In the United States, Medicare is a federally-funded social health insurance program for people over the age of 65 who have worked and paid into the system, persons under age 65 who have disabilities and people suffering from the final stage of chronic kidney disease and Amyotrophic lateral sclerosis. To be eligible for this insurance, you must be a US citizen or a permanent US resident lawfully residing in the US. Medicare is financed by a portion of the payroll taxes paid by employees and their employers as well as from monthly premiums deducted from social security checks. In essence, Medicare consists of four main parts: A, B, C and D. Here is a detailed look at each of those parts:
Medicare Part A: Hospital Coverage
Medicare Part A (hospital insurance) helps you pay for:
• Inpatient hospital care: This includes semi-private rooms, meals, and tests for up to 90 days in an inpatient facility, 60 lifetime reserve days in a general hospital, and a maximum of 190 days in a Medicare-certified psychiatric hospital.
• Skilled nursing facility (SNF) care: Medicare covers convalescence in a skilled nursing facility provided the following three conditions are met:
1. The patient must have completed a three-day inpatient hospital stay, including 3 midnights prior to seeking SNF care.
2. The nursing home must be for something diagnosed during the stay, the care availed in the facility must be skilled. Long-term care, non-skilled care, daily living and custodial activities are not covered. The expenses covered by part A include: meals, semi-private room, skilled nursing care, medications, medical supplies and equipment, and transportation for those needing skilled nursing services seven days a week, or physical, occupational or speech therapy services five days a week.
3. The maximum allowable stay period for a nursing facility is 100 days. During this period, Medicare pays for the first 20 days in full. However, for the remaining 80 days, the patient has to foot a portion of the bill (copayment).
• Hospice care: This is for the terminally ill patients or those patients with about six months to live. This package covers doctor services, nursing care, medical equipment, and medical supplies including pain relief and symptom control medications.
Medicare Part B: Medical Insurance/Physician Coverage
Part B helps to pay for care from doctors and other health providers that are medically necessary to diagnose, treat or manage your health condition. It covers, but is not limited to, many of the following services:
• Doctors services, including an annual wellness exam.
• Ambulance services if your health condition requires transportation to and from your home to the health facility.
• Rehabilitative services such as outpatient physical therapy and occupational therapy.
• Many preventive care services such as flu and pneumonia shots.
• Laboratory services such as blood tests, urinalysis and other related services.
• X-ray, MRI, CT scan, EKG and some other related diagnostic tests.
• Select diagnostic tests such as colorectal and prostate cancer tests and mammograms.
• Durable medical equipment for use at home such as oxygen, wheelchairs and walkers. Your doctor must certify that you need these and they must be supplied by a Medicare approved vendor.
• Emergency room services .
• Skilled nursing care and health aide services for the homebound on a part-time or intermittent basis.
• Mental health care as an outpatient.
• Certain prescription drugs as well as some physician-administered drugs.
Medicare Part C: Medicare Advantage
Medicare Part C refers to Medicare-approved private health insurance plans for individuals eligible for or enrolled in Original Medicare (Part A and Part B). It is worth noting that, when you join the Medicare Advantage Plan, you would still need to continue paying your Part B premium. Medicare Advantage Plans provide all of your Medicare Part A and Medicare part B coverage. These plans offer additional benefits, such as optical, dental, and hearing care and many include prescription drug coverage. Medicare Advantage plans often charge a premium in addition to the Medicare Part B premium. They also generally charge a fixed amount called a copayment whenever you receive a service. You can join any Medicare Advantage plan if you meet the following conditions:
• You have Medicare Parts A and B
• You live in the plan’s service area
• You do not have End-Stage Renal Disease (ESRD).
Medicare Part D: Prescription Drug Coverage
Medicare Part D is essentially private insurance that pays for prescription drugs. This coverage is available to Medicare beneficiaries in one of two ways:
• A Medicare prescription drug plan: This is a stand-alone plan that can be added to your Original Medicare coverage.
• A Medicare Advantage Prescription Drug Plan: This plan offers the same benefits as Original Medicare and includes prescription drug benefits.
Medicare Part D plans generally prescription drugs for a medically acceptable condition. It is worth noting that drugs covered by Part D cannot be covered under Part A or Part B. Additionally, to enjoy Part D coverage, you would need to pay a monthly premium.
Medicare consists of four main parts: A, B, C and D. This article has discussed each of these parts in detail.Read more