and lost your premium-free Part A coverage because you went back to work. Original Medicare does not require you to buy Part B, but you will be assessed a late penalty if you do not take it when it becomes available. If you have limited income, your state may provide financial assistance for your Part A and B coverage.
Medicare hospital insurance includes a variety of medically-necessary services, like hospital stays (a minimum of 3 days), so long as you do not need long term or custodial care. Part A consists of semi-private rooms, hospital services and supplies, the doctor, emergency room services, and drugs that you are prescribed for your treatment. Hospital services like anesthesia, chemotherapy, and inpatient dialysis are covered by Part A as long as they are deemed medically necessary. Personal care items and private rooms are not covered by Medicare Part A.
Blood is another service that the original Medicare program covers. As long as the hospital receives blood from a blood bank without any charge, you do not need to worry about payment. However, if the hospital needs to purchase blood for you, you must either pay the hospital costs for the first 3 units of blood you get in a calendar year or have the blood donated. This service includes blood transfusions as well as other blood work you are given in a hospital. For more information on hospital coverage click here.
Hospice, skilled nursing facility, and home health services are also covered by Part A. If you have a terminal illness, and your doctor has confirmed that you have 6 months or less to live, your hospice care (including pain relief, grief counseling, and other service) will be covered by Medicare. In order to receive skilled nursing facility care, a doctor must declare that you are in need of daily skilled care like physical therapy. Home health services are also covered, provided they are ordered by a doctor and are also supplied by a Medicare certified home health agency: you must be determined home-bound in order to receive these services, and the home health services are again limited to medically necessary care.
Original Medicare provides you with a semi-private room and meals in hospitals, hospitals, and nursing facilities. These services do not include private nursing or private rooms, and unless deemed medically necessary, also do not cover long term or custodial care. Televisions and telephones are also not covered if they incur an additional charge.