What does health insurance cover? – InsuranceNewsNet
Medicare is the federal health insurance program for people 65 years of age and over and for certain people with disabilities. In 1965 Medicare was enacted to provide a “safety net” of health care coverage to eligible people.
Medicare is packaged in two main parts. Part A is hospital insurance coverage. It covers hospitalization, some palliative care, and a limited amount of post-hospital skilled nursing and home health care. Part B, which is medical insurance, helps cover doctors’ services, outpatient hospital care, physiotherapy, diagnostic tests, and a variety of other services. More recently, Medicare added Part D, prescription drug coverage.
At first glance, it looks like Uncle Sam has it all covered. But unfortunately there are many limitations.
Each time you go to the hospital, you have to pay a certain amount of your hospital costs, unless your visits are less than 60 days apart. If so, you only pay the deductible the first time. If you stay in the hospital for more than 60 days, you will need to pay a co-payment each day for days 61 to 90.
You also have a 60-day lifetime reserve that can be used in conjunction with multiple extended stays. These days also have an associated copayment. Medicare will not cover stays longer than 90 days after you exhaust your 60-day supply.
Will Medicare Pay For Qualified People
Medicare will pay for the first 20 days of skilled nursing care, but only after you’ve been hospitalized for three days. This means that you will have paid at least the deductible for this three-day stay. From day 21 to day 100, Medicare will cover a portion of the cost of skilled nursing care, but you will still have a co-payment. After 100 days, Medicare will not pay for the skilled nursing care and you will have to bear the full cost. The 100 days are per benefit period.
What about Medigap?
Medicare supplemental insurance, or “Medigap”, is designed to pick up where Medicare leaves off. As such, it typically pays the deductibles and copayments required by Medicare. Coverage will vary depending on the benefits described in each specific policy.
Medigap insurance may not pay for additional procedures that are not specifically addressed by Medicare. Most policies will only help cover the deductibles and copayments imposed by Medicare.
What about long term care?
Medicare only provides limited coverage for skilled nursing care and only pays for up to 100 days of care after a three-day hospital stay. Medigap does not fill the gaps in this coverage.
If you’re worried about meeting your potential long-term care needs, you should consider additional insurance to help fill the gaps. In many cases, it may be best to consider purchasing a private long-term care insurance policy to protect yourself against these potentially devastating costs.
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