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