Long-Term Care And Medicare
What is Medicare?
Medicare is a kind of big entitlement program that covers health care for people who are either over sixty five or who are otherwise disabled. So, if you get social security, after two years you qualify for Medicare even if you are under sixty five. It covers a variety of different medical services and quasi-medical services.
What is the difference between Medicare A and Medicare B fee-for-service plan?
Medicare A is essentially the inpatient benefits. It's for hospital care, and skilled nursing facility care following a hospitalization, and related to the same condition. Also home health care related to a hospitalization and related to the same condition. It also encompasses the hospice benefit. So, that's Medicare A. Medicare Part B, on the other hand, is generally considered the outpatient benefit. That's doctors office visits, durable medical equipment like wheelchairs and things like that, and home health care if you're not just coming off a hospitalization. Everybody who has Medicare gets Medicare A. In order to get Medicare B though, you have to pay a monthly premium.
What is Medicare C?
Medicare Part C isn't an official word, but it is a term that is generally used to refer to the Medicare HMO's or what is sometimes called Medicare Plus Choice Insurance. That would be things like Secure Horizons or Health Net Seniority Plus. Essentially, when you sign up for this you are allocating your Medicare A & B benefits to the insurance company and you are allowing them to essentially administer the benefits to you as they see fit. There are some advantages to picking a program like that. One advantage is, for example, that you don't have to have a three-day qualifying stay in a hospital before you can go to a nursing home. They can put you right in there from the emergency room. Since Medicare has started covering medications with part D, there aren't as many advantages to picking a Medicare C or Medicare HMO program as there once were.
Who qualifies for Medicare?
In order to qualify for Medicare, you have to be 65 years old, or you have to be disabled and receiving social security benefits for at least two years.
What does Medicare cover?
Well, in fact, Medicare doesn't really cover long term care at all. Because it's basically covering only skilled care for acute problems. Now in reality people sometimes come into the nursing home and it's clear that they're going to require long term care. In those situations, Medicare will cover the first 100 days of it. At least to some degree. But if you look at the overall cost of long term nursing home patients, Medicare covers only about ten percent of that, whereas Medicaid covers at least fifty percent of all the long term care that's provided in nursing facilities across the country.
When can I enroll for Medicare?
You can enrol for Medicare when you are Medicare-aged. That's 65 or two years after getting on Social Security, typically.
What is the difference between Medicare and Medicaid?
Well, Medicare is a program essentially for everybody, which is designed to take care of your medical needs, particularly hospital, sort of catastrophic medical needs under Part A and then with the options of Part B and Part D for outpatient and drug coverage. Medicaid, on the other hand, is not for everybody. Medicaid is only for people who don't have assets. It is basically an entitlement program for indigent people. I think in order to qualify for it you have to have less than $3,000 in cash and no significant amount of tangible assets. So it is really a totally different thing. It covers both acute medical care, outpatient medical care, drugs and long-term custodial care.
What are the worst widely-held misconceptions about Medicare?
Probably the biggest misconception about Medicare is that people want to believe that because they have Medicare, everything's going to be covered. It comes as a real shock for example when we get a 95 year old lady who's just been barely squeaking by at home, just barely managing and she falls and let's say she breaks her hip or she has a compression fracture of the spine. She spends a few days in the hospital, she comes out to the nursing home, she does some therapy and within two or three weeks let's say she's walking a hundred feet with her walker, with somebody just standing by they don't have to actually hang on to her. She can get herself in and out of bed, she can get herself on and off the toilet and the facilities say, “Well that's it, you're at a plateau, you've met the goals and Medicare is no long going to cover you.” Well then you've got this furious family members, you know, “She's 95 years old, she can't go home, she can't look after herself, she needs somebody to look after her. " You say “That's right, but she's certainly welcomed to stay here but Medicare doesn't pay for that,” and so people really think the coverage's are far better than it really is.