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Medicare Information

medicare-information

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 to www.medicare.gov to learn more. Also check out Bankers Fidelity's post on the difference between Medicare Advantage and Medigap.

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