What Does Medicare Cover?Financial & Legal Planning | January 26, 2016
Medicare Benefits for Seniors
Medicare is a federal program that was created back in 1965 and signed into law by President Lyndon Johnson, giving those who reached age 65 access to healthcare at a time when it was increasingly difficult to get private health insurance. However, it might be confusing to some to know exactly what Medicare benefits will cover, especially when it comes to long-term senior care.
Medicare Coverage Explained
Different parts of Medicare cover different services. There are four parts to Medicare: Part A, Part B, Part C and Part D. Part A and Part B are considered traditional Medicare coverage. Below is a brief explanation of these four parts and what each covers.
Medicare Part A
Medicare Part A is commonly known as “hospital insurance”. It will cover the costs you incur throughout a stay in the hospital, as well as inpatient care in skilled nursing facilities, inpatient rehabilitation facilities and hospice care. Your room and board and routine nursing care are all covered under Medicare Part A. It’s important to note that care in a skilled nursing facility will be covered only after a three day hospital stay in a Medicare-certified facility. Post-acute care at an in-patient rehabilitation facility must be prescribed by a doctor, and the care must include at least two types of therapy for three hours per day.
Medicare Part A will also cover home health care services like part time skilled nursing care or home health aide services, along with durable medical equipment and supplies.
Medicare Part B
Medicare Part B is medical insurance and helps cover services performed by your doctor, as well as outpatient care, some in home healthcare, physical and occupational therapies and supplies as they become medically necessary. Preventative care, x-rays, laboratory tests, mental health, some home health and ambulance services are also covered by Medicare Part B. There is a monthly premium associated with this Medicare coverage.
Medicare Part C and Part D
Medicare Part C is also known as a Medicare Advantage Plan, which allows private health insurance companies to provide Medicare benefits. It’s not a separate benefit; you can choose to get your Medicare coverage through a Medicare Advantage Plan instead of original Medicare. A Medicare Advantage Plan will cover all of Part A, Part B and sometimes part D coverage, which is outpatient prescription drug insurance, or insurance coverage that subsidizes Medicare coverage for the costs of medicine. Medicare Advantage Plans also go above and beyond traditional Medicare, and will provide coverage for costs associated with vision, hearing, dental or wellness programs.
Medicare Coverage Criteria and Limitations
If you’re using Medicare coverage for skilled nursing care, there are certain criteria and limitations to keep in mind. For instance, as mentioned above, you must have had a prior inpatient hospital stay of up to three days, with one of those being while Medicare eligible. This does not include the day you’re discharged from the hospital. You must also be admitted to a Medicare-approved skilled nursing facility within 30 days of your discharge from the hospital or within 30 days of a previous Medicare-covered stay. Lastly, your doctor needs to certify that you require daily skilled nursing services by a licensed nurse or therapist in a certified Medicare unit.
You’ll be covered for up to 100 days at a qualified skilled nursing facility, and during the first 20 days Medicare will pay for 100% of the costs of covered services and supplies. Non-covered services include things like a private room (unless it is medically necessary) and convenience items like cable television and a private phone line. From day 21 to day 100 of your stay in a skilled nursing facility, Medicare will establish a daily coinsurance amount for covered services. If you require care that goes beyond 100 days, you will become fully responsible for all charges incurred during the remainder of your stay.
For more information about Medicare coverage, please download our helpful brochure.