Iron County Nursing Home


Medicare Coverage

Who qualifies and why?


Many people are quite content to believe that all their medical worries and woes will be automatically taken care of by Medicare.  Not So!!  Medicare is a qualifying insurance very similar to other health insurances and it has limitations on coverage, term, and exclusions.  There is some excellent reading on the subject:


            Paying for Long Term Care


            Medicare Benefits


            Medicarewatch Oraganization


At the time of this writing, Congress is considering the addition of adding prescription drug benefits to Medicare coverage.  If you feel strongly and want to be involved you can contact your Senator and Representative here:


            Contact Your Senator


            Write Your Representative - Contact your Congressperson in the U.S. House of Representatives.


            General Information on the House


            General Information on the Senate


Following is some in-depth information on Medicare qualification provided by Iron County Nursing Home.


The Medicare plan is divided into two parts: Part A (Hospital Insurance – most people do not have to pay), and Part B (Medical Insurance - You pay monthly including and includes preventive services).

While this information is designed to give you a broad understanding of your benefits, it is important to note that the types of coverage are subject to change.

Qualifications for Medicare

You can receive help from Medicare to receive home health services and limited skilled nursing home care.  However, many people have the mistaken notion that Medicare will cover the full costs associated with nursing home services.  They don’t.  Medicare is a health insurance program that you pay into as a deduction from your wage earnings.

Once you turn 65 you may be qualified to receive Medicare benefits to help defray the costs associated with medical coverage.  If you are disabled under 65 you may also qualify.  Additionally if you have permanent kidney failure referred to as End-Stage Renal Disease (ESRD) or require dialysis or require a kidney transplant you may also qualify as of this writing.

In order to receive help from Medicare, you first must have been admitted into a hospital for an acute condition for a period of three consecutive days, must have a condition which requires the services of skilled care, and finally, be admitted into a Medicare certified nursing home facility within 30 days of leaving the hospital. 

You will have to check with the hospital’s discharge representative in order to make sure that the nursing home you are considering, is approved by Medicare.  Once admitted, Medicare will help to pay the cost of skilled care and rehabilitation services for a limited amount of time.  They will not pay for custodial care while in a nursing home.

Medicare Plans Offered And How They Work

Generally you will find two different types of plans offered by Medicare.  Understanding these plans will help you to locate your current position for coverage and assist you in selecting the types of care plans you or a family member may require in at home or in a skilled nursing home setting.  Below you will find an explanation of the different plan structures and how they may benefit you. 

The Original Medicare Plan: Nationwide Acceptance

This type of plan is available anywhere throughout the country.  Under this plan you may choose any doctor, specialist, or hospital institution that accepts Medicare with the exception of prescription drugs.  Under this plan, you will be required to pay your share for medical coverage and Medicare will pay their portion of the required coverage.

More Detailed Look At Medicare Part A (Hospital Insurance)

Part A (Hospital Insurance) helps to cover your impatient cost in skilled nursing, hospice care, and some home health care necessary in the treatment of a medical condition. 

If you are in a nursing home facility, under this plan you generally do not have to pay but are automatically eligible when you turn 65. Once you are eligible for Medicare Part A, you may receive up to 100 percent of coverage for all services during the first 20 days while in a nursing home facility for skilled care.

On day 21 you will be required to pay a co-payment of $105.00 each day as of 2003 up till day 100 to receive all covered services and from day 101 an on, you will required to pay 100 percent of all services received. 

You are more than likely to get Part A once you turn 65 and will not be required to pay a monthly premium.  However, if you did not pay Medicare Taxes while you worked and you have already reached the age of 65, you may be able to buy into Part A.  Check your Medicare card in the lower left corner and see if “Hospital Part A” is printed on the card.  If not call the Social Security Administration toll-free at 1-800-772-1213 and see if you can buy into Part A.  If you don’t have a Medicare card, call 1-800-772-1213.

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