Medicare is a federal health insurance program that the federal government administers. Originally, seniors age 65 plus were eligible to enroll in a Medicare plan. Medicare has expanded to include two more groups. These two groups include those diagnosed with E.S.R.D. (End-Stage Renal Disease) and those receiving Social Security Disability income for at least 24 consecutive months.
Medicare Part A and Part B coverage include:
Part A – Hospital insurance provided by the federal government.
Part B – Medical insurance and outpatient expenses provided by the federal government.
Medicare Part A
Medicare Part A is available to those who qualify through Social Security, Railroad Retirement, or government employment. The federal government funds Medicare Part A coverage by payroll and FICA contributions and is premium-free. Those individuals over age 65, that do not qualify, may receive benefits for Part A by paying a monthly premium.
Medicare Part A coverage includes:
- Inpatient Hospitalization – covers up to 90 days per benefit period. Medicare pays 100% of covered charges for days 1-60. For days 61-90, the insured is responsible to pay a specified daily co-payment and Medicare will pay the balance.
- Mental Health Care – covers inpatient mental health care similarly to inpatient hospital care.
- Skilled Nursing – covers limited benefits for skilled nursing care after 3 days of hospitalization. Part A covers the first 20 days of hospitalization at 100%. Days 21-100 paid (co-payment paid by insured). After 100 days of skilled nursing care, there is no added benefit through Part A, and the insured pays 100%.
- Home Health Care – covers nurse’s visits, home health aide services, and medical supplies for medically necessary care following hospitalization.
- Hospice – Support and pain relief services provided to the terminally ill and family members.
- Blood – Medicare Part A covers the first three pints of blood in one calendar year.
Medicare Part B
Medicare Part B is optional coverage and an individual becomes eligible for Medicare Part B once they become eligible for Medicare Part A. Part B recipients to pay a monthly premium. Medicare Part B pays 80% of covered expenses after the annual deductible. The insured pays 20% coinsurance with no maximum out-of-pocket.
Medicare Part B coverage includes:
- Medical Expense – Medicare Part B covers physician’s and surgeon’s services, both inpatient and outpatient. Part B also covers medical and surgical services that are necessary. This includes medical supplies. Added coverage includes occupation, physical, speech therapy, diagnostic tests, medically necessary ambulance, other transportation, and certain medical equipment. It will also cover kidney dialysis treatments.
- Laboratory Services – Blood tests, urinalysis, other (outpatient), and biopsies.
- Blood – Medicare Part B covers the cost of blood. The First 3 pints of blood per year excluded. Since Part A covers transfusions on an inpatient basis, Medicare Part B covers blood transfusions on an outpatient basis.
- Preventive Care – Medicare Part B covers a one-time well care preventive visit along with annual “wellness” visits.
- Mental Health Care – Medicare Part B covers mental health services on an outpatient basis. The provider must be willing to accept Medicare payment.
- Home Health Care – For those who are home-bound (in personal residence), Medicare Part B covers medically necessary skilled care, home health aide services, and medical supplies for those not having a qualifying hospitalization.
Medicare Part A is health insurance provided to those ages 65 or older. Those diagnosed with E.S.R.D. or receiving disability income for at least 24 months also qualify. Medicare Part A covers hospitalization/inpatient expenses.
Medicare Part B is optional coverage for an individual qualifying for Medicare Part A. Medicare Part B is coverage for physician and surgeon costs along with medical expenses, laboratory services, blood, preventive care, mental health care, and home health care.