Knowing the ins and outs of this nation’s senior health insurance program is not exactly a piece of cake—Medicare is a very intricate system. Still, it’s a good idea to understand the fundamentals of the system if you’re close to 65 or a caregiver. Care experts in our senior living community share the details of Medicare. Continue reading for a look at Medicare’s primary characteristics.
Parts A through D make up the four portions of Medicare. Americans who have had Medicare taxes taken from their income for at least 40 calendar quarters are eligible to receive Part A, which together with Part B makes up the Original Medicare Plan.
The expense of inpatient hospital services, such as general nurse care, drugs taken while in the hospital, meals, and semi-private rooms (private rooms may be paid if deemed medically essential), is assisted by this coverage. Be aware that a doctor must have prescribed your hospitalization for you to be labeled an inpatient.
Medicare does not typically pay for long-term care expenses, but in a few specific cases, Part A will cover the costs of skilled nursing facilities and home health services, such as physically or occupationally necessary part-time skilled nursing care, as well as home health aide services. For patients with terminal illnesses who are anticipated to pass away within six months, Part A will also cover hospice care and medication. Medicare also covers some short-term hospital stays and inpatient care for caregiver respite.
Outside of hospitals, medically necessary health care services such as doctor visits, mental health treatment, physical and occupational therapy, and speech-language therapy are covered under part B. Mammograms, pap smears, screenings for cardiovascular disease, HIV, and diabetes, as well as other lab tests and screenings that are intended to detect diseases early on are all free of charge. Additionally covered is the screening for specific cancers, such as lung, prostate, colorectal, and cervix. Keep in mind that most of the time a copayment is needed to see the doctor who orders these tests.
Ambulance services and 80% of the price of medical equipment, such as wheelchairs, scooters, and oxygen tanks, are also covered by Part B. Part B covers the majority of the costs for numerous diagnostic and therapeutic services provided by hospital outpatient departments, as well as second and, in some situations, third surgical opinions.
Although routine physical exams are not covered by Medicare, new enrollees are still entitled to a one-time “Welcome to Medicare” preventative visit and annual wellness exams after that. Additionally, Medicare does not cover the majority of dental treatment, eye tests for glasses prescriptions, dentures, hearing aids, or regular foot care.