Medicare Part A: provides coverage of inpatient hospital services, skilled nursing facilities, home health services and hospice care.
Medicare Part B: pays for doctor fees, outpatient hospital services, medical equipment and home health care.
Part A coverage is free while Part B is voluntary for a monthly fee deducted from the person's Social Security payments. Medicare pays 80% of the medical expenses. The individual, a supplemental insurer or a HMO pays the remaining 20%.
Coverage begins when a person enters a hospital.
- Care is limited to 60 days during a benefit period with an initial uryment of $776.
- Co-payments of $194 are required only for days 61 through 90.
* If the patient exhausts the 90 days of hospital care in a benefit period, he or she can elect to use an additional 60 days of coverage from a non-renewable "lifetime reserve" with co-payments of $388 per day.
There is no limit to the number of benefit periods covered by Medicare during a person's lifetime. Medicare pays nothing after 150 days of care in a hospital.
Home health care by a home health agency may be provided part-time if intermittent or part-time skilled nursing and/or certain other therapy or rehabilitation care is necessary. Certain medical supplies and durable medical equipment may also be provided. There must be a plan of treatment established by a physician with periodic reviews. Home health care has no duration limitations, no co-payment, and no deductible. For durable medical equipment, beneficiaries must pay a 20% coinsurance. Full-time nursing care, food, blood, and drugs are not provided as Home Health Agency services.
If there is a need for rehabilitation or additional skilled care following a stay in a hospital, Medicare will pay for a maximum of 100 days while the person is in a skilled care facility. This coverage is only available if the person spends three days in a hospital prior to entering a skilled care facility. Medicare pays for all expenses incurred in the first 20 days. The next 80 days the individual pays a deductible of $97 per day. If the patient has a supplemental Medicare policy or HMO, they will pay the deductible. After the 100-day period Medicare and the supplemental insurer pays nothing.
Hospice care is a service provided to terminally ill persons with a life expectancy of six months or less who elect not to receive traditional medical treatment and receive only hospice care. Care is generally in the home to avoid an institutional setting and to improve the individual's quality of life until death. Services covered include: nursing care, physicians' services, counseling services, home health aide, medical appliances and supplies including drugs and biologicals and physical and occupational therapy. In general, the services must be related to the management of the patient's terminal illness or to enable the individual to maintain activities of daily living and basic functional skills. The individual pays no deductible, but does pay a very small coinsurance amount for drugs and the cost of inpatient respite care.
- Sodexo Senior Services
- Caring Communities
- Hamlin Capital Management
- Presbyterian Foundation