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Introduction to Medicare

Medicare is the federally administered health insurance program for people sixty-five years of age and older, certain disabled people under sixty-five years of age, and people with end-stage renal
disease. Medicare is divided into four parts, known simply as Part A,Part B, Part C and Part D.

The benefits associated with Part A are free and automatic once an individual turns sixty-five. Part B is an add-on that requires a monthly premium.

Benefits:

The benefits associated with each plan are:
Part A – Hospital Insurance

* Inpatient hospital care
* Skilled nursing care
* Hospice care
* Home health care (with certain restrictions)

Part B – Medical Insurance (Medicare Supplemental Insurance)

* Doctors
* Services
* Outpatient hospital care
* Durable medical equipment such as wheelchairs and hospital beds
* Additional medical services not covered by Part A

Part C-Medicare Advantage

* Medical savings accounts
* Coordinated care plans—private health care plans provided by preferred HMOs, POSs, PPOs and PSOs

Part D-Prescription Drug Coverage

* Individual plans are available through Medicare-contracted insurance companies

Eligibility and Qualifications:

Medicare is provided when Social Security benefits begin, unless the individual is under sixty-five years of age and disabled or has end-stage renal disease, in which case it is provided at that time.
Individuals who are entitled to Part A and enrolled in Part B are eligible to switch to Part C.
Detailed information:

There are several ways to pay for nursing home facility care. These include Medicare, Medicaid, long-term care insurance policies,veterans benefits, and private funding. Initially, many nursing home
facilities are covered by Medicare, after which your options are long-term care insurance policies private payment or a combination of all. You should carefully read the description of all available
reimbursements.

Medicare

What can you expect for Medicare coverage?

* The first 20 days are covered in any Medicare approved skilled nursing facility.
* For the days 21 through 100 Medicare will pay all covered services. The exception to this is a coinsurance that is adjustable annually in 2008 was $128.
* Doctors’ visits
* Nursing care
* Semiprivate room rates
* All meals (including special diets)
* Physical, occupational and speech therapies
* Lab and X-ray services
* Prosthetic devices
* Prescription drugs
* Some medical supplies and equipment

Conditions and Limitations

* Medicare has strict coverage limitations for skilled nursing facilities.
* Not including the day of discharge, the beneficiary must be in the hospital for 3 continuous days
* An individual must be admitted to the nursing facility within 30 days of their hospital discharge.
* Treatment must be similar nature to that which was treated at the hospital.
* Daily nursing or rehabilitation services are required.
* There must be a determination that only inpatient services will be sufficient.
* In addition to a doctor, specifying daily nursing services. They must also recertify at intervals of 5 days and 14 days after admission. In addition to that the doctor must recertify the need for
daily nursing services every 30 days thereafter.
* In addition to Doctor recertification of the need for services.Medicare will also have to review and approve the need for nursing services.
* Lastly, they must be in nursing care for 100 days or less, and Medicare will also have to approve the length of stay. A 100 day stay is not automatically granted under the Medicare system.

If you’re using Medicare as your primary funding source, you should use that criteria when searching the OurParents Directory. This will ensure that you review only nursing home that are Medicare certified.

Managed-care

What Is Covered?

While typically excluding the prior hospital stay requirement,managed-care typically covers all the same items that Medicare does. Typically there is a copayment charge, that is half of the costs
during the 21 through 100 day stay.

Conditions and Limitations

Residents need to receive authorization from their insurance company,and the facility must be Medicare certified.

Medicaid

Participants using the Medicaid service must pay a portion of their nursing care costs with any Social Security benefits they receive What Is Covered?

In most cases, an individual would need assistance with at least two activities and Medicaid would cover all the costs of nursing and medical equipment that a doctor may deem necessary.

In addition, Medicaid will cover the holding of a bed for a for a select amount of time usually one to two-week period if a resident is requiring temporary hospital care.

Also to allow visits with family or friends, and absence of 18 days per year is covered.

Long Term Care Insurance (LTCI)

What Is Covered?

LTCI usually only cover facility care, but is dependent on individual policies. If you have LTCI, you should consult your policy or your insurance agent.An overview of which facilities are covered by Medicare/Medicaid

How to find a nursing home?

You can use the OurParents directory search on our site to find nursing homes in your area. We recommendt that you make use of the OurParents Care Options Advisor™ to get better options for your needs.

About Author
Albert Simpson has been actively involved in OurParents – Find the Best Nursing Homes, Assisted Living and In-Home Care – and is very keen to continue working on it.

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