What Is Medicare and What Does It Cover?
Medicare is a federal health insurance program that gives benefits to Americans 65 and older. It also covers some disabled people under 65.
It has four parts, and they each cover different aspects of your loved one's care.
Part A covers services and supplies that he needs to treat a disease or condition. That includes things like:
- Hospital care
- Skilled nursing facility care for a limited time. This includes things like getting an injection. It doesn't include help with daily tasks such as bathing and getting out of bed.
- Home health services, such as a visiting nurse or a physical, occupational, or speech therapist
- Blood transfusions at a hospital or skilled nursing facility
- Medical supplies
- Hospice care that keeps a sick person comfortable at the end of his life
- Mental health treatment given in a hospital
Part B covers doctors' bills and things like:
- Preventive services to keep a person healthy
- Ambulance rides
- Physical, speech, and occupational therapy
- Medical supplies and equipment such as wheelchairs, hospital beds, oxygen, and walkers
- Blood transfusions if you don't need to stay overnight in a hospital
- Medical/surgical supplies and services for outpatients (you don't stay overnight in a hospital)
- Mental health care when you don't need to stay overnight in a hospital
Part C is also known as Medicare Advantage. These are insurance plans you buy from private insurers that are approved by Medicare. If you get one, you're still in the Medicare program, but you'll get your Part A and Part B benefits from the Medicare Advantage Plan.
Part D pays for part of your prescription drugs. Medicare works with insurers and other private companies to offer different plans. You will pay a monthly premium and part of the drug costs.
Medicare Coverage of Skilled Nursing Care Homes
Medicare offers some coverage, for a limited time, if your loved one needs to enter a skilled nursing care home. But there are certain conditions he has to meet in order get it, such as:
- He needs to have had a 3-day hospital stay before being admitted to the skilled nursing home. There are some exceptions though, so check the Medicare web site for details.
- He must be admitted into the skilled nursing home within 30 days of leaving the hospital.
- He needs to enter the skilled nursing home for treatment of the same condition that he was treated for in the hospital.
- He must need daily skilled care.
- The home must be Medicare-certified.
- His doctor must write a care plan.