 Personal Finance PowerPoint Presentation. Medicare Part A. Prepare to get financially fit by practicing personal finance. Insurance is part of our long-term risk mitigation strategy where we follow the adage of measure twice, cut once, put it a formal process in place looking something like setting the goals, develop a plan to reach them, put the plan in action, review the results and repeat the process periodically. Most of this information can be found at Investopedia Medicare Part A, which you can find online. Take a look at the references, resources, continue your research from there. This is by Julia Kagan, updated November 30th, 2021. In prior presentations, we've been taking a look at insurance in general, moved then to the medical insurance, which can be more complicated due to the medical system itself and the laws and regulations around it and the related insurance to it. Now we're looking at the Medicare Part A in conjunction with that discussion. So what is Medicare Part A then? Medicare Part A is one of the four components of the federal government's health insurance program for older adults and other eligible people. Medicare Part A helps pay for bills related to inpatient hospital stay and procedures inpatient care in a skilled nursing facility, hospice care and home healthcare. It covers expenses such as semi-private rooms at skilled nursing facilities, as well as inpatient care, supplies and drugs during a hospital stay. Physical and occupational therapy in your home, if you are homebound, is also covered for terminally ill patients, doctors, services, medication and grief and loss counseling for the families are covered. Understanding Medicare Part A, Medicare Part A, AKA Medicare Hospital Coverage, so you wanna know the terminology you're talking about here, pays for care at a hospital, skilled nursing facility, a nursing home and for home health services and role-ease who paid Medicare taxes during their work years or people whose spouses paid these taxes don't pay premiums for Medicare Part A once they're age 65 years old. So in other words, you're paying into the system when they're taking money out of your wages, for example. So you'd have your gross wages, they take out the payroll taxes, which includes the social security, Medicare, federal income taxes. And so you're basically paying for it in that way and therefore hopefully automatically enrolled when qualifying for the Medicare, which for most people is Medicare Part A that is once they're age 65. So this means you're already paid your premiums through the 1.45 Medicare payroll tax that you and your employer each paid on all of your wages. I like how they're stating it here because it's not free, right? You're not paying for it at that time. You pre-paid for it through your entire career. Obviously we might not have paid enough for it to cover everybody on Medicare because notice these systems are kind of as-you-go type of systems, meaning because especially now with the older population being larger than possibly the younger populations going into it. The money that's going into the system is going right back out to pay. It's not like it's coming out of a fund necessarily, but you still paid into it. That's the point. You paid into it for quite some time at the 1.45 and so did your employer paying into it for some time as well as the employer on the employee side. You might have also paid into it through the self-employment tax where you're paying kind of twice that rate because you're paying the employer and employee portion. So if you don't pay this tax during your work in years, you do pay premiums as much as $499 per month in 2022, 471 for 2021. Younger people who receive long-term social security disability benefits also qualify for premium-free Part A. However, even when Medicare Part A is premium-free, most people will still have out-of-pocket expenses for copayment and insurance that you'll have to be dealing with in a similar fashion as you might be dealing with the insurance before you're on the Medicare type of situation. So Medicare Part A eligibility. In general, you're eligible for Medicare Part A if you meet the citizenship and residency requirements and you are age 65 or older, get disability benefits from Social Security or Railroad Retirement Board for at least 25 months. So in other words, if you're not 65 or older, you may still qualify. This is my interpretation. If you had some kind of disability, which they can determine if you're getting, say, disability benefits from Social Security or Railroad Retirement Board, get disability benefits because you have amatrophic lateral sclerosis. That's the ALS, also known as Lou Gehrig's disease. Just call it the Lou disease, the Gehrig's disease that I can understand that. What's with this lateral amatrophic thing? Have in-stage renal disease, the ESRD, and meet certain requirements. So how to sign up for the Medicare Part A? Many people are automatically enrolled when they qualify while others have to sign up for it. So hopefully for many people, you're saying you're just automatically, you're in, you're rolled into it. Why? Because you've been paying for like the last 40 years for it. So it's finally kicking in here. So in general, it depends on whether you've received Social Security benefits. So obviously if you're receiving Social Security benefits, that's another thing that you've been paying in for that you might keep benefits from. These two things can kind of, you can kind of determine them together to some degree because they're linked or they're similar in that you're paying into it with withholdings from the payroll taxes. So you may, for example, be enrolled automatically in Medicare Part A and Medicare Part B. If you have received benefits from Social Security or the Railroad Retirement Board for at least four months before you turn 65. So you've been getting paid from Social Security. So that's how they kind of know that's the triggering factor. Have received Social Security benefits for at least 24 months. Have Amatrophic Lateral Sclerosis, ALS, also called the Lou Gehrig's Disease. I know that guy. He played some kind of sport baseball, I think. I didn't know him personally, but I should just call it that. So you will automatically get the Medicare Parts A and B when your disability benefits start. So if you have in-stage renal disease as the ESRD, you're eligible for the Medicare and can enroll in Part A and B or in Medicare Advantage Plan. If you choose Original Medicare Parts A and B, you will need both parts to get the full benefits available with Medicare to cover certain dialysis and kidney transplant services. Please, I don't wanna need that. I hope I don't need that, but in any case, that's there. So if you're interested in Medicare Advantage Plan, be sure to check that the healthcare providers you currently see or want to see in the future are in the plan's network. If you aren't automatically enrolled in the Medicare and you'll be eligible when you turn 65, you should sign up through Social Security during your initial enrollment period. This is a seven-month period that starts three months before the month you turn 65, includes the month you turn 65, ends three months after the month you turn 65. So if you need to get in on that window, make sure to get in on that window. Special considerations for Medicare Part A. Although Medicare Part A covers many hospital-related services, it doesn't cover everything, you know. Providers must ask patients to sign