Medicare: What is it?

Medicare is a national health care program that provides medical coverage to U.S. residents over the age of 65 years. Those under the age of 65 with certain disabilities and individuals with end-stage renal (kidney) failure may also qualify for Medicare benefits. The enrollment process is automatically initiated at the age of 65 years and consists of two parts, Part A and Part B.

Here is a video created by the Centers for Medicare & Medicaid Services that explains the benefits seniors receive from Medicare:

Medicare Part A

Part A provides insurance for inpatient hospital stays, skilled nursing care, home health care services and hospice services. There is no premium required to receive benefits covered under Part A.

  • In-Patient Hospital Stays - Covered services include a semi-private room, nursing care, medications required during hospitalization, meals, other hospital services and supplies needed for the provision of care. Care required for participation in scientific research studies and in-patient mental health care are also covered by Part A.
  • Skilled Nursing Care - If a patient covered by Medicare is hospitalized for at least three days (midnights), they are eligible for up to 100 days of coverage at a skilled nursing and/or rehabilitation facility. Covered services include a semi-private room, skilled nursing care, therapies including physical, occupational and speech, other services and supplies.
  • Home Health Care Services - Medically necessary, intermittent (not full-time) home health care services are covered by Part A. Covered services include skilled nursing care, physical, occupational and/or speech therapies, home health aides, durable medical supplies and medical social services.
  • Hospice Services - For those with a terminal diagnosis and less than six months to live (per a certified physician), Part A covers hospice services. Coverage includes nursing care, medical services, medications specific to the terminal illness and/or those used for comfort measures, and grief counseling for family members not usually covered by Medicare.

Medicare Part B

medicare

Part B provides medical insurance and requires a monthly premium of approximately $96.40 in 2011. The decision whether or not to participate in Medicare Part B must be made during a seven-month window that begins three months prior to turning 65. There is also a General Enrollment period from January 1st to March 31st of each year.

Services covered under Part B include outpatient hospital stays, physician’s services, blood and other laboratory services, and outpatient therapies that are not covered under Part A. Preventive services including a one-time “Welcome to Medicare” physical exam, flu shots, diabetes screenings, mammograms and cardiovascular screenings are also covered by Part B.

Medicare Parts C & D

Part C refers to Medicare Advantage Plans, which are offered by Medicare-approved HMOs or PPOs. The plans include Medicare Parts A & B and often include a prescription-drug plan (Medicare Part D) as well. The deductibles and premiums vary depending on the organization and benefits beyond those covered by Medicare are frequently included in such plans.

Part D provides prescription-drug coverage to Medicare recipients and various plans are offered by Medicare-approved insurance companies, HMOs and PPOs.

For more information about Medicare coverage and eligibility requirements, please visit the official website at www.medicare.gov.

Written by gerontologist Sara Shelton.