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Medicare Part A

an insurance agent with elderly coupleWhat does Medicare Part A Cover? Do I Need a Supplement Plan?

The first thing you need to understand is that all supplement plans sold are identical with every company that offers them. There are 11 plans (A through N designed by the Federal Government).

For example, Plan F sold by one company has the same coverage as a Plan F sold by another company. So when you consider purchasing a plan, your decision comes down to price and service. BGA Insurance Group works with companies that have some of the lowest rates in NJ, PA, DE and our customer service is 2nd to none.

Our agents meet with you in person at your home, our office, or even a coffee shop so you can meet them and have everything laid out in front of you.

Unlike an HMO, Medicare Supplements offer freedom to use virtually any doctor and any hospital of your choice in the United States, and you never need a referral. You may even choose a plan that covers your entire doctor visit, tests, hospital stays, etc. without having to pay a co-pay or deductible.

Just show your card, and walk away. It’s all paid for! Isn’t this the way insurance is supposed to be?

Hospitalization: Part A is the hospital coverage and skilled nursing care portion of Medicare. Part A also does pay for some blood and Hospice Care.

FOR HOSPITAL STAYS IN 2016, YOUR COSTS FOR EACH BENEFIT PERIOD ARE:

Days 1-60

$1,288 Part A Deductible,

Days 61-90

$322 per day co-payment

Days 91-150

$644 per day Lifetime Reserve Days co-payment. When your hospital stay exceeds 90 days during a benefits period, a feature referred to as “Lifetime Reserve Days” takes effect. Lifetime Reserve Days are 60 extra days of Medicare-paid care, subject to the $644 per day co-payment. When you use a reserve day, Medicare permanently subtracts it from your 60-day lifetime limit.

Days 151 and after

All costs after your Lifetime Reserve Days run out. But, if you don’t have the full 60 reserve days left, you pay all Part A expenses before the 151st day of the benefits period.

FOR SKILLED NURSING CARE IN 2016, YOUR COSTS FOR EACH BENEFIT PERIOD ARE:

Days 1-20 you pay nothing

Days 21-100 you pay up to a $161 per day co-payment

Days 101 and after you pay all costs

Medicare covers only short-term skilled nursing care, with no payments after 100 days

It does not cover custodial or intermediate care

Medicare pays benefits for skilled nursing care only if: You have a qualifying hospital stay, your doctor has determined that you need daily care given by, or under the direct supervision of, skilled nursing or rehabilitation staff.

Medicare pays benefits for skilled nursing care only if: You receive these skilled services in a SNF that is certified by Medicare, you need these professional services for a medical condition that was either: A hospital-related medical condition or condition that began while you were receiving care in the skilled nursing facility for a hospital-related medical condition

Medicare pays benefits for home health care only if: The home health agency caring for you must be Medicare-certified. Your doctor must certify that you’re homebound, you must be under the care of a doctor while receiving services under a plan of care established and regularly reviewed by a doctor.

Medicare pays benefits for home health care only if:

You must need (certified by a doctor) one or more of the following:

Intermittent skilled nursing care (other than just blood drawing)

Physical Therapy, Speech Language Pathology, or continued Occupational Therapy

BGA Insurance Group can offer consulting and retirement advice for seniors located in Pennsylvania, New Jersey, Delaware, and Florida.

Read about Part B here.

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