What Does Medicare Pay

2014 Medicare and Medigap Updates

What Does Medicare Pay

It gets confusing for many elderly people when they try to understand exactly what does Medicare pay. Let's look at the requirements first to see what is necessary for a person to receive Medicare.

To receive Medicare Part A, a married person or spouse must have worked for a Medicaid-covered employer for a total of 10 years. This does not have to be continuous work, just the total overall time worked.

If the husband or wife neither one has worked the allotted time, a fee is charged for Part A of Medicare. If anyone classified as disabled and under the age of 65 lost disability benefits because they were working during that period, they lose their Medicare benefits and have to pay for Part A.

Part A is hospital insurance for a limited stay, so what does Medicare pay under this coverage?

* A semi-private room

* Nursing care while in the hospital

* Hospital supplies and services

* Meals in the hospital

* Mental health care for inpatients, but there is a lifetime limit of 190 days

Based on the time in the hospital per visit, patients under Medicare are encouraged to get well and go home. If they stay up to sixty days, they will pay up to $952 for that time. After 60 days and up to 90 days, the patient pays $228 per day. After 90 days, the patient begins to pay $456 per day, and after 151 days, the patient pays all costs.

What does Medicare pay for skilled nursing facility care? First, the stay has to follow a three-day visit in the hospital to determine if a nursing facility is necessary. After that, Medicare begins coverage for the following:

* A semi-private room

* Nursing care while in the facility

* Supplies and services

* Meals in the nursing facility

* Rehabilitation such as physical therapy

A skilled nursing facility is not the same as an extended stay nursing home, which is not covered by Medicare. Similar to the hospital, extended stays are not good economically for the patient.

For the first 20 days, the patient pays nothing, but after that and up to 100 days, the patient pays up to $114 per day. After the 100 days are up, the patient is responsible for all costs.

Home health care is better supported by Medicare. What does Medicare pay for home health care? If the providers are certified by Medicare, there is no cost for benefits listed in the benefits program. The patient has to pay 20% of costs attributable to Medicare approved durable medical equipment.

Hospice care is a service for terminally ill patients. Hospice is provided in the home, and it covers most of the services and supplies necessary to make the patient as comfortable as possible during their last days. Respite care is covered for short-term stays at a hospice facility to allow the family caregiver a chance to rest. The hospice patient pays no more than $5 per prescription drug and 5% of any amounts that Medicare must pay for respite care.

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