What Medicare Does And Does Not Cover

Medicare is a government-sponsored program that people over the age of 65 and those who meet their special criteria turn to for their social insurance. This program provides health insurance to a certain age group, normally seniors. Medicare is also partly financed by payroll taxes by the FICA of the Federal Insurance Contributions Act and the Self-Employment Contributions Act of 1954.

What Is Medicare

Medicare is a social insurance programs by the United States. It was initially singed into law by President Lyndon Johnson on July 30, 1965 to make changes to the Social Security legislation. During the first signing of the bill, President Johnson registered former President Harry Truman as the foremost Medicare beneficiary and gave him the first Medicare card.

Medicare is also administered by the CMS or the Centers for Medicare and Medicaid Services, who also provides Medicaid and the SCHIP or the State Children’s Health Insurance Program. The department responsible for giving out cost projections and accounting information to the Medicare Board of Trustees in order to help them assess the financial health of the program is the Chief Actuary of CMS. The Board of Trustees, on the other hand, is required by the law to issue yearly reports on the financial status of the Medicare Trust Funds.

Ever since the start of the Medicare program, the Centers for Medicare and Medicaid Services have bonded with privately-operated companies to assist with the administration. Often, these contractors are already in the health care or insurance area. The contracting process might involve payment and claims processing, clinician enrollment, call center services and fraud investigation.

What It Does and Does Not Cover

Medicare can provide coverage for nursing care to those who require long-term care. It can cover delivered care by inside skilled nursing facilities for those beneficiaries who require long-term medical treatment. However, Medicare can not actually pay for custodial care, including assistance with bathing, eating and other daily living activities.

Aside from long-term medical care, Medicare can pay for outpatient services that a beneficiary can get at a community mental health center or a hospital under the outpatient prospective payment system. Such outpatient services include emergency room visit, X-rays or radiology, getting a cast, or stitches for a cut.

If you are 65 years older and you go out of the United States, Medicare will not cover any health care expenses you incur outside the country. However, there are rare cases, where Medicare can pay for the inpatient hospital services that you receive in Mexico or Canada. While they may provide you medical care services under special circumstances, it is handy to have a good travel insurance plan when you are planning to go outside the country.

What is Medicare Part A

Originally, the Medicare program has two parts, namely Part A and Part B. There are few cases where the original Medicare covers prescription drugs. However, drug coverage was made possible as of January 2006 due to Medicare Part D.

Medicare Part A is for the Hospital Insurance. The section can cover beneficiaries’ hospital stays, including those in a skilled nursing facility, if definite conditions are met. Firstly, the stay at the hospital must be at least three days, three midnights excluding the discharge date. The stay at the nursing home must also be for a case diagnosed during the hospital stay or for the main reason for the stay.

Also, the care being rendered to the beneficiaries must be skilled, when they are staying at a nursing home. Part A of Medicare does not cover non-skilled or custodial services, including assistance in activities of daily living or ADL.

What is Medicare Part B

For the products and services not covered by Part A, Medicare Part B can help you. Part B of the Medicare program is generally for outpatient services. It is not obligatory and can be postponed if the beneficiary or their spouse is still working actively. More so, a lifetime penalty of 10% per year can be imposed for not taking Part B if not working actively.

Some services included in Medicare Part B are physician services, such as: X-rays, laboratory, nursing services, vaccinations for pneumonia and influenza and diagnostic tests. In addition, Part B can also aid with DME or durable medical equipment, including walkers, mobility scooters, wheelchairs and canes for those patients with mobility impairments.

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