What Does Medicare Cover?

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ALL DOLLAR AMOUNTS ARE BASED ON 1997 FIGURES.

Medicare is packaged in two parts. Qualified individuals automatically receive "Part A." Part A is hospitalization insurance and, when all coverage requirements are met, it will help pay for:

• limited hospitalization coverage
• limited post-hospital skilled nursing home care
• home health care
• limited hospice care
• blood, after the first three pints

Part B is medical insurance and it covers:

• physicians' services
• outpatient hospital care
• physical therapy
• diagnostic care
• other services

How much does Part A Pay For Skilled Nursing Care?

It will pay for the first 20 days if you go directly from the hospital to the skilled nursing care facility. It will pay $95 per day for the 21st through the 100th day per benefit period.

How much does Part A pay for Inpatient Hospital Care?

During a benefit period, Medicare Part A will help pay for the first 90 days of medically necessary care in a Medicare-certified hospital. During the first 60 days, Medicare will pay all covered costs except the deductible. During a benefit period, you pay the deductible only once, regardless of the number of times you go to the hospital. During the 61st through the 90th day, Medicare pays all covered costs except for coinsurance of $190 per day. You are responsible for paying the coinsurance.

What is a Benefit Period?

Medicare measures coverage for care in hospitals and skilled nursing facilities. If you exceed the allowable benefit period, you are responsible for all charges for each additional day of care.

What is a Reserve Day?

If you are in the hospital for more than 90 days in a benefit period, you can use your reserve days to help pay the bill. If a reserve day is used, Medicare will pay all covered cost except $380 per day. You are responsible for the coinsurance.

Under Part A, Which Hospital Services are Covered?

Part A helps pay for the following while you are in the hospital:

• semiprivate room
• meals
• regular nursing services
• rehabilitation services
• drugs
• medical supplies
• lab tests
• x-rays
• operating room
• recovery room
• intensive care
• coronary care
• medically necessary services and supplies

Under Part A, Which Hospital Services are NOT Covered?

• telephone
• television
• private duty nurses
• amount between a semiprivate and private room rate unless it is medically necessary

How Do I File A Claim?

The best news yet is that you do not have to file a claim for payment. The facility from which you received care will file the claim for you.

What is the Deductible?

A deductible is an amount that you will pay before Medicare pays anything. As of January 1, 1997, the deductible per benefit period is $760.

Curious about Part B?

What Does Medicare Part B Cover?

Medicare Part B is medical insurance rather than hospital insurance. It helps to pay for:

• physician services
• outpatient hospital services
• emergency room visits when you are treated and released
• outpatient surgery
• diagnostic tests
• clinical lab services
• outpatient physical therapy
• speech therapy
• medial equipment and supplies
• rural health clinic services
• renal dialysis
• other health services and supplies

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