Medicare

Medicare Basics

Medicare is health care coverage. Medicare focuses on short term, acute care for conditions that are expected to improve. Medicare does NOT cover long term care. “For the first 20 days, Medicare pays 100 percent of your costs. For days 21 through 100, you pay your own expenses up to $140.00 per day (as of 2013), and Medicare pays any balance.”

Qualifying for Medicare

There are several different ways to qualify for coverage. In general to qualify you:

  • are over age 65
  • or have End Stage Renal Disease
  • or are Disabled

Check the Medicare website here for more details on how to qualify. The Centers for Medicare and Medicaid Services (CMS) website also offers information on qualifying for Medicare.

Medicare Coverage Plans

Medicare Part A is usually free for those that have been employed or who’s spouse was employed. Medicare Part A is often referred to as hospital coverage. Medicare Part A covers inpatient hospital stays (you must be admitted to the hospital for 3 consecutive days not held for observation), skilled nursing home facilities, skilled home health care and hospice.

Medicare Part B is not free. Medicare Part B helps cover certain doctors’ services, outpatient care, medical supplies, and preventive services. Medicare Part B may provide additional coverage for physical and occupational therapy and some home health care. This additional coverage is dependent on a doctor certifying that they are medically necessary.You can drop out of Medicare Part B at any time however you can only enroll during specified  enrollment periods.

Medicare Part C  (Medicare Advantage Plans) is administered through a regular Health Insurance Company that has a contract with Medicare.

Medicare Part D is prescription drug coverage.

Nursing Home Stay and Medicare Coverage

For the first 20 days, Medicare pays 100 percent of your costs. For days 21 through 100, you pay your own expenses up to $140.00 per day (as of 2013), and Medicare pays any balance.


It is strongly recommended that you review the following government websites for more information:

www.Medicare.gov

www.CMS.gov

www.LongTermCare.gov

Your Medicare Benefits (booklet that can be printed)  https://www.medicare.gov/Pubs/pdf/10116.pdf

If you prefer to speak with a State Health Insurance Plans (SHIP) counselor you may find a directory here.


Why Should I Care?

It is important to know what your insurance covers.

If you need further assistance contact your State Unit on Aging. or Area Agency on Aging

to identify what your plan may or may not cover.