Medi-Cal Planning

Medicare

Contrary to many people’s understanding, Medicare is NOT a social welfare program but an insurance program, a federally insured hospital and medical program that everyone who has reached the age of 65 is entitled to receive if he or she has worked and paid into Social Security for the required number of quarters.  It is NOT based upon the financial need of the applicant or the applicant’s financial status - even the wealthy are entitled to Medicare. Medicare is paid for through payroll deductions by people who are working or who have worked. It requires certain co-payments and deductibles and is divided into two areas of coverage.

• Part A (Hospital insurance program): covers hospital care, skilled nursing facilities, home health care, and hospice care

• Part B (General): covers doctor’s charges, durable medical equipment, medical supplies, outpatient services, and other secondary medical care
  

In order to qualify for Medicare Treatment:

• The treatment must be prescribed by a doctor

• The provider must be a Medicare certified provider

• The care and supplies must be medically necessary for the treatment

When does Medicare cover nursing care?

If and only if there is a prior three-day hospital stay, then Medicare will pay for nursing care in a Skilled Nursing Facility if:

• The patient required rehabilitation THERAPY five days per week or skilled nursing care seven days per week, AND

• The care could only be rendered in a Skilled Nursing Facility, AND

• The medical condition being treated is the same condition that was being treated in the hospital

If the patient satisfies all of these conditions, Medicare will pay a portion of the cost up to the first 100 days of the Skilled Nursing Facility during each "spell of illness". There is no deductible for this care, and no co-payment for 20 days. The co-payment for days 21 - 100 is approximately $100 per day.

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