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Your Prescription for Medicare Coverage

Certain conditions required before accepting benefits

By LeadingAge | June 22, 2012

Medicare is a health insurance program managed by the United States government.

People who are eligible for Medicare are:

  • People over the age 65.
  • People under age 65 with certain disabilities.
  • People with permanent kidney failure that requires dialysis or a kidney transplant.

What Does Medicare Cover?

There are three major elements of Medicare coverage. These elements include:

Medicare Part A (Hospital Insurance): Medicare Part A helps cover a person’s care costs in hospitals, including critical access hospitals and skilled nursing facilities. It also helps cover hospice care and some home health care. Certain conditions must be met to get these benefits.

Most people don’t have to pay a monthly payment, or premium, for Part A because they or a spouse paid Medicare taxes while working. Individuals can buy Part A coverage if they do not receive Social Security and are aged 65 or over, or are younger than 65 and disabled but no longer covered under Part A because they returned to work.

Medicare Part B (Medical Insurance): Medicare Part B helps cover the costs of doctors’ services and outpatient care. It also covers some medical services that Part A doesn’t cover, like occupational therapy and some home health care, when the services are deemed medically necessary.

As of 2009, Medicare Part B beneficiaries pay a monthly premium of $96.40. This amount increases by 10 percent for each full 12-month period a person could be covered under Part B but didn’t sign up for it. They will have to pay this penalty as long as they have Part B. Part B beneficiaries also pay a deductible each year before Medicare starts to pay its share. In 2009, the Part B deductible for 2005 is $135. Individuals may be able to get help from their states to pay for the premium and deductible.

Medicare Prescription Drug Coverage (Part D): Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs for beneficiaries. Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status or current prescription expenses. Individuals who participate pay a monthly premium, which varies by plan, and a yearly deductible. Participants also pay for a portion of their prescription drug costs and a co-payment. Costs vary depending on their plans. Individuals with limited incomes and resources may not have to pay a premium or deductible.

Each year plans change what they cost and what they cover. Medicare offers an open enrollment period from Nov. 15 to Dec. 31 of each year. During this time, beneficiaries have the chance to review the changes being made by their current plan, compare it to others and enroll in the plans that best meet their needs. Those who don't have prescription drug coverage can also enroll in a drug plan during open enrollment.

What Should I Know About Medicare and Aging Services?

Medicare covers some, but not all, of the services and supports individuals need as they age. The services Medicare covers include:
  • Nursing home care after a hospital stay of at least three days. In addition, this coverage requires substantial insurance co-payments after the first 20 days, and can be used for no more than 100 days.
  • Short-term services through a home care agency. These can be delivered wherever you live, including an assisted living facility. Medicare does not usually cover assisted living costs.
Home health care is provided only if individuals are homebound and need therapy or skilled nursing care, according to their physician's plan.

Medicare does not cover the costs of assistance with activities of daily living, like eating, dressing or bathing, which many people with chronic conditions like Alzheimer’s disease may need.