MEDICARE The Medicare program has two parts. Part A is Hospital Insurance (HI) and Part B is Supplemental Medical Insurance (SMI). Part A is financed by payroll taxes based on covered work before and after eligibility for Medicare. Part B (SMI) is partly financed by premiums and partly by the general tax revenues of the government. Medicare becomes available at the beginning of the month in which an individual reaches age 65, whether one is retired or still working. It is also available if one has been receiving Social Security disability benefits for two years or has a chronic kidney disorder. PART A. Hospital Insurance The amounts you pay for hospitalization change every year, depending on the increases in hospital costs. However, you never have to pay more than the actual charges. Hospital Benefits On immediate admission the client must pay a deductible. In 1994, it was $696. After the first 60 days, you would pay $169 per day. With each admission, you will need to pay another deductible charge. Skilled Nursing Facility Benefits You may qualify for nursing facility benefits if both your situation and the facility meet Medicare's strict standards. Skilled nursing facility care is available only after a hospital stay of at least three days. It is important to note that custodial care is not covered. In 1994 if you qualified, you would pay nothing for the first 20 days of covered expenses, and for the next 80 days, you would pay $84.50 per day. Benefits stop after 100 days. Home Health Services Benefits Care such as part-time or intermittent skilled nursing care, physical therapy, medical social services, medical supplies and some rehabilitation equipment may be covered if prescribed by a doctor. A hospital stay prior to these benefits is not required. Hospice Benefits (An organization that provides in-patient and outpatient programs for the terminally ill). Available for up to 210 days, they are subject to an out-of-pocket cap of $696. However, if hospice care is selected, all other Medicare benefits stop. Psychiatric Hospital Benefits Hospital Insurance will pay for no more than 190 days of in-patient psychiatric care in a lifetime. Benefits provided in this area are complicated and help from Medicare should be obtained. Other Care Care in Christian Science Sanatoriums and non-participating hospitals can be covered, if qualified by Medicare. PART B. Supplemental Medical Insurance Benefits. In 1994, you would pay for the first $100 of qualified charges for covered medical services. This is the deductible. After that, Supplemental Medical Insurance will pay 80% of covered expenses, subject to the maximum of the standard charges recognized by Medicare.
- physician services, wherever provided, and supplies furnished as part of services. - physical, speech, and occupational therapies, with limits. - non-routine vision services by qualified optometrists, if covered under standards. - diagnostic services x-ray, laboratory and other tests. - blood for transfusions after the first three pints per year. - X-ray, radium and radioactive-isotope therapy. - surgical dressings, casts, splints, or other supplies. - artificial replacements for all or part of an internal body organ. - braces for limbs, back or neck. - ambulance services, if required. - outpatient mental illness under special rules covered to the extent of 50%. Non-Covered Expenses - services not reasonable or medically necessary. - items or services for which you are not legally obligated to pay (a very vague statement that requires a call to Medicare services). - routine physical exams, eye exams, glasses, hearing aids and dental care. - prescription drugs and medicines taken at home. - routine foot care and orthopedic shoes. - cosmetic surgery, except after an accident. - private nurses. - extra charges for inpatient personal comfort items, i.e., telephone and television. - services provided outside the U.S. (some exceptions exist for care in Canadian facilities if closer to your home). |
