Health Care Insurance and Cost Management - Medicare and Hospital Expenses

Eligibility Requirements
Part A - who is eligible?

  • All persons age 65 or older who are eligible for social security retirement benefits.
  • Dependants, age 65 or older, of fully insured individuals age 62 and older
  • Survivors, age 65 or older, of those eligible to receive social security retirement benefits.
  • If under age 65, those deemed disabled under social security and have been receiving benefits for two or more years.
  • Disabled widows or widowers aged 65 or older.
  • Children 18 or older who were disables prior to age 22
  • Worker or dependants of workers who are fully or currently insured and have been diagnosed with end-stage renal disease.

Workers, age 65 or older, who want Medicare benefits and do not fall under any of the eligibility requirements above, may pay premiums for Medicare part A coverage and part B coverage. These workers must pay for both parts to qualify.

Part B - who is eligible?
  • Those eligible for Part A coverage are also eligible for Part B.

Part A - Hospital Expense
This part of Medicare pays benefits for inpatient hospital care. The covered expenses include room and board, regular hospital equipment usage, nursing care, hospital administered drugs, cost of an operating room, physical therapy or therapeutic services, and blood transfusions.

Part A benefits will also cover the costs for 100 days in a skilled nursing facility, an unlimited number of home health care visits, and hospice care. See the cart below for deductible and co-payment amounts.

Hospital Care
Deductible Days 1 through 60 - $992
Days 61 through 90 - $248/Day
Days 91 through 150 - $496/Day

Home Health Care
Cost $0 for care
20% for durable medical equipment

Hospice Care
Co-Payment $5 for outpatient prescription drugs
5% for approved amount of respite care

Skilled Nursing Facility
Deductible Days 1 through 20 - $0
Days 21 through 100 - $124/Day

Cost 100% of the first 3 pints
20% for any additional pints

*All numbers are as of the 2007 plan documents Medicare and Medical Expenses
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