Critter Corner: What Medicare Covers

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Dear Metta,

Medicare is our country’s health insurance program for people age 65 or older and for certain people with disabilities. The program helps with the cost of health care, but it doesn’t cover all medical expenses or ANY of the cost of long-term care.

Medicare covers the following:

● Hospital insurance (Part A) helps pay for inpatient care in a hospital or temporary skilled nursing facility (following a qualifying hospital stay), some minimal home health care (following a qualifying hospital stay), and hospice care (assuming your doctor has given you less than 6 months to live).

● Medical insurance (Part B) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services. Medicare Part B also helps pay for medically necessary outpatient physical and occupational therapy, and speech-language pathology services. There are limits on these services when you get them from most outpatient providers. Please keep in mind that a recent settlement determined that Medicare coverage doesn’t depend on the “potential for improvement from the therapy, but rather on the beneficiary’s need for skilled care.” Read our newsletter article on this topic (will add link when available) for more details.

● Medicare Advantage plans (Part C) are available in many areas. People with Medicare Part C choose to receive all of their health care servicesthrough a single HMO provider.

● Prescription drug coverage (Part D) helps pay for the costs of prescription drugs.

Wellness Visits: Within the first 12 months of signing on for Part B, you will get a “Welcome to Medicare” visit where your weight, height and blood pressure will be measured and your body mass index calculated; you will be given a simple vision test, and your medical and social history will be reviewed. You will also be counseled about preventive services available and provided with a written plan about screenings, shots, and other preventive services that may be appropriate. After that, you will get an annual “wellness” visit that covers much of the same material, and checks for any signs of cognitive impairment. You will also get personalized health advice and a list of any risk factors and treatment options. You will pay nothing for these wellness visits as long as your health care provider accepts Medicare assignment. If you receive any additional tests, you may have to pay co-insurance and the Part B deductible may apply. If your doctor recommends other tests or services that Medicare doesn’t cover, you may have to pay some, or all, of the costs.

To see a list of the preventative and screening services covered by Medicare, click here. You can get more details about what Medicare covers from Medicare & You 2017 (Publication No. CMS-10050).

It is important to understand that Medicare does not pay one penny for long-term care. Medicare only pays for medical care delivered by doctors and hospitals, and in certain cases short-term rehabilitation which might take place in a nursing home. Medicare covers, at most, 100 days of short-term rehabilitation, and does not cover help with activities of daily living, such as eating and bathing, that the aged can need for years.

Hope this is helpful,

Angel