Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). Medicare provides partial coverage for certain medical services. The main coverage has two parts, Part A and Part B.
Medicare Part A Hospital InsuranceMedicare Part A is also known as Hospital Insurance, or HI. People who are eligible for a Medicare plan in Wisconsin or Texas can usually get Part A coverage without having to pay a monthly premium, because they have already paid into the system with their Social Security withholdings. Part A pays for inpatient hospital stays, skilled nursing facility care, and hospice care after you pay deductibles and coinsurance.
Hospital CarePart A provides coverage for a semi-private room, meals, and certain other services, up to 90 days per benefit period.
- You pay a Part A deductible of $1,484 per benefit period
- For the first 60 days, eligible care is covered in full after you pay the deductible
- For days 61-90, you pay coinsurance of $335 per day
- For your additional 60 lifetime reserve days, you pay coinsurance of $670 per day.
- You pay any charges not covered by Medicare
Skilled Nursing Care FacilityPart A covers up to 100 days for eligible services in a Medicare-certified facility after a hospital stay of at least 3 covered days.
- For the first 20 days, care is covered in full.
- For days 21-100, you pay $167.50 per day.
Hospice CareTerminally ill patients may receive up to 210 days of care (Two 90-day periods & one 30-day period) plus a benefit period of unlimited days during a hospice patient’s lifetime. As a result of health reform, many preventive services are NOW covered by Medicare Parts A or B. For a complete list of Medicare covered preventive services, visit the official U.S. government site for Medicare, www.Medicare.gov.
What Original Medicare Doesn’t CoverOriginal Medicare doesn’t cover all medical costs. There are deductibles and coinsurance you must pay when you receive medical services. Original Medicare also does not cover routine preventive services, eye care and prescription medications. Your out-of-pocket expenses (the amount you pay) for these “coverage gaps” can add up quickly. Fortunately, you can enroll in several private insurance plan options to help cover the costs that Original Medicare does not cover. Some of these plan option include:
- Medicare Advantage Plans (Medicare Part C)
- Medicare Prescription Drug Plans (Medicare Part D)
- Medicare Supplement Plans (Medigap)