KATS Network

Medicare

Center for Medicare & Medicaid Services, US Department of Health & Human Services

Overview:

Medicare covers certain medical services and items in hospitals and other settings. Some are covered under Medicare Part A, and some are covered under Medicare Part B. As long as you have both Part A and Part B, these services and items are covered whether you have the Original Medicare Plan, or you belong to a Medicare Advantage Plan (like an HMO or PPO).

Part A helps cover your inpatient care in hospitals. This includes critical access hospitals and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and home health care. You must meet certain conditions to get these benefits.

Part B helps cover medical services like doctors’ services, outpatient care, and other medical services that Part A doesn't cover. Part B is optional. Part B helps pay for covered medical services and items when they are medically necessary. Part B also covers some preventive services.

The Original Medicare Plan is one of your health coverage choices as part of the Medicare Program. You will be in the Original Medicare Plan unless you choose to join a Medicare Advantage Plan (like an HMO or PPO). Most people get their coverage through the Original Medicare Plan.

Medicare Advantage Plans are health plan options that are approved by Medicare and run by private companies. They are part of the Medicare Program, and sometimes called “Part C.” When you join a Medicare Advantage Plan, you are still in Medicare. Some of these plans require referrals to see specialists. In many cases, the premiums or the costs of services (co-pays) can be lower in a Medicare Advantage Plan than they are in the Original Medicare Plan or the Original Medicare Plan with a Medigap policy.

Medicare Advantage Plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services. They generally offer extra benefits, and many include Part D drug coverage. These plans often have networks, which mean you may have to see doctors who belong to the plan or go to certain hospitals to get covered services. In many cases, your costs for services can be lower than in the Original Medicare Plan. Some of these plans coordinate your care, using networks and referrals, more than others. This can help manage your overall care and can also result in savings to you.

Medicare offers prescription drug coverage for everyone with Medicare. This is called Part D. This coverage may help lower prescription drug costs and help protect against higher costs in the future. It can give you greater access to drugs that you can use to prevent complications of diseases and stay well.

Eligibility Requirements:

people age 65 or older,
people under age 65 with certain disabilities, and
people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

AT Services Provided/Covered:

Evaluation/Assessment
Purchasing/Acquisition
Selection/Design
Training/Technical Assistance

AT Devices Provided/Covered:

Daily Living
Speech Communication
Mobility, Seating and Positioning
Vision/Hearing Equipment
Other: Home/Worksite Modifications

Application Process:

Applications for a Medicare health insurance card are taken at your local office for the Social Security Administration.

Contact Information:

For more information about Medicare, call (800) 633-4227, or visit their website at: http://www.medicare.gov

Additional Information:

You can download the National Medicare Handbook “Medicare and You”, as a .pdf file at: www.medicare.gov/publications/pubs/pdf/10050.pdf

Bridges & Potholes:

Bridges

This is an important source of funding for aging people who can no longer meet eligibility requirements of other funding sources

Potholes

Only a limited number of devices are allowable for purchasing under Medicare. The medical need for a piece of assistive equipment is strictly interpreted. The exceptions in this category include artificial larynxes, which replace a body part that has been removed. If a strong enough case can be made illustrating medical need, exceptions can be made, but they are rare.
The rate schedules place a cap on how much Medicare will pay for a particular item. If the provider's price is higher than the amount allowed under Medicare, the consumer will have to pay the difference.
In many cases, the Part B Carrier may choose to rent or lease an item instead of purchase it outright. In these cases, the equipment does not become the permanent property of the individual.

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