Financial Planning for Parkinson's Disease
Medicare and Medicaid
What Is Medicare?
Medicare is a federal health insurance program providing health care benefits to all Americans age 65 and over, as well as some disabled individuals under age 65. Eligibility for Medicare is linked to Social Security and railroad retirement benefits.
Medicare has co-payments and deductibles. A deductible is an initial amount you are responsible for paying before Medicare coverage begins. A co-payment is a percentage of the amount of covered expense you are required to pay.
What Are Medicare's Coverage Options?
Medicare has two parts: Part A (hospital insurance) and Part B (medical insurance).
Part A Medicare coverage includes:
- All normal hospital services
- Skilled nursing facility care
- Some home health services
- Medical supplies
- Hospice services
Part B Medicare coverage includes:
- 80% of reasonable charges from doctors and other health care professionals (after the annual deductible is met)
- Medically necessary ambulance services
- Physical, speech, and occupational therapy
- Some home health care services (doctor certification is necessary)
- Medical supplies and equipment
- Transfusion of blood and blood components provided on an outpatient basis
- Out-patient surgery
Part B Medicare benefits require that you pay a monthly premium. You must also be entitled to Part A benefits to receive Part B benefits.
Medicare Coverage of Skilled Nursing Care Facilities
In order to receive care in a nursing home under Medicare:
- You must have had a three-day hospital stay prior to admission into the skilled nursing facility.
- You must be admitted into the skilled nursing facility within 30 days of discharge from the hospital.
- You must enter the skilled nursing facility for treatment of the same condition that you were hospitalized for.
- You must require daily skilled care.
- The condition must be one that can be improved.
- The facility must be Medicare-certified.
- Your 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 Care
In order to receive home care under Medicare:
- You must be home-bound.
- Your doctor must certify a plan of care.
- Care must be needed on an intermittent (not continuous) basis.
- Care cannot exceed 35-hours per week or eight hours per day.
- Physical 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 of these therapies.
- If you qualify for home health care, you are entitled to a home health aide to provide some personal care.
What Is Medicaid?
Medicaid is a joint federal-state health insurance program providing medical assistance primarily to low-income Americans. It also is available to people under 65 if they are blind or disabled.
The purpose of Medicaid is to provide preventive, therapeutic, and remedial health services and supplies that are essential to attain an optimum level of well-being.