Medicare Federal Health Insurance Program

Medicare is a federal health insurance program for people age 65 and older, people of any age with permanent kidney failure, and certain disabled people under age 65. Medicare is managed by the Health Care Financing Administration, which is part of the Department of Health and Human Services. This article summarizes Medicare covered services.

Medicare Has More to Offer

Medicare allows you to choose the way you receive your benefits. Newly eligible seniors are enrolled automatically in the Original Medicare Plan, which is the traditional payment-per-service arrangement. If you want to stay with the Original Medicare Plan, you don't have to do anything. The basic benefits of this plan are described below.

Starting in 1999, Medicare offers more ways to receive your benefits through other health plan choices. Choices that may be available in your area include Medicare Managed Care Plans, such as Health Maintenance Organizations, Preferred Provider Organizations, or Provider Sponsored Organizations. In addition, Private Fee-For-Service Plans and Medicare Medical Savings Account Plans may be available in your area. One of the new health plan choices might be right for you. The choice is yours. No matter what you decide, you are still in the Medicare program.

Your copy of Medicare & You will explain the Original Medicare Plan and other Medicare health plans in detail. It also will explain how to enroll in other health plan options, if you are interested. If you don't have a computer, your local public library or senior center may be able to help you find this information.

All Medicare health plans must provide at least the basic Medicare covered services.

Medicare hospital insurance helps pay for necessary medical care and services furnished by Medicare-certified hospitals, skilled nursing facilities, home health agencies, and hospices.

The number of days that Medicare covers care in hospitals and skilled nursing facilities is measured in benefit periods. A benefit period begins on the first day you receive services as a patient in a hospital or skilled nursing facility and ends after you have been out of the hospital or skilled nursing facility and have not received skilled care in any other facility for 60 days in a row.

Inpatient Hospital Care

Medicare Part A helps pay for up to 90 days of inpatient hospital care in each benefit period. Covered services include your semi-private room and meals, general nursing services, operating and recovery room costs, intensive care, drugs, laboratory tests, X-rays, and all other necessary medical services and supplies.

Skilled Nursing Facility Care

You may need inpatient skilled nursing or rehabilitation services after a hospital stay. If you meet certain conditions, Part A helps pay for up to 100 days in a participating skilled nursing facility in each benefit period. Medicare pays all approved charges for the first 20 days; you pay a coinsurance amount for days 21 through 100.