Medicare Coverage Options
Every American gets Medicare coverage when they turn 65. However, there are different versions of Medicare, each with its own unique rules. That can be confusing because the financial impacts of each are different also. Let’s take a better look at this.
Medicare has 4 coverage options, with different rules within each one. Let’s take a look at each of these in more detail.
Medicare Part A covers inpatient stays at both hospitals and nursing homes. Coverage isn’t complete, however, as each type of coverage has limitations. Let’s look at hospital stays first:
Medicare is the primary insurance for inpatient coverage unless you’re still employed. It covers all normal hospitalization charges at 100% except for deductible amounts. Those deductible amounts change every year, yet have some standard rules:
• The standard Medicare deductible is a flat fee and covers the first 60 days of a hospital stay. If you leave the hospital and go back within 90 days, you won’t have to pay another deductible amount as long as you stay less than a total of 60 days from the first visit. If you leave the hospital after that and stay out at least 90 days, if you go back into the hospital that deductible amount will be all that’s owed again.
• If you’re in the hospital from 61 to 90 days, there’s what’s called Coinsurance Days, in which case you pay 1/4th of whatever the deductible amount is every day until you reach 90 days. The same rules for discharge apply if you go back in within 90 days.
• If you’re in the hospital from 91 to 150 days, you’ve gone into what’s known as Lifetime Reserve Days. In this case, you pay 1/2 of the standard Medicare deductible every day until you reach 150 days, at which point coverage ends. The same rules apply for discharge with one major difference. If you have a second long stay and reach 91 days, your lifetime reserve days don’t start over. This means if you had to dip into 10 days of lifetime reserve you only have 50 left, no matter what the circumstances are.
• Strangely enough, Medicare does cover maternity services if a patient is on social security and covered by Medicare as well.
With nursing homes, the rules are slightly different. Medicare Part A covers the first 20 days in full, and then days 21 through 100 will have a daily co-pay amount. Not everyone who goes into a nursing home has to be a permanent resident, though. If you have to go to a nursing home for specific rehabilitation treatment Medicare will cover those services.
Medicare Part B covers outpatient services, and there’s a monthly fee to get coverage. It doesn’t cover everything, however. There’s no coverage for podiatry or dental services, although it will cover that if you’re in an accident that requires surgery and doesn’t involve work or motor vehicles. It covers rehabilitation services as long as a patient is getting better; Medicare doesn’t cover any maintenance services whatsoever. Medicare also won’t cover any services that don’t match up with an approved diagnosis, although these services can always be appealed.
Medicare Part C refers to Medicare HMO plans, and you can only apply for this coverage if you’re Medicare eligible. Since these plans are insurance plans on their own behalf, they may cover things Medicare doesn’t cover, but they must cover everything a traditional Medicare plan covers.
Medicare Part D refers to prescription medication coverage. This isn’t a standard plan across the board, as the rules differ from plan to plan and state to state based on which medications are being addressed, based on different groupings. Once again this is a paid plan based on the types of pharmaceuticals you might need.
Luckily, there are many supplemental insurance plans, including Medicaid, that can help cover any expenses Medicare doesn’t cover.