Medicare Part A hospital insurance for Goodyear Tire & Rubber employees (2023)

What is this?

Many of our Goodyear Tire & Rubber customers have questions about Medicare Part A. Medicare Part A is a part of Medicare that is available at no cost to anyone eligible*. Medicare Part A provides hospital, hospice, skilled nursing, and home care services.

While Part A is free for most people, it's important for our Goodyear Tire & Rubber customers to know that those who need to purchase insurance can pay about $499 a month. In addition, we would like to make our Goodyear Tire & Rubber employees aware of possible additional costs, such as:

• $400 per day for 2023 coinsurance for hospital stays 61-90 (an increase of $11 from $389 in 2022).
• 20% copay for Medicare-approved durable medical equipment (DME).
• $200 in 2023. Coinsurance rate for days 21-100 per stay in a qualified care facility (up to $5.50 of $194.50 in 2022).
• Co-financing of 20% of mental health services related to the hospital stay. (1)

What does Medicare Part A cover?

Another question we often get from our Goodyear Tire & Rubber customers is what Medicare Part A covers. Part A covers the costs associated with these types of medical care:

• Hospital stays
• Stays in a skilled care facility (i.e., where medically qualified nursing and rehabilitative care is provided), as opposed to a nursing home that provides care
• home health care
• hospital psychiatric care
• hospice care

Medicare Part A is based on benefit periods

How are benefit periods determined?

Now, some of our Goodyear Tire & Rubber customers may be wondering, how are service periods determined? Medicare Part A is linked to a benefit period of 60 sick days. The sickness benefit period begins on the first day of your stay in a hospital or skilled care facility and continues until 60 days have passed in a row and you have not received qualifying care. Medicare doesn't cover care that is or becomes primary care, like help with bathing and eating. The deductible applies to each benefit period.

Your Medicare coverage period, or sick period, does not end until 60 days after you are discharged from the hospital or skilled care facility. Therefore, if you are reinstated during these 60 days, you are considered to be in the same benefit period. Medicare, on the other hand, considers readmission more than 60 days after hospital discharge as a new period of illness. The good news is that this means that if you are reinstated within 60 days you will not be charged another deduction; The bad news is that your earlier admission is added to your second when calculating the percentage that Medicare will cover, because full Medicare coverage only covers 60 days. There is no limit to the number of sick periods Medicare will cover during your lifetime.

Examples): Uncle George is admitted to the hospital on June 1 and released on July 31. On November 1 he is readmitted to the hospital. Once George meets his deductible again, Medicare will cover all of his costs through December 30. However, if George is readmitted to the hospital within 60 days of his discharge on July 31, there is no additional deductible.

Cover the cost of inpatient hospital care

If you are hospitalized, Medicare will cover:

• 100 percent of the cost for up to 60 days of hospital care, after deductible is paid. You pay $1,556 for the 2022 benefit period.
• After 60 days, beneficiaries bear coinsurance costs. In 2022, beneficiaries will have to pay $389 per day.
• Beneficiaries are also entitled to a lifetime reserve for an additional 60 days. If these reserve days are also used, recipients must pay $778 per day in 2020 for days 91-150.
• If you choose not to use the lifetime reserve, all Medicare coverage ends after 90 days of hospital care or after 60 days without skilled care during this period of illness. (2)

Advice: Part A coverage covers all Medicare-approved inpatient hospital costs, except medical bills, which are covered under Part B. Medicare approves costs that are considered medically necessary and reasonable.

Specific services covered by Part A

We would like our Goodyear Tire & Rubber customers to know about specific Part A services such as:

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• semi-private room
• foods
• General and skilled nursing services, including nursing in special care units such as intensive care
• Medicines administered in the hospital
• clinical laboratory tests
• X-rays in radiotherapy
• Medical supplies like dressings and IV lines
• Use of equipment such as wheelchairs.
• Operating room and recovery room charges
• Rehabilitation services such as physical therapy and speech therapy provided in the hospital.

