|
|
|
|
|
|
|
MEDICARE BASICS If you're 65 or over and get social security, you will be entitled to Part A Medicare; if you have received social security disability benefits for at least 24 months, you can get Medicare; if you have end stage renal disease, you can get Medicare; if you are not eligible for social security, and you are over age 65 you may still purchase Medicare benefits. Medicare is not a poverty program so you are entitled to it no matter how great your wealth. Medicare pays for skilled services; since 1972 it pays for skilled rehabilitation services. In terms of coverage, the Medicare program covers skilled care where the services needed are medically reasonable and necessary for the diagnosis or treatment of illness or injury to improve the functioning of a malformed body member. Medicare does not cover custodial care (as for dementia) except for hospice services. Part A covers skilled inpatient hospital care, inpatient nursing home (NH) care, home care services, and hospice. Part B covers physicians, other medical personnel, durable medical equipment and outpatient services among others. Lets look at Hospital care coverage: You get 90 days for each "spell of illness" after paying a deductible of $776. After 60 days in the hospital there is a copayment of $194 per day until day 90. The spell of illness begins when the patient first obtains Medicare covered care in a hospital and ends after 60 days outside of the hospital (or skilled NH). Patients also have a lifetime reserve of 60 days. The 60 day lifetime reserve coverage carries with it a copayment of $388 a day. If a patient had a Medicare supplement insurance policy, the deductible ($776) and the copayments would be paid by the insurance. Lets look at Nursing Home care coverage: You get coverage of up to 100 days in a skilled nursing home provided that it is preceded by a three day hospital stay within the 30 day period prior to admission to the NH. The first 20 days are free and the next 80 days require a copayment of approximately $97 dollars a day in 2000. There are certain requirements to get this benefit. First a physicain must say that the patient needs the care in a SNF; Next, the patient must require daily skilled nursing or rehabilitation; Next, the care needed must only be available on an inpatient basis. Home Care under Medicare is difficult to come by and getting more difficult from time to time. First, there are no deductiobles or copayments. Next, the physician must prescribe it as part of a plan of care; next, the patienty must be homebound. This sounds worse then it really is. Next, the patient needs or will need physical or speech therapy, or intermittent skilled nuring care. Finally, the care must be provided through a Medicare certified provider. BUT, as was stated earlier, the benfits have been further restricted by recent legislation. See below:
|
