Medicare is a federal program that covers most medical costs for people and their families. The program also helps ensure everyone has access to affordable health care. The program covers many costs, including doctor’s fees and prescription drugs. Medicare comprises four parts: Part A, Part B, Part C and Part D.
Who’s covered?
Medicare is designed to cover everyone from age 65 or older. Medicare is also for certain people with disabilities and those under 65 who have had a kidney transplant.
How to Get Covered by Medicare
Medicare is another word for health insurance. Medicare has four parts. Each Part provides different medical services.
Medicare Part A
You’re automatically covered by Medicare Part A if you’re a U.S. citizen or legal permanent resident who meets certain conditions. This Part of Medicare covers inpatient hospital care, skilled nursing facility care, home health care and hospice care.
Suppose you’re a U.S. citizen or legal permanent resident. In that case, you can also get Part A coverage if you have certain diseases, are 65 or older and are receiving Social Security Disability benefits.
Inpatient Hospital Care
You have Part A coverage if you have Medicare and are admitted to a hospital. Part A pays for a certain number of days in the hospital. If you are hospitalized after paying a deductible, Medicare will pay for your room and board upon your doctor’s approval.
Skilled Nursing Facility Care
Medicare covers up to 100 days of skilled nursing facility stays. Skilled nursing facilities are hospitals in which you are monitored closely by trained nursing staff for your comfort and safety. The hospital part of Medicare covers only a limited number of days for short-term rehabilitation. If you require more than 100 days of skilled nursing facility care, you must get long-term care or disability coverage from another source.
Home Health Care
Medicare will cover home health care if you are otherwise eligible for Medicare benefits. Your doctor certifies that you need home health care and have Medicare home health coverage. Medicare will pay for medically necessary services and supplies. Medicare must accredit a Medicare home health agency to provide these services. Your doctor must send a complete care plan to the home health agency for approval.
Hospice Care
Hospice care is a program to help people with serious illnesses. You pay for hospice care, usually in a monthly or self-pay arrangement. Medicare will pay for medically necessary services and supplies under a contract with an approved hospice organization.
Medicare Part B
Part B covers medical services, such as doctor’s fees, outpatient care, medical supplies and preventive care. You must pay a monthly premium to get Part B coverage.
You are eligible for part B coverage if you have Medicare, have certain diseases, are 65 or older, and receive Social Security Disability benefits. Also, if you live in a nursing home and meet the low-income level requirements, you may be able to get Part B coverage. Part B covers:
Provider Services
Provider services are medically necessary and supplies when you receive them from a doctor or other health care provider accepting Medicare assignments. Your doctor must write a bill to Medicare. The doctor can also request services and supplies. You can pay the provider directly and submit your bill to Medicare, or you can pay all at once to Medicare.
Durable Medical Equipment
Durable medical equipment are medical devices with an expected lifetime of more than three years. Medicare will pay for this equipment when your doctor determines that you need it. You can use the equipment and receive payments until the equipment is no longer needed or until you stop getting benefits.
Home Health Services
Home health services are provided by nurses, physical or occupational therapists and other medical professionals who live in your home or home-like setting. Home health services can include bathing, dressing, feeding, medication administration and other activities.
Ambulance Services
Ambulance services are provided by travel paramedics who arrive at your home to render emergency medical assistance. The services include transporting the patient to a hospital or health care facility. Ambulance service may also include transporting the patient to a hospital or health care facility for routine medical care.
X- Rays and Lab Tests
X-rays and lab tests are covered under Medicare if they are required to diagnose a disease or provide preventive care. Coverage for x-rays and lab tests varies by state. Medicare Part B also covers kidney dialysis, chemotherapy and other services.
Medicare Part C
At a minimum, Medicare part C offers the same benefits as Original Medicare. Part C covers doctors’ fees, inpatient hospital and some outpatient services.
You are eligible for this coverage if you are enrolled in Original Medicare. In addition to this, you must be at least 65 years of age or older. If you receive monthly Social Security Disability income, you will be eligible for Medicare Part C regardless of age. You must also have at least 30 months of creditable coverage. Creditable coverage includes work-related and group health plans through employers or unions. It does not include specific types of government-sponsored plans.
Medicare Part D
Medicare Part D prescription drug benefit offers prescription drug coverage to eligible individuals. It is similar to private health insurance but is financed by the government and administered by state D.C. plans. Part D offers some people more choices and lower costs for their prescription drug needs. The eligibility for Medicare part D is the same as that of Medicare part C. Part D pays for drugs only if your plan covers them. It also requires you to pay a monthly premium.
