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Medicare At A Glance
Medicare is a federal health insurance program for persons 65 or older and their spouses at 65,
or persons of any age with end-stage renal disease (kidney failure), and certain disabled
social security and Railroad Retirement beneficiaries who have received disability benefits
for at least 24 months. The original Medicare as "fee-for-service" Plan consists of two parts:
- Hospital Insurance (PART A) provides institutional care,
including inpatient hospital care, skilled nursing home care,
past hospital home health care, and hospice care.
The Part A program is compulsory and is financed by social security
payroll tax deduction (1.45% of the 7.6% FICA Tax) withheld from wages in 2007.
- Medical Insurance (PART B) is a voluntary program of health insurance,
which covers doctor services, outpatient hospital care, physical therapy,
ambulance, medical equipment and a number of other services not covered by Part A.
It's financed through monthly premium ($93.50 for most in 2007*) paid by those who
enrolled and contributions by the federal government.
The government's share is approximately 75% of the cost.
Medicare does not cover custodial care or long term nursing home care.
Much of the care provided in a nursing home, is to people with chronic, long-term illnesses, or disabilities,
that care is considered custodial and therefore not covered by Medicare.
* If your income is above $80,000 (single) or $160,000 (married couple),
then your Medicare Part B premium may be higher than $93.50 per month.
ORIGINAL MEDICARE PLAN AT A GLANCE - 2007
| Medicare has two parts: Part A ( Hospital Insurance) and Part B (Medical Insurance). |
| |
| PART A SERVICE |
TIME LIMIT |
YOU PAY |
MEDICARE PAYS |
Hospital Stay: Semiprivate room, meals, general nursing, and other hospital services and supplies. This includes care in critical access hospitals and inpatient mental health care.
Inpatient mental health coverage in an independent psychiatric facility is limited to 190 days in a lifetime.
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First 60 days
per
Benefit Period
|
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--------------------
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Next 30 days of
confinement
|
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Additional 60 lifetime
reserve days (once
used not replaced)
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Beyond 150 days
|
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$992.00
Maximum
|
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$248.00
a day
|
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--------------------
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$496.00
a day
|
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All Cost
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Balance
Does not include:
First 3 pints of blood,
private duty nursing, TV,
telephone, or private
hospital room,
(unless medically necessary).
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----------------
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Nothing
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Skilled Nursing Facility (SNF) Care:
Semiprivate room, meals, skilled nursing
and rehabilitative service, and other service
and supplies (must occur within 30 days
of hospital confinement which lasted 3 or
more days).
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First 20 days per
Benefit Period
|
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----------------
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Next 80 days of
continuous confinement
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----------------
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Beyond 100 days
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Nothing
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$124.00
a day
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All Cost
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100% of approved charges
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----------------
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Balance
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----------------
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Nothing
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Hospice Care: Medical and support
services from a Medicare-approved hospice,
drugs for symptom control and pain relief,
short-term respite care, care is a hospice
facility, hospital, or nursing home when
necessary, and other services not
otherwise covered by Medicare. Home
care is also covered.
|
Two 90 day periods followed
by an unlimited 60 day
periods
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Up to $5 for
outpatient
prescription drugs
and 5% of
approved amount
for inpatient respite
care.
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Balance
Doctor must certify that
you are terminally ill and
you elect to reserve these
services.
|
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| PART B SERVICE |
TIME LIMIT |
YOU PAY |
MEDICARE PAYS |
Medical And Other Services:
Doctors' services, outpatient medical and
surgical services and supplies, diagnostic
tests, ambulatory surgery center, facility
fees for approved procedures, and durable
medical equipment. Also covers second
surgical opinions and outpatient physical
and occupational therapy including
speech-language therapy.
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Outpatient mental health care:
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Outpatient Hospital Services: For the
diagnosis or treatment of an illness or injury.
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--------------------
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Clinical Laboratory Services:
Blood tests, urinalysis, and more.
|
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No Limit
(except one deductible per calendar year)
Exclusions: Most prescription drugs and medicines taken at home;
long-term nursing home care and custodial care; services not reasonable or
medically necessary; routine physical exams, eye exams, glasses, hearing aids,
and dental care; routine foot care and orthopedic shoes, except for diabetics;
nearly all services outside the U.S.; and most immunizations (pneumococcal vaccine
and flu shots are covered).
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First $131.00 each
calendar year then
20% of approved
amount plus any
charges above
approved amount and
costs for the
first 3 pints of
blood in a calendar
year.
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--------------------
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50% of approved
amount
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--------------------
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20% of approved
amount
|
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--------------------
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Nothing
|
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80% of approved amount
with some exceptions
(when services are covered
with no cost-sharing)
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--------------------
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50% of approved
amount
|
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--------------------
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80% of approved
amount
|
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--------------------
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100% of approved
amount
|
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Home Health Care
(Part A and B): |
TIME LIMIT |
YOU PAY |
MEDICARE PAYS |
|
Part-time skilled nursing care, physical,
occupational, speech-language therapy,
home health aid and medical social
services.
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--------------------
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Durable Medical Equipment: and
medical supplies, and other services.
|
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First 100 visits per spell
of illness
(must be home confined)
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No Limit
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Nothing
|
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20% of approved
amount
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100% of approved
amount
(Doctor must set-up a
plan of treatment)
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80% of approved
amount
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Sources: "Medicare & You 2007," Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services, 2002; "Mutual Care®," Mutual of Omaha Insurance Company, 2004.
AFN31402
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