Medicare is a federal program for hospital and medical needs for
individuals over 65 years of age. The program offers many great
benefits to seniors. This article contains general Medicare
information on what is covered under Medicare Parts A and B.
Medicare Parts C (Medicare Advantage Plans) and D (Medicare
Prescription Drug Coverage) are not discussed below. For additional
Medicare information visit www.medicare.gov
Medicare Part A
Medicare Part A is actually "Hospital Insurance." It helps cover
your inpatient care in hospitals and skilled nursing facilities. It
also covers hospice care and some
home health care. The program is premium-free if you meet
certain conditions; individuals who don't qualify can still buy in
for a monthly premium of $451 in 2012.
Medicare Part A Helps Cover Your:
-
Hospital Stays:Semiprivate room, meals, general nursing, and
other hospital services and supplies. This does not include private
duty nursing, or a television or telephone in your room. It also
does not include a private room, unless medically necessary.
-
Skilled Nursing Facility Care:Semiprivate room, meals, skilled
nursing and rehabilitative services, and other services and
supplies are covered, but only after a related 3-day hospital stay.
Medicare does not cover "custodial care." Custodial care is care
that helps you with usual daily activities such as walking, eating,
or bathing. This type of care is often given in a nursing home but
is not covered by Medicare. Other payer sources would pay for
custodial care such as private pay, Medicaid, HMO or insurance.
-
Home Health Care:Part-time skilled nursing care, physical
therapy, occupational therapy, speech-language therapy, home health
aide services, medical social services, durable medical equipment
(such as wheelchairs, hospital beds, oxygen, and walkers) and
medical supplies, and other services.
-
Hospice Care:Medical and support services from a
Medicare-approved hospice for people with a terminal illness, drugs
for symptom control and pain relief, and other services not
otherwise covered by Medicare. Hospice care is given in your home.
However, short term hospital and inpatient respite care (care given
to a hospice patient by another caregiver so that the usual
caregiver can rest) are covered when needed.
-
Blood:Pints of blood you get at a hospital or skilled nursing
facility during a covered stay.
Medicare Part B
Medicare Part B is "Medical Insurance" and helps cover your
doctors' services, outpatient hospital care, physical and
occupational therapists, and some home health care. Part B helps
pay for these covered services and supplies when they are medically
necessary. You pay the Medicare Part B premium of $99.90 per month
(higher if income is higher than Medicare limits; see
www.medicare.gov) in 2012.
Medicare Part B Helps Cover Your:
-
Medical and Other Services:Doctors' services (not routine
physical exams), outpatient medical and surgical services and
supplies, diagnostic tests, ambulatory surgery center facility fees
for approved procedures, and durable medical equipment (such as
wheelchairs, hospital beds, oxygen, and walkers). Also covers
second surgical opinions, outpatient mental health care, outpatient
physical and occupational therapy, including speech-language
therapy.
-
Clinical Laboratory Services:Blood tests, urinalysis, and
more.
-
Home Health Care:Part-time skilled nursing care, physical
therapy, occupational therapy, speech-language therapy, home health
aide services, medical social services, durable medical equipment
(such as wheelchairs, hospital beds, oxygen, and walkers) and
medical supplies, and other services.
-
Outpatient Hospital Services:Hospital services and supplies
received as an outpatient as part of a doctor's care.
-
Blood:Pints of blood you get as an outpatient or as part of a
Part B covered service.
Medicare Also Helps Cover:
- Ambulance services (when other transportation would endanger
your health).
- Artificial eyes.
- Artificial limbs that are prosthetic devices, and their
replacement parts.
- Braces - arm, leg, back, and neck.
- Chiropractic services (limited), for manipulation of the spine
to correct a subluxation.
- Emergency care.
- Eyeglasses - one pair of standard frames after cataract surgery
with an intraocular lens.
- Immunosuppressive drug therapy for transplant patients as long
as you are covered by Medicare (transplant must have been paid for
by Medicare).
- Kidney dialysis.
- Macular degeneration of the eye ("wet" age-related) treatment,
using ocular photodynamic therapy with verteporfin.
- Medical nutrition therapy services for people with diabetes or
kidney disease with a doctor's referral.
- Medical supplies - items such as ostomy bags, surgical
dressings, splints, casts, and some diabetic supplies.
- Outpatient prescription drugs (very limited). For example, some
oral drugs for cancer.
- Preventive services.
- Prosthetic devices, including breast prosthesis after
mastectomy.
- Second opinion by a doctor (in some cases).
- Services of practitioners such as clinical social workers,
physician assistants, and nurse practitioners.
- Telemedicine services in some rural areas.
- Therapeutic shoes for people with diabetes (in some
cases).
- Transplants - heart, lung, kidney, pancreas, intestine, bone
marrow, cornea, and liver (under certain conditions and when
performed at approved facilities).
- X-rays, MRIs, CAT scans, EKGs, and some other diagnostic
tests.
Medicare Health Plans (like an HMO) may include extra benefits
such as prescription drugs, dental care, routine physical and
vision services. Medicare has a very informative website where you
can obtain more Medicare information about questions and coverage.
Go www.medicare.gov learn
more.