a notice before receiving treatment when a service may not be covered. This procedure allows the patient to choose whether to accept the services and pay for it out of pocket or refuse the services. So obviously you can't be tricking people, especially when we're getting older and we need medical services and we're dependent on these medical people, they can't be saying, they can't just say, well, this is covered. When it's not covered, they gotta tell you whether it be covered or not covered. So you know if you have to pay for it or not. So to be proactive about keeping your medical bills down, it's a good idea to find out before using a Part A service if Medicare will cover all, part or none of the cost. If Medicare won't cover enough of the expense, find out why. There may be an alternative that covers that would still help you or you can file an appeal to try to get the coverage decision changed on your favor. So you can determine what's not covered, you can then maybe see a workaround to see something that would be covered. And if you think it should be covered when they say it's not covered, you might be having the ability to go through an appeals process to try to change their mind. So the three reasons why Medicare Part A might not cover something are, so the general federal and state laws, so the state laws are just saying, no, apparently special federal laws about what Medicare covers. So this is the general kind of hierarchy oftentimes you have to go through within the legal system. So obviously, if you're in a gray area or something's covered, which in the medical area, clearly there's a lot of stuff where you're gonna say, they don't know what's going on, I need this kind of procedure. They say it's important. Some people may not think it's important, but my doctor thinks it is or something like that. If it's in the actual law as to whether it's covered or not, well, if it's black and white and it says right there, then that's the end of the road. That's what your appeal is gonna be based on, what the actual law is. But if it's not that clear cut, you might have special federal laws about what Medicare covers. And then, and so once again, you might then go to those laws, which then would be, if it's in the law and it's black and white, then it's pretty much, it is what it is you would think. Local Medicare claims processors assessment of whether a service is medically necessary. So now you're getting into the gray area, right? So what, who are you medical claims processor to say it's my doctor, my doctor says it's necessary and they are half more expensive. You know, this is where the gray area comes where you might have an appeals process in place. So one example of the service Medicare does not usually cover is custodial care in a skilled nursing facility help with basic activities of daily living, such as getting dressed, bathing and eating. For some people that need that full-time care, that's that long-term care kind of thing that isn't generally in the Medicare because the Medicare is more part of kind of a replacement kind of like the normal insurance which isn't really there for that long-term care kind of situation. So that's where possibly Medicaid or long-term care insurance which we've talked about in the past may fall in. So if it's the only care you need, so you must have more serious medical needs for Medicare to cover your stay at a nursing home. So the CARES Act of 2020, what did it do? On March 27th, 2020 former President Trump signed into law a $2 trillion coronavirus emergency stimulus package called the Coronavirus Aid Relief and Economic Security. Now, otherwise known as the CARES Act, everything has to sound like nice these days with their acronyms. So it's a care, you get it, like the government cares, even though I wouldn't depend on the government caring that much. But in case it expanded Medicare's ability to cover treatment and services for those affected by COVID-19, the CARES Act also increased flexibility for Medicare to cover telehealth services. So you can go online with your doctor now and they can, maybe they can't stick something in your ear but they can tell you maybe to stick something in your ear and then they can look through the camera at it or something, I don't know. But authorized Medicare certification for home health saving for physicians' assistance, nursing practitioners and certified nurse specialist increase Medicare payments for COVID-19 related hospital stays and durable medical equipment. For Medicare, the CARES Act clarifies the non-expansion states can use the Medicaid program to cover COVID-19 related services for uninsured adults who would have qualified for Medicaid if the state has chosen to expand. Other populations with limited Medicaid coverage, now we're talking Medicaid, not to be confused with the Medicare. So other populations with limited Medicaid coverage are also eligible for coverage under the state option. Is Medicare Part A expensive? It depends. For most Americans, Part A has no monthly premium because they or their spouse paid Medicare taxes through their career. So again, it's a kind of deceiving question because at the time you get it, you prepaid for it your entire life and it's still not enough to cover for everybody. And because actually when you're getting the benefits, the person that's paying for it is the person that is currently working. But again, it is kind of expensive because it's like one of the biggest budget programs on the federal budget that we're funding. So there is a cost to it. Just we should recognize that it's not free. It's not free. So if this is not the case, an individual will have a premium of up to $499 per month in 2022 and 471 for 2022. Regardless of premium costs, all individuals with Medicare will be responsible for additional costs like co-pays, co-insurance and deductibles. How do I sign up for Medicare Part A once again? Didn't we go over this? Yeah, but we're summing it up now. We're putting the bow on it, wrapping it together. So for many people, enrollment in Medicare Part A is automatic. It's just automatic for a lot of folks out there. This is the case for individuals who have received Social Security or railroad retirement. So you get the Social Security. If you're paying into that, then that might, because you're paying into it for like 30 to 40 years or something, then it pays off, pays off like right before you die, then you get money. So board benefits for at least four months before the age of 65 or at least 24 months enrolled in our enrollment is also automatic for anyone diagnosed with, here we go, amatrophic lateral sclerosis, ALS, also called Lou Gehrig's disease. And then do I need any other insurance besides Medicare Part A? And they're gonna say, yes, we're gonna need that. That's the most direct answer that we get oftentimes because we're expecting when you ask a question like that, that's a yes or no question. With the depends, it depends. But no, we're gonna go yes here. Medicare Part A does not include coverage for every medical need. It does cover most costs for care at a hospital, skilled nursing facility or nursing home and for home health services. However, you will need coinsurance for other needs like dental, vision, doctor visits, prescription drugs and more. So we'll talk about some more of that stuff, including other Medicare stuff, because there's other letters there. It doesn't just stop at A on the alphabet. It goes B and it continues. So we'll talk more about it.