It is important for these Goodyear Tire & Rubber employees to remember that Medicare will not pay for items that are considered luxuries, such as a television in the bedroom or a private room, unless the patient's condition requires it for medical reasons.

Insurance for skilled nursing care

What is a skilled nursing facility? The short answer is: it is not a nursing home. Medicare doesn't cover care in a nursing home, but it does cover care in a skilled nursing facility, which can be a nursing home or hospital, or it can be freestanding. An important attribute is the type of care provided. A skilled nursing facility provides medically necessary nursing and/or rehabilitation services.

To receive Medicare coverage for care in a skilled nursing facility:

• Your doctor must certify that you need skilled daily care that can only be provided to an inpatient in a skilled nursing facility.
• You must be hospitalized in a hospital for at least three days in a row for the same illness or condition before you can be admitted to a skilled nursing facility.
• You must be admitted to a skilled nursing facility within 30 days of being discharged from the hospital to receive Medicare.
• The facility must be approved by Medicare to provide skilled nursing care

Coverage is limited to a maximum of 100 days during the benefit period. $194.50 per day is charged between days 21 and 100, and all costs are charged after the 100th day in 2022. (3)

The scope includes:

• semi-private room
• foods
• rehabilitation services
• Center-administered prescription drugs

Home health coverage

Home health care is care provided in the home, usually by a visiting nurse or home aide. Medicare Part A covers medically necessary home health care provided by an agency certified by Medicare to provide home health care. The home health agency agrees to receive payment from Medicare and accepts only the amount approved by Medicare for its services.

To receive Medicare home health services, the following rules apply:

• You must be locked in your house.
• Your doctor must confirm that the care is medically necessary and approve the treatment plan

Goodyear Tire & Rubber employees should also be aware that:

• Medicare does not cover care that is primarily nursing care, such as assistance with daily tasks.
• Medicare will cover services like nursing care, physical therapy, speech therapy, occupational therapy, and 20 percent of the cost of durable medical equipment, like a wheelchair.
• There are currently no benefit periods, deductibles, copays, or coinsurance requirements for home health care.

Insurance for stay in a psychiatric hospital

For inpatient mental health care, Medicare Part A will cover the same types of services as for a stay in a general hospital:

• semi-private room
• foods
• nurse care
• Rehabilitation services such as physiotherapy or occupational therapy
• Prescription drugs administered in the hospital.
• Medical products
• Laboratory tests, X-rays and radiation therapy

One important difference from general hospital care is that you must use a facility that accepts Medicare orders for all claims. The deductible and coinsurance costs are the same as for a normal hospital stay. During your lifetime, Medicare will only cover 190 days of inpatient mental health care (lifetime limit).

palliative care insurance

Hospice care is care for the terminally ill. Medicare Part A hospice care is comprehensive care, in the home or in a facility where you live, to treat symptoms and manage pain for people with terminal illnesses. To get coverage:

• The provider must be certified by Medicare to provide hospice care
• The patient's physician and hospice director must certify that the patient is terminally ill (meaning, has a life expectancy of up to six months)
• The patient must choose hospice coverage for the terminal illness instead of the standard Medicare benefits, although Medicare will continue to cover the care as long as it is not related to the terminal illness.

Services include nursing care, medical equipment and supplies, prescriptions, home health care and home management assistance, medical social services, and counseling.

There are two categories of costs that a Medicare hospice patient may be responsible for:

• Up to $5 copay for each outpatient prescription for pain relief or symptom control.
• Temporary care. Hospice may arrange for a hospice patient to be transferred to an inpatient facility for up to five days at a time to provide respite for hospice staff. The Medicare beneficiary may be charged a nominal daily fee for hospital care (5 percent of the Medicare-approved amount for hospital respite care).

We would also like our Goodyear Tire & Rubber customers to point out that Medicare does not cover room and board when you receive hospice care in your home or facility where you live.

1. How much will Medicare cost in 2022 and 2023? Parts A, B, C and D” (humana.com, 2022)

23. "What is Medicare Part A?" (policygenius.com 2022)