The government-funded medical insurance, Medicare, comes in different parts. There is Medicare Part A, Part B, Part C, and Part D. Each of these parts cover a different aspect of health coverage. You can receive Medicare for free.
When you reach the age of 65 and receive benefits from the Railroad Retirement Board (RRB) or the Social Security Administration, you qualify for Medicare Part A. Also, If you have a disability or have ALS (amyotrophic lateral sclerosis), or ESRD (end-stage renal disease), you could have eligibility for Part A benefits before turning 65. The only other requirement for qualification to enroll is for you to be a US citizen or have for at least five consecutive years been a permanent resident of the country legally.
Medicare Part A covers:
- Hospice care
- Home health services (limited)
- Inpatient hospital care
- Skilled nursing facility care (under certain conditions)
Hospice coverage is available if your physician certifies you to be terminally ill, with about six months or fewer to remain living. The focus of hospice care is palliative care, meaning to lessen without curing. This care aims to give the patient a comfortable environment and mitigate physical suffering as much as possible.
You must receive your care from a Medicare-approved hospice facility. You can stop hospice care whenever you return your attention to curative efforts. However, under Part A hospice coverage, you may receive grief and spiritual counseling, which the government insurance does not cover under normal conditions. Also, only your hospitalized room and board get covered if the hospice providers feel that short-term inpatient care for pain management is necessary.
Home Health Coverage
If your doctor determines you should have home health care services, Medicare Part A benefits cover the care if your doctor orders it. Only if you have eligibility and your doctor prescribes durable medical equipment (DME) for you, is when the Medicare benefit covers the costs. Otherwise, Medicare Part B benefits will cover those expenses. If you qualify for DME coverage, Medicare will pay 80 percent of only an amount they approve. Some types of DME include:
- power mobility devices
- oxygen equipment
- insulin pumps
- mobility assistive equipment
- hospital beds
Meals, 24-hour home care, or homemaker services not connected to your treatment do not get covered by Medicare. If the only treatment you need is personal care services, like help to dress or bathe, then you will not receive coverage. If your doctor certifies you are homebound, meaning you require substantial effort to leave home, and the doctor deems it medically inadvisable for you to go out away from home without help, then you must receive care from a Medicare-certified agency for home health services.
Medicare beneficiaries have coverage for inpatient care and any critical hospital expenses such as medications, meals, nursing services, a semi-private room, and any other supplies and services needed for treatment. Any private-duty nursing, non-medically required private rooms, personal care items, or extraneous costs like television don‘t get covered by Medicare Part A.
If you need blood, the blood should come from a blood bank, so you do not get charged. Medicare does not pay for it otherwise. If the hospital needs to buy blood for you, Medicare requires you to pay out-of-pocket for the first three units received within each calendar year. The exception to this would be if you or somebody else donated the blood.
Nursing Home Benefits
If you have been an inpatient at a hospital and then moved to a skilled nursing facility for related injury or illness, Medicare will pay for your stay. You are eligible for coverage if your hospital stay was for a minimum of three days. W
If you qualify, the month of your 65th birthday you can receive the Part A insurance benefit. If your birthday is the first of the month, you can get coverage the month prior. When not eligible for Social Security benefits for retirement or the benefit from the RRB. Then you must enroll during the initial enrollment period, known as the IEP. You can apply online, by calling 1-800-772-1213 (TTY 1-800-325-0778) from 7 am to 7 pm, Monday through Friday or by visiting your local Social Security Administration office.
The IEP is for seven months. It starts three months before you turn 65, includes your birth month and three months afterward. If you miss the initial enrollment period, you must wait until the next January 1 to March 31 which is the general enrollment period when you can enroll for free.