The U.S. Government’s Medicare(1) insurance program is an essential government program for older Americans. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney requiring dialysis or a transplant), sometimes called ESRD(2).
In the African American community, the services Medicare provides is especially important since private insurance may not be affordable. There are several reasons that many elderly African Americans fail to buy private insurance, and one of the main reasons is low household incomes. Read the post on African Americans Household Incomes Below National Average for more information.
Medicare Insurance is Broken Down into Four Parts
- Hospital Care Insurance (Part A)
Covers the time you are an inpatient in a hospital and many other healthcare facilities.
- Healthcare provider services (Part B)
Includes physician services, preventive screenings, care outside the hospital, and medical supplies.
- Medicare Advantage Plans (Part C)
Medicare health insurance plans offered by private companies. They provide the benefits of Parts A and B through their networks.
- Prescription Drug Coverage (main focus of Part D)
The Medicare Advantage Plans may offer this coverage.
Jay Harold will focus on Medicare Part A in this article. The Medicare website was used extensively to provide timely and accurate info.
What does Medicare Part A cover?
Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Certain conditions must be met to get these benefits. (Centers for Medicare and Medicaid Services).
If you’re in a Medicare Advantage Plan or other Medicare plan, you may have different rules, but your plan must give you, at least, the same coverage as Original Medicare. Some services may only be covered in certain settings or for patients with certain conditions.
In general, Part A covers:
Skilled nursing facility care(4)
Nursing home care(5)
Home health services(7)
Two ways to find out if Medicare covers what you need
Talk to your doctor or other health care provider about why you need certain services or supplies, and ask if Medicare will cover them. If you need something that’s usually covered and your provider thinks that Medicare won’t cover it in your situation, you’ll have to read and sign a notice saying that you may have to pay for the item, service, or supply.
Find out if Medicare covers your item, service, or supply(8).
Medicare coverage is based on three main factors
Federal and state laws.
National coverage decisions made by Medicare about whether something is covered.
Local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
African Americans must become familiar with all aspects of Medicare Part A. Knowledge will avoid additional delays and expenses during a time of intense stress for you. Jay Harold covers Medicare Part B in another article.
Tell me your experiences with Medicare Part A in the comment section, on Facebook or Twitter.
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