Medicare Basic Coverage

Author: Nasiya Ahmed, M.D. & Rechelle Asirot, M.D.

Key Points

  1. A legal resident of the United States is eligible for Medicare if the following criteria are met:
    1. Age > 65 years old and has worked for 10 years (or married to someone who has)
    2. End stage renal disease
    3. Disabled, by Social Security criteria, for at least 24 months
  2. Medicare Part A covers inpatient services, including rehab, skilled nursing facilities, home health, long term acute care, and hospice (not nursing home).
  3. Medicare Part B covers outpatient services, including home health, clinic visits, labs, imaging, and counseling.
  4. Medicare Part C includes private health plans that are Medicare approved.
  5. Medicare Part D covers prescription drugs.
  6. Private HMOs, PPOs, and capitated plans also receive money from Medicare to care for patients who have relinquished their right to traditional Medicare. Some things to know:
    1. These plans have varying deductibles and premiums;
    2. These plans differ in the services they cover;
    3. These plans may be advantageous for patients because they offer dental coverage, vision plans, gym memberships, for example;
    4. In-patient hospital coverage varies.
  7. All parts of Medicare have deductibles, premiums, and/or co-pays. These extra costs can be covered by a supplemental or medigap insurance.
  8. Medicare does not cover foot care, hearing aids, acupuncture, cosmetic surgery, routine vision or dental care or custodial care.
  9. It is expected the 2010 Affordable Care Act will be creating reforms to the Medicare plans as the law is implemented.

 

References

Medx Publishing. Medicare Coverage Basics. (2013). http://www.medicare.com/medicare-coverage-basics/medicare-coverage-basics.html Accessed: October 15, 2013.

Social Security Administration (2013, May). Social Security Medicare Benefits. http://www.ssa.gov/pubs/EN-05-10043.pdf Accessed: October 15, 2013.