What You Should Know About Medicare Insurance Coverage

American citizens are eligible for Medicare insurance when they retire at the age of 65. Some people qualify for Medicare coverage when they are under the age of 65 years, if they have some sort of disability. You may not need certain medical services now, but you need to know what is available to you when you do need it.

Like any other insurance, Medicare has deductibles and copays. A deductible is an annual amount of money you have to pay out of your pocket before the Medicare Program pays anything on your behalf. Copays are amounts that you have to pay for each doctor visit or lab test. Sometimes a second insurance policy will cover copays. An example of secondary coverage or gap coverage is from Blue Cross/ Blue Shield or a commercial insurance company like Aetna or Banker’s Life.

Medicare is divided into two parts--Part A and Part B. Each part reimburses the medical services provider for services rendered. Here is a list of what kinds of services are covered under each part:

PART A SERVICES

Hospitalization
Semi-private room and board, general nursing, some hospital services, and supplies are covered. But if you stay in the hospital for more than 60 days there is a different amount of money paid to the hospital for each day you stay. Deductibles and copays apply to your hospital stay.

Skilled Nursing Facilities (Nursing Homes)
Semi-private room and board, skilled nursing and rehabilitation services, and some other services and supplies are covered. After 100 days in a nursing home, Medicare does not pay for anything.

Home Health Care
Part-time or intermittent skilled care, home health aide services, durable medical equipment and supplies, and some other services are covered. Some services are paid for 100% and some are only paid for at 80%. So, you still have copays and deductibles for these medical services that can be provided in your home.

Hospice Care
Pain relief, symptom management, and support service for those that are terminally ill are covered.

PART B SERVICES

Physician Visits
Doctor’s office visits and doctor home visits (house calls) are covered Medicare benefits. Visits are paid for at 80% and you have a copay of 20%.