Medicare is a federal insurance program for senior citizens aged 65 and older, certain types of disabled people under 65, and those who have experienced permanent kidney failure and are on dialysis or have had a transplant. It covers approximately 38 million people in the United States and is the largest insurance program in the United States. Medicare is not free, like Medicaid; rather, people on Medicare pay premiums, deductibles, and coinsurance.
Medicare has two parts – A and B, each of which cover different things. Part A is hospital insurance and covers not only hospital stays, but nursing homes, home health care, and hospice care. Part B is medical insurance and covers doctor visits, outpatient hospital procedures, and medical equipment and supplies, such as oxygen tanks and walkers.
Part A
Like most insurances, Medicare has limitations on what it will and will not cover.
For hospital stays, which are costly anyway, a Medicare patient can expect to pay the following:
? Semiprivate room (usually shared with one other person), meals, general nursing and other hospital services and supplies (this does not include private duty nursing, a TV or phone in the room, or a private room unless doctors have deemed it medically necessary): No more than $912 for a stay between 1-61 days. After 61 days, the patient will pay $258 each day between 61 and 90 days, and $456 each day for 91-150 days in the hospital.
For Nursing Home stays, a Medicare patient covers the following costs:
? Semiprivate room (shared with another person), meals, nursing and rehabilitative services (such as physical therapy), and other services and supplies: Patient pays nothing for the first 21 days. After 21 days, up to $114 per day between 21-100 days, and after 100 days, the patient covers all costs.
Part B
Part B is regular medical insurance and pays for things like doctor’s visits, ambulances, and any kind of outpatient therapy deemed medically necessary.
For services such as visits to the doctor, both inpatient and outpatient procedures and services, physical therapy, and a variety of different medical equipment, the Medicare patient pays a deductible of $110 each year. From there, the Medicare patient pays the following:
? 20 percent of approved amount after the deductible, except in the outpatient setting.
? 50 percent for most outpatient mental health.
? 20 percent for all outpatient physical, occupational and speech-language services.
For lab services, such as blood work and urinalysis, the Medicare patient also pays nothing.
Home Health Care is also covered to an extent by Medicare. For intermittent skilled care, home health services, and home health aide services, the Medicare patient pays nothing. For durable medical equipment, he or she pays 20 percent of the cost.
Part B also covers a number of other things, including:
X-rays
Emergency care
Speech language pathology services
Limited chiropractic services
Artificial limbs and eyes
Medical supplies such as splints and casts
Arm, leg, back and neck braces
Kidney dialysis and kidney transplants
Breast prostheses if the patient has undergone a mastectomy
On occasion (must be approved), heart, lung and liver transplants in a Medicare approved facility
Clinical psychologists, clinical social workers, and nurse practitioners
Preventive services, such as blood pressure and cholesterol screenings, cancer tests, glaucoma tests, bone mass readings, and flu shots
A few outpatient drugs
One pair of eyeglasses after cataract surgery