Sunday, January 15, 2006

Medicare

Medicare is the health-care coverage provided to anyone over 65 except for the few not covered by Social Security or Railroad Retirement and those who refuse it (the program is also available to disabled people under 65). Medicare is a shared-cost program with a monthly premium automatically deducted from the individual's Social Security check. Medicare has annual deductibles that may change from year to year. Medicare's part A provides coverage for hospital costs after the yearly deductible is met. For the first 60 days in the hospital Medicare covers the cost. From days 61 through 90, the individual is required to share part of the costs. Each individual is given 60 reserve days during his or her lifetime. If the individual must be hospitalized more than 90 days he or she will be required to share a larger part of the cost for these reserve days.
Medicare pays for some nursing home costs if the older individual's doctor decides the patient can continue therapy and convalese in a nursing facility rather than staying on in a hospital. Medicare will pay all the costs for the first 20 days. Thereafter, up to the 100th day, the individual must share the costs. Medicare does not pay for nursing home care after the 100th day, nor does it customarily pay for care not associated with a hospital stay (i.e., long-term care).
Medicare's part B provides medical coverage and pays for physicians and surgeons fees, medical services, outpatient hospital care, and some home health care. The individual must pay a yearly deductible for part B also. After this deductible is met, Medicare then pays 80 percent of the remaining "reasonable charges." Medicare determines what is reasonable. If the doctors' fees are higher than the Medicare standard then the individuals must pay the difference, plus their share (20 percent) of the "approved charge." If the physician "accepts assignment," however, that means he or she accepts what Medicare considers reasonable as payment in full and the individual will owe only the 20 percent not covered after the deductible is met.

Everyone who has Medicare should have a Medicare card that is issued by the Social Security office. This card will give the Medicare number, which may be the Social Security number plus a letter although this is not always the case.
Medicare's rules and regulations change from year to year. What has been described here is a basic, overall picture of Medicare.
For exact amount of deductibles and other rules the older individual should contact his or her local Social Security office to obtain a current Medicare handbook.
See also INSURANCE, SUPPLEMENTAL; MEDICAID; MEDICAL BENEFITS; SOCIAL SECURITY.
Deedy, J. Your Aging Parents. Chicago: The Thomas More Press, 1984.
Gillies, J. A Guide to Caring for and Coping with Aging Parents. Nashville: Thomas Nelson Publishers, 1981.

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