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Medicare continued...

Part B Medicare benefits require payment of a monthly premium. A patient must also be entitled to Part A benefits in order to receive Part B benefits.

Part C refers to Medicare Advantage, which are managed care insurance plans you can buy from private insurers to replace your traditional Medicare coverage. They include Medicare HMOs, Medicare PPOs, Medicare Special Needs Plans, and Medicare Private Fee-for-Service Plans.

Part D provides some coverage of prescription drugs. Medicare works with insurers and other private companies to offer many different plans. Expect to pay a monthly premium and part of the prescription cost. 

Medicare Coverage of Skilled Nursing Care Facilities

If nursing home care becomes necessary, your loved one may be eligible for Medicare. To receive care in a skilled nursing home under Medicare the following conditions may apply:

  • Plans generally require patients to have had a three-day hospital stay prior to admission into the skilled nursing facility. There are exceptions, however, and the patient's insurance provider should be consulted to determine whether these restrictions apply.
  • The patient must meet specific criteria to receive treatment. The patient's doctor or nurse will help him or her determine if the criteria are met.
  • The patient must be admitted into the skilled nursing facility within 30 days of discharge from the hospital.
  • The patient must enter the skilled nursing facility for treatment of the same condition for which he or she was hospitalized.
  • The patient must require daily skilled care.
  • The condition must be one that can be improved.
  • The facility must be Medicare-certified.
  • The patient's doctor must write a care plan. The care plan must be carried out by the skilled nursing facility. (Once the skilled needs are met, Medicare will no longer pay for services.)

Medicare Coverage of Home Health Care

In order to receive home care under Medicare:

  • The patient must be homebound.
  • The doctor must certify a plan of care.
  • Skilled nursing care must be needed on an intermittent (not continuous) basis.
  • Care cannot exceed 35 hours per week or eight hours per day.
  • Physical, occupational, or speech therapy must be provided on a "necessary and reasonable" basis. There are no restrictions on the number of days or hours per week for these therapies.
  • If a person qualifies for home health care, he or she is entitled to a home health aide to provide some personal care.

Visit the Medicare web site for the most up-to-date rules and regulations. 

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