Medicare is a federal
health insurance program for people 65 and over
and certain disabled people under 65. It does not
provide a comprehensive long term care component
and generally does not cover assisted living costs
but may pay for short term services (e.g. physical
and other therapies) contracted through a home health
care agency and provided to the resident at the
assisted living facility. Medicare covers only those
skilled nursing facility services rendered to help
a beneficiary recover from an acute illness or injury.
Medicare is administered by the federal government’s
Centers
for Medicare and Medicaid Services (CMS) and
is divided into two parts: Hospital Insurance (Part
A); and Medical Insurance (Part B).
Eligibility
Nursing facility
coverage falls under Part A of Medicare and is very
limited. If certain conditions are met, Medicare
only pays fully for the first 20 days of care in
a skilled nursing facility (SNF).
For the 21st through
the 100th day, the patient must share, or co-pay,
for the cost of care by paying a daily coinsurance
rate, which changes yearly. In 2002 the coinsurance
payment is just over $101 per day.
Medicare Pays
for Nursing Facility Care Only Under the Following
Conditions:
The nursing home
is a skilled nursing facility (SNF). SNFs provide
24-hour nursing care to convalescent patients.
Continuous skilled nursing care or skilled rehabilitation
services (as defined by the federal government)
are required on a daily basis.
The patient has spent at least three consecutive
days in a hospital and if the admission to the SNF
occurs within 30 days after discharge from the hospital.
A physician certifies that SNF services are needed
for the same or related illness for which the person
was hospitalized.
Services
Covered by Medicare
- A semi-private room
- Meals, including special
diets
- Regular nursing services
- Rehabilitation services
- Drugs furnished by the facility
- Medical supplies
Services
Not Covered by Medicare
- Personal convenience items
- Private duty nurses
- Extra charges for a private
room
- Medicare Part B may help
pay for covered services you receive from your
doctor in a SNF, if you choose to participate
in the Part B medical insurance program. If
you have used up your Part A coverage for a
spell of illness, Part B also covers a portion
of services received in a SNF, such as physical
and occupational therapy.
- Under the Part B program,
you must pay an annual premium and a deductible
for all Part B services, including physician
services, after which Medicare pays 80 percent
of the reasonable charges for covered services.
Services
Not Included Under Medicare Part B
- Routine physical examinations
and tests
- Routine foot care
- Eye or hearing exams for
prescribing or
fitting eyeglasses or hearing aids
- Immunizations other than
for the flu or pneumonia
How to Apply for
Medicare
Contact your nearest
Social Security office to find out if you are automatically
covered for Part A because of credits for the number
of (calendar) quarters worked in your lifetime.
Also, if you are interested in signing up for Medicare
medical insurance (Part B), the Social Security
office can assist you with that process. Keep in
mind, though, that you can only sign up for the
insurance in the first three months of the calendar
year.
