Understanding Medicare Part A Payment Plans for Hospital and Home Health Care

1. Medicare Unit 9

2. Medicare Part A Payment PlanBeneficiary Pays Hospital Stays 1-60 days $812. 61-90 days $203/day 91-150 days $406/day 151+ days all costs SNF 1-20 days nothing 21-100 days $101.50 per day max 101+ days all costs

3. Medicare Part A Payment PlanBeneficiary Pays Home Health Care Nothing for approved home health care services 20% of approved durable medical equipment Hospice Co-payment of $5 for prescription drugs 5% of Medicare-approved amount for respite care

4. Medical & Other $100 deductible $54 per mo. premium 20% of Medicare approved physician cost 20% outpatient physical, occupational, & speech-language therapy 50% outpatient mental health care Full prescription med costs Medicare Part B Beneficiary Pays Home Health Care Nothing for Medicare-approved services 20% of Medicare-approved durable medical equipment

5. Clinical Lab Services Nothing for Medicare-approved services Medicare Part B Beneficiary Pays Outpatient Hospital Services 20% of billed amount after deductible

6. Medicare + Choice Plans Beneficiary Pays Part A Same payments Part B $50/mo. premium + additional Choice Plan’s premium (?) Choice Plan’s co-payments for services

7. “Accepting Assignment” Payment to Physician

8. Example of Accepting Assignment

9. Main Problems in Providing Care for Elderly • Limited coverage under Medicare - homebound status - skilled nursing - no prescription coverage • Private insurance option at cost to elderly • Cost of home health care services expensive • Cost of long-term care expensive • Problems with Managed Care Plans