Over 47 million seniors age
65 and older, and people with certain disabilities and medical conditions, get
their health care coverage through Medicare. While Medicare covers many health
care services, it does not cover everything. Below is what you should know.
If you have Original, Fee-for-Service Medicare,
the following applies to you:
Medicare Part A ("Hospital Insurance")
does over:
Inpatient
care in a skilled nursing facility for a limited number of days, following a
qualifying three-day minimum inpatient hospital stay for a related illness or
injury
Home health services as ordered by a doctor (or other health care provider), including nursing care; physical, speech or occupational therapy; medical social services; home health aide services and medical supplies for use at home
Hospice care if you have a terminal illness with a life expectancy of 6 months or less, as certified by doctor, at home or facility where you reside. Limited coverage for stays in a hospice facility, hospital or skilled nursing facility for pain or symptom management
Services Medicare Part A
does not cover include:
Custodial care or long-term
care in a skilled nursing facility or nursing home. Custodial care includes
non-skilled personal care, such as help with bathing, dressing, eating, getting in and out
of a bed or chair, or toileting.
Medicare does not pay for
room and board costs or non-skilled personal(custodial) care in a nursing home,
or long-term care or assisted living facility. It does cover Medicare-approved
medical care and services, ordered and rendered by a Medicare-enrolled health
care provider, such as a doctor or physical therapist, to the beneficiary who
is a resident.
Services Medicare Part B ("Medical Insurance") does cover:
- Doctors' visits, services and tests; outpatient care
and services; some home health services
not covered under Part A; Medicare-cove red durable medical
equipment (DME), prosthetics, orthotics and supplies
- Medicare-covered services provided by non-physician
health care providers, such as nurse practitioners, physician assistants,
social workers, psychologists, physical therapists, and other
- Many preventive services and test
- Outpatient mental health care
- Kidney dialysis services and
supplies
- Ambulance transport for
medically-necessary services (limited)
- Chiropractic services (limited)
- Eyeglasses (limited to
after-cataract surgery that implants an intraocular lens)
- Some prescription drugs (i.e.
injections in doctor's office, certain oral cancer drugs
- Transplants and immunosuppressive
drugs
Things that are not covered by Medicare, under either Parts A or B, include:
routine dental care, dentures, hearing aids and exams for fitting hearing aids,
cosmetic surgery and acupuncture.
For those who get coverage
through a Medicare Advantage Plan (Medicare Part C), the story is a bit
different. Medicare Advantage Plans are offered by Medicare-approved private
insurers, and must cover all the services covered under Original Medicare,
except hospice care, which continues to be covered by Original Fee-for-Service
Medicare even when a person is enrolled in a Medicare Advantage Plan.
These plans, which may charge a premium,
deductible and co-insurance, may include extra benefits and services not
covered under Original Fee-for- Service Medicare, such as dental and vision
care, glasses, hearing aids and health and/or wellness programs. Most plans
also include prescription drug coverage, available to those in OriginalMedicare under Part D.
E-mail your Medicare questions to me at Ask Will at wwillbar@gmail.com
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