Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes
The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.
Medicare Part B (Medical Insurance)
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Medicare Part C (Medicare Advantage Plans)
A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren't paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.
Medicare Part D (prescription drug coverage)
Part D adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare. Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans.
How Medicare relates to DME (Durable Medical Equipment)
Most seniors know Medicare covers their prescriptions and doctor visits (at least the standard 80%). However many may be surprised to learn that Medicare will also cover many items classified as durable medical equipment or DME. This benefit becomes increasingly valuable as we age and our mobility decreases. Durable Medical Equipment covers a vast array of items including home oxygen equipment, hospital beds, walkers, wheelchairs, etc. Anyone with traditional Medicare or Medicare Part B will be able to receive DME under Medicare. To qualify for payment, the recipient will need to have a doctor's prescription for the item. For some equipment, the doctor must also fill out a form and send it to Medicare for approval of the equipment. You can expect to pay 20% of the Medicare rate for the items.
How Medicare relates to Home Health
Medicare will also pay for skilled nursing and therapy services in your home. These are provided under your home health benefits. In order to qualify you must meet certain conditions. These include factors like being under the care of a physician; having your doctor certify you need wither intermittent skilled nursing, physical therapy, speech-language pathology services, or continued occupational therapy; whether you are homebound and others. Medicare pays a Medicare-certified home health agency for 60 days of care. These 60 day intervals are called the "episode of care." It is important to note that Medicare will only pay for skilled nursing services. It does not pay for non-skilled services like home-care (cooking, cleaning, bathing, laundry), even though you may not be able to complete these activities of daily living. There are now new Medicaid programs, which may provide assistance with these needs.
If you have questions regarding your Medicare coverage or the services you may be able to receive, give us a call. The Council Law Firm may be able to help you receive the care you need. www.councilfirm.com Call us today! (972) 423-1025.
For other helpful resources on Medicare, visit the following:
Some material for this article was obtained from www.medicare.gov