Medicare Coverage: What You Need to Know

The realm of potential socialized health care has been under great debate over the last few years, particularly with the new bill that passed in congress on Christmas Eve, 2009. But, our great nation has tried tirelessly to provide for the young and old, healthy and ill, and that is where Medicare comes into play. It is a government administered social insurance program, signed into law in 1965 by President Lydon B. Johnson, with the first Medicare beneficiary being former President Harry S. Truman, present at the bill signing ceremony. The program is complex, but intended for United States citizens who are seniors (those over 65 years of age), under 65 but with disabilities, have end stage renal disease and may need a kidney transplant, or have Amyotrophic Lateral Sclerosis (also known as ALS or Lou Gehrig's disease). The original plan included two parts, but more have been added on in recent years.

Medicare Part A
Medicare Part A covers inpatient overnight hospital stays, including semiprivate rooms, doctors fees, food, and tests. It will also cover a maximum of 100 days in a skilled nursing facility, or hospice facility. The first 20 days are covered completely by Medicare, while the remaining 80 days require, as of 2009, a co-payment of $133.50 per day.

Medicare Part B
Part B Medical Insurance covers (generally) outpatient services and supplies, including x-rays, diagnostic tests, chemotherapy, etc. Part B also covers medical equipment, such as walkers and wheelchairs. This part of Medicare is optional if the beneficiary or the spouse is still working, but there is a large fee if the plan is deferred and the beneficiary or spouse is not actively working.

Medicare Part C : Medicare Advantage Plans
The Balanced Budget Act of 1997 gave Medicare beneficiaries the option of getting their health care provided by private insurance companies, thus Part C came into existence. It combines Part A and Part B, adding in coverage of prescription drugs, dental and vision care. Traditional Medicare has a standard benefit package that any member can get from any hospital or doctor in the country. For those that opt for the Advantage Plan, Medicare pays a standard amount to a private insurer for every member every month, and this is often combined with monthly premiums from beneficiaries.

Medicare Part D : Prescription Drug Plans
Going into effect January 1, 2006 due to the Medicare Prescription Drug, Improvement, and Modernization Act, prescription drugs are now covered by Medicare. Anyone with Part A or Part B is eligible for Part D. A person with Medicare, to receive this benefit, must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan that happens to have prescription drug coverage (MA-PD). The Medicare program regulates and approves these plans, but they are actually designed and administered by private health insurance companies. Part D coverage is not standardized like Original Medicare (Part A and Part B). Private companies get to choose which drugs to cover, which to provide at no cost, and some choose not to cover certain drugs what so ever. Medicare specifically excludes benzodiazepines, cough suppressant and barbiturates from coverage, so private plans that include coverage of these are not included in Part D Medicare Provisions.

For hospital insurance Part A of Medicare will accommodate you for your stay. The requirements to qualify for this accommodation, are persons of 65 years of age or older, including younger people with certain disabilities; for example, end-stage renal disease. The benefactors of hospital insurance under Part A Medicare are employees along with employers matching their contributions. In addition, these contributions are also collected along with regular Social Security deductions from wages of self-employment income earned during a person’s working years.

The benefits of Medicare Part A, begins once a doctor warrants you to be admitted to a hospital or nursing facility and ends when you have been discharged, from in any hospital or nursing facility, for 60 continuous days. While you are a patient in a hospital setting; Medicare Part A benefits include, a semiprivate room and board, general nursing and multifarious hospital services and supplies. In addition, transplant patients must enrolled in Part A before the time of the transplants to receive immunosuppressive drug therapy. Furthermore, surgically implanted breast prostheses while in a hospital inpatient setting are allowable. In addition, osteoporosis treatments for women are included. Other benefits, while you are in an hospital inpatient setting, are chemotherapy and defibrillators. Equally important benefits, are dialysis for inpatients admitted to the hospital for special care. Furthermore, Part A will pay for hospital stays for emergency or complicated dental procedures. Medicare Part A does not include; for example, television rental, phone or personal items; such as, toothbrushes, hairbrushes, slippers and a bathrobe.

Hospital insurance portions are renewed every time you, as a patient, begin a new benefit period. There are no limits to the number of benefit periods you can have for hospital or nursing facility care. In order to received benefits, while in a nursing facility the facility must be a Medicare-approved facility.

Being confined to one's home, does not exclude you from receiving benefits. In particular, with the pronouncement from your doctor that medical care at home is a requirement; services include, part-time or intermittent skilled care, home health aide services, durable medical equipment and supplies and other services.

However, special limited benefit period apply to hospice care. A doctor is obligated to certify that the patient is terminally ill and diagnosed as having 6 months or less to live. In addition, the patient is committed to accept palliative care instead of care to ameliorate the illness.

There are restrictions regarding Medicare Part A; for example, a patient who requires psychiatric care or specialized psychiatric hospitalization can only receive benefits up to 190 days in a lifetime. Persons who regularly take care the incurable at home care, can acquire temporary relief which is called respite care. Respite care, for the incurable, are limited to stays of not more than 5 consecutive days.

Medicare is a well-known name in the world of medical insurance. It is a governmental health insurance entity that is administered by the Centers for Medicare and Medicaid Services. It is the largest health insurance service in the US. When dealing with Medicare, you should be aware that it consists of four parts: Part A, Part B, Part C, and Part D. All of them provide a particular set of services or coverage.

Medicare Part B coverage consists of some medical services and supplies. In most cases, there is a premium that Medicare recipients are required to pay before being able to utilize services covered under Medicare Part B. Some things that are covered by the plan are doctor's visits, home health care, outpatient care, occupational therapists, physical therapists, and other services. Medical Part B is also referred to as Medical Insurance, while many people refer to Part A as Hospital Insurance.

Medicare Part B covers many different types of medical events and situations. They range from covering artificial limbs and eyes when ordered by a doctor to covering emergency ground ambulance transportation to a hospital or skilled nursing facility. It will even cover arm, neck, back or leg braces if needed.

The general enrollment period to enroll in Medicare Part B is between January 1 and March 31. When you first become eligible for Medicare Part A, you have the option to then enroll in Medicare Part B. You have up to seven months to decide then. If not, you can enroll within the general enrollment period. There is a monthly premium involved. It is important to remember that medical needs can often change for anyone so this should be considered when trying to decide whether or not to enroll in Medicare Part B or not. When signing up during the general enrollment period, the coverage date will begin the following July. It is not immediate. In most cases, the monthly premium increases by ten percent for each twelve month period a person is eligible for, but did not enroll in. There are a few exceptions for those that retired from the federal government. They can turn down Part B and still have the federal insurance continue to cover them the same way that it did while they were still employeed. Medicare Part B does also include a yearly deductible.

In truth, Medicare Part B can be a very good supplement to Medicare Part A. It covers many things that Part A doesn't cover that go hand in hand with each other. It is important to consider all options when deciding what parts of Medicare one chooses to opt into. The future is unpredictable so planning for anything is a best case scenario.