All Americans over 65 who qualify for social security also qualify for Medicare.
There is no charge for hospital coverage under Medicare – Part A. Medicare pays all but a specified relatively minimal amount of charges for hospital stay up to 60 days. From the 61st day on, payments are also available on a specified basis and cover only part of the costs. Medicare pays for the first 20 days in nursing homes and the costs over a specified amount for the next 80 days, provided the patient has first been in a hospital for at least three days and provided the home has the medical services to qualify.
Because actual dollar amounts of benefits change regularly, exact benefits are not given but they can be readily obtained from your local social security office.
Part B of Medicare pays 80 percent of “reasonable” doctors’ fees both in and out of the hospital, after the patient has paid a set initial cost per year. Part B participation requires payment of a premium and coverage is automatic unless an individual specifically rejects it.
When Medicare benefits run out, the patient must use his or her own savings before turning to government help (Medicaid), which is a state-federal plan. As a rule, Medicare covers hospital costs very well, but pays a smaller share of doctor’s fees. Many of the most common health needs of the elderly, such as regular checkups, dentures, eyeglasses, drugs, private nurses, long-term care in nursing homes, are excluded from Medicare.
Medicare discourages inexpensive treatment that can be given outside of hospitals.
Doctors may bill Medicare direct or the patient direct, and remember, Medicare will pay only 80 percent of the “reasonable” charge of doctors. It is wise to find out in advance whether your doctor will accept Medicare “assignment.”
Medicare forms are simple to complete and they should be filled in fully and accurately. It is wise for most elderly citizens to carry extra health insurance to supplement Medicare benefits.
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