Medicare is a health insurance program for people who are age 65 and older, people
under age 65 with certain disabilities, or people of any age with end-stage renal
disease. Medicare is divided into two major parts:
- Medicare Part A, or hospital insurance, helps cover your inpatient care in hospitals,
critical access to hospitals, and skilled nursing facilities. It may also help cover
hospice care and some home healthcare. Most people do not have a monthly payment
for Part A because they or their spouse paid Medicare taxes while they were working.
- Medicare Part B, or medical insurance, helps cover your doctor's services and outpatient
hospital care. It also covers some other medical services that Part A doesn't cover,
such as some physical and occupational therapy and some home healthcare. For Part
B, most people must pay a premium of $88.50 per month.
Medicare pays for home health services provided by Medicare-certified home
health agencies, including skilled nursing and therapy but does not pay for long
term care that is personal or custodial care.
Medicare may cover long term care up to 100 days after a recent hospital stay, doctor-prescribed
home care as part of a rehabilitative program, and hospice in the case of terminal
illness. Medicare pays in full for 0-20 days in a skilled nursing facility after
a recent hospital stay. If you need additional care, Medicare will cover up to 100
days after you pay a daily copay if the care is skilled rehabilitative care.
Medicare provides some coverage in the aftermath of a major medical event.
You must be at least 65 years old, disabled, or suffering from end stage renal disease.
Because coverage is meant to be rehabilitative, you must show continual signs of
improvement to qualify for the full 100 days of coverage.
Medicare covers some skilled nursing care, therapy, and home health services
that are ordered by a physician and provided by a Medicare-certified provider.
Medicare does not cover personal or custodial care provided at home or in the community.
You may need help around the home before a major medical event occurs.
Part A coverage requires no premiums for most taxpayers.
You must receive care from a Medicare-certified provider. Care provided in assisted
living and continuing care facilities is not covered.