As you enter your senior years, your medical insurance may become more difficult to understand. This is especially true if you are chronically ill and moving to transitional care. In this situation, children often handle the medical information of their sick parents or other loved ones. The good news is that Medicare provides resources to ensure transitional care is easy to understand. Elder Care Alliance encourages family members of adults in transitional care to learn as much as they can about Medicare’s guidelines.
What Is Medicare?
As the largest insurance program in the nation, Medicare covers people aged 65 and older. It also covers people who are permanently disabled for ten years or more, even if they are younger than 65 years old.
Understanding the Two Parts of Medicare
Medicare is divided into Part A, and Part B. Part A is typically free and can help cover hospice and inpatient hospital care. When you turn 65, you are eligible for Part A if you or your spouse have paid into the program for most of the year. You may be able to buy Part A if you did not pay Medicare taxes for the year.
Part B usually requires a monthly payment. It can help pay for outpatient hospital care, doctor services, home healthcare, and medical services. When you turn 65, you are eligible to purchase Part B. Some people pay for Part B because it covers some services that are not covered under Part A. Thus, it provides an additional financial security net if your loved one requires significant medical care in their senior years.
Hospital Services Covered by Medicare
Medicare Part A provides coverage for long-term acute care in a hospital setting. Some of the covered costs include:
- Pain management
- Nursing care
- Inpatient services, supplies and medications
- Semi-private room
- Rehabilitation services
Your loved one’s benefit period begins the day they are admitted into the hospital, intensive care unit or emergency room. The benefit period ends when your loved one has been outside the hospital for at least 60 consecutive days. If your loved one is transferred from the hospital to a transitional care hospital, you will not need to pay another deductible. However, if your loved one is out of the hospital for at least 60 days and then returns to the hospital, it will initiate a new benefit period.
Services Not Covered by Medicare
Just as it’s essential to know what’s covered under Medicare, it’s equally important to know what’s not covered so you aren’t saddled with unexpected costs. Medicare does not cover the following services:
- Custodial care
- Razors and other convenience items
- A private room
- Private-duty nursing care
- Inpatient days beyond those that fall into the maximum number f benefit period days established in Medicare Part A
You’ll need to check your policy to figure out precisely what you’ll need to pay as part of your loved one’s inpatient care that’s not eligible for Medicare Part A coverage. You may need to pay coinsurance or a deductible.