“Well will my insurance cover that? Medicare should cover that, right?”
“Yes, this will be covered under your Part A Medicare coverage”
“My what? Part A, what’s that?”
Generally Medicare is known to cover medical expenses over the age of 65. Take it one step further and it is known that Medicare Part A is generally the hospital portion, and the rest is Part B. Let’s take it one more step to fully understand.
Medicare Part A
As mentioned above Part A generally refers to hospital based coverage, however there are various services that are also covered by Part A that do not take place within the hospital. So what does Part A cover?
- In-patient care at a hospital: It is well known that this is covered under Medicare Part A. This includes your stay itself, as well as the tests and procedures that may come along with it.
- Skilled Nursing Facility (SNF): A skilled nursing facility is utilized to help those recover after injury or illness. Most often individuals who are admitted into a SNF are in need of specialized, extensive hands-on care for a period of time. A stay within a skilled nursing facility is temporary.
- Hospice Care: hospice care provides care within the home for those who are terminally ill. Hospice care allows the individual to maintain a particular quality of life prior to passing.
- Home Health Care: Services such at physical therapy, occupational therapy, speech therapy and nursing oversight can be provided through home health care. These services are utilized for those who have been deemed homebound based on the guidelines set forth by Medicare.
Medicare Part B
- Medically Necessary Services: this includes service or supplies that have been deemed medically necessary by a healthcare provider to treat or diagnose a medical condition.
- Ambulance services such as non-medical transportation
- Clinical research studies that may be used to help with a diagnosis or treatment
- Durable medical equipment such as walkers, wheelchairs, bedside commodes, canes, crutches, hospital beds, etc.
- Preventive Services: this includes services such as outpatient physical therapy, various screenings, flu shots, COVID vaccine, yearly visits and more.
Generally Medicare will only continue to provide coverage for various services if and only if they are deemed medically necessary. For example, as an individual progresses through a physical therapy recovery protocol they may progress to the point in which Medicare will no longer deem service medically necessary. Both patient and therapist know it is important to continue, however Medicare can not continue to provide service. Medicare may also hold place caps on patients, such as therapy caps that do not allow individual patients to receive care beyond a particular payment threshold.
The limitations created under Medicare guidelines highlight the importance of alternative methods to continue care.
Medicare coverage can be confusing at times. It is best to speak with your healthcare provider to understand what you or a loved one may qualify for.