Original Medicare insurance plan overview and requirements:
The original Medicare insurance plan is divided into two parts: Part A, which includes hospital insurance; and Part B, which is basically medical insurance for outpatient services.
Part A Medicare insurance covers most hospital bills, hospice care and a limited amount of nursing home and home care. Most people who meet the Medicare requirements do not have to pay anything to receive Part A, the hospital insurance, but they may be responsible for certain deductibles and co-payments once they actually receive services.
If for some reason your parent or loved one is not enrolled in Part A Medicare insurance, they should enroll right away; if they wait until they are hospitalized, they will face a mountain of paperwork and bureaucratic delays at an already very difficult time.
Part B Medicare insurance, is the medical insurance portion which covers most doctors fees (but not annual checkups), medical equipment, diagnostic tests, outpatient care, and some mental health and rehabilitative therapy. Most people pay a monthly premium of about $70 for this part of their Medicare insurance, which comes directly from their Social Security payments. Beginning in 2007, the premium will be linked to income, with higher rates for those making over $80,000 per year.
An annual deductible of about $100 must be met before payments begin. After the deductibles are covered, the enrollee pays a “coinsurance” or share the cost of any covered service (about 20% for most services) and Medicare will pay the rest.
Part B Medicare insurance is optional. If your elder receive Social Security payments, they are usually enrolled automatically. If for some reason they do not want Part B (possibly because they are adequately covered by another policy), they need to contact a local Social Security office to let them know immediately. But, there may be penalties if they decide to change their mind and sign up at a later time.
Medicare insurance requirements are as follows:
Services must be provided by a Medicare-approved hospital, agency, institution, or company, except in emergencies.
Services must be “medically necessary”, that is they must be ordered by a physician to diagnose or treat acute or chronic illness.
Services must be provided within the United States are in some emergency situations, Canada (some Medicare advantage plans have different rules regarding travel.)
Some information from How to Care for Aging Parents by Virginia Morris
Additional information and web page by Paul Susic Ph.D. Licensed Psychologist Clinical Director- Senior Care Psychological Consulting