What is Covered by Medicare?

Medicare is a government-controlled health insurance program that financially protects the medical and surgical expenses of individuals that qualify for their eligibility requirements.

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Medicare Eligibility Requirements

– You must be sixty-five years of age or above
– If you are younger, you must be disabled and must have received Social Security Disability Insurance

Types Of Medicare Coverage

There are four different types of Medicare programs represented in letters (Part A to D). Medicare Part A and Medicare Part B are the basic Medicare coverage, mutually called Original Medicare. The four parts of Medicare include:

– Medicare Part A (Hospital Insurance)

– Medicare Part B (Medical Insurance)

– Medicare Part C (Also called Medicare Advantage Plan)

– Medicare Part D (Prescription Drug Coverage)

Medicare Part A (Hospital Insurance)

Medicare Part A is hospital insurance that provides coverage for hospice care, hospital stay, and professional nursing care after hospitalization for several types of health conditions that require rehabilitation, usually in a nursing home, such as strokes and broken hips.

Medicare Part A coverage does not require any particular enrollment scheme where you will have to qualify for an eligibility requirement. Rather, your enrollment will be automatic so long as you apply for the federal health program.

Cost Of Medicare Part A

Medicare Part A does not obligate you to pay a certain premium charge like other private health insurance because it has been paid for in your paycheck in the form of a Medicare tax deduction. The absence of premium charge makes people conclude that Medicare is entirely free, but on the contrary, they are not. You will be charged a huge deductible, mostly when you get admitted to a hospital.

What Medicare Part A Covers

Nursing Home care: Medicare Part covers nursing care that does not involve the typical nursing custodial care.

Home health care: Medicare Part A offers coverage for home health care that involves the remediation of certain health conditions following a diagnosis, such as physical therapy and occasional therapy.

Hospice care: Medicare Part covers hospice care if your doctor certifies that you are suffering from a terminal health condition that requires immediate medical attention.

Inpatient hospital care: Medicare Part A will cover your medical expenses if you are admitted to a hospital (inpatient) in accordance with the order of a health care specialist.

Skilled nursing facility care: Medicare Part A offers coverage for the expenses you may incur in a skilled nursing facility for your health care.

Medicare Part B (medical insurance)

Medicare Part B offers coverage specifically for two services; medically necessary services and preventive services. The coverage they offer also extends towards other services that include durable medical equipment, ambulance services, outpatient prescription drugs and mental health care.

Medically necessary services

Medicare Part B offers coverage for requisite medical services and supplies needed for the diagnosis and treatment of your medical condition.

Preventive services

Medicare Part B offers coverage for routine check-ups and several other preventive cares you need to forestall illnesses and for the detection of illnesses at their infant stage for easy treatment.

Durable Medical Equipment (DME)

Medicare Part B also provides coverage for the durable medical equipment essential for the treatment and rehabilitation of your health condition in your home (outpatient); the necessary pieces of equipment include, wheelchair, crutches, blood sugar test strip and hospital beds.

Ambulance services

Medical insurance may cover the cost of the type of ambulance conveyance (land or air) based on the severity of your health condition. In cases of emergency, medical insurance usually pays for air ambulance conveyance, such as helicopters.

Medicare Part C (Also called Medicare Advantage)

Medicare Part C, which is also called Medicare Advantage, is different from original Medicare coverage (Medicare Part A and B) because they are controlled by private health insurance providers rather than the federal or state government.

Medicare Part C covers the health care services covered by Medicare Part A and Medicare Part B with extra coverage that includes vision, hearing, dental and wellness coverage.

Categories of Medicare Advantage

Medicare Advantage can be categorized into two different options; Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO).

Health Maintenance Organizations (HMO) offers coverage that restricts the insured to their in-network care providers. Viz. Medicare Advantage plan will not cover the expenses you incur from health care providers outside your plan (out-of-network services).

Preferred Provider Organizations (PPO) does not restrict the insured to their in-network health care providers, but it usually costs less if you use their in-network services.

Medicare Part D (Prescription drugs coverage)

Medicare Part D, which is also called Prescription drugs coverage, usually offers coverage for the cost of prescription medications the Original Medicare coverage (Medicare Part A and B) does not provide. There are two ways you can benefit from prescription drug coverage; Medicare Part D Plan and Medicare Advantage Plans.

1. If you purchase a stand-alone Medicare prescription drugs coverage plan to cover the cost of your prescription drugs
2. If you purchase a Medicare Advantage plan (Medicare Part C) because they usually offer coverage for prescription drugs

Does Medicare Cover All Health Care Needs To The Eligible Individuals?

Although Medicare offers several forms of coverage—from Medicare Part A to Medicare Part D—to the eligible individuals, there are various health care needs they do not cover, and they include long-term care, cosmetic surgeries and overseas treatment.

Long-term care

Medicare does not provide coverage to patients who are unable to perform their daily living activities, such as bathing and dressing. Although they may provide coverage for long-term health care services in the patient’s home or a skilled nursing facility, they do not cover services that involve custodial care.

Cosmetic surgery

Although Medicare offers coverage for surgical expenses you may incur, they do not cover that which involves the improvement of one’s appearance, such as facial implants, nose reshaping (rhytidectomy) and liposuction.

Overseas treatment

The Original Medicare coverage (Medicare Part A and Medicare Part B) and Medicare Advantage Plans coverage does not cover any medical and surgical expenses you incur outside the United States of America. Viz. The services Medicare offers are limited to the United States of America alone.

Medicare does not cover some physical check-ups, such as eye examinations for the prescription of eyeglasses and hearing aids. In addition to this, Medicare does not cover the expenses you may incur from routine foot care and supportive devices, such as the cutting & trimming of foot nails and orthopedic shoes.

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