Medicare
MR. WATSON: All right. Let's talk about Medicare. It was added in 1965 with the Social Security Amendments.
MR. WATSON: You are eligible for Medicare under three circumstances:
- when you turn age 65, or
- if you have chronic kidney problems (at any age), or
- if you are receiving social security disability benefits (at any age).
MR. WATSON: The original Medicare consisted of two parts.
MR. WATSON: Medicare Part A and Medicare Part B. There's also a Medicare Part C and Medicare Part D, we will go over that later. But now we will go over Part A and Part B.
MR. WATSON: What does Part A cover?
MAN: Hospitals.
MR. WATSON: Good. Medicare Part B covers doctors and everything else. Know the chart!
Medicare Part A
- 90 day benefit period
- deductible required (per benefit period)
- compulsory
MR. WATSON: Medicare Part A (hospital coverage) is compulsory. What does "compulsory" mean? It means "must." You have to take it. You are automatically eligible for it. You have been paying for it out of your FICA taxes all of your working life. Almost everyone who works pays a 7.65% FICA tax. Of this, 6.20% goes to Old Age, Survivors, & Disability Income (OASDI). And, 1.45% goes towards funding Medicare.
MR. WATSON: Medicare Part B (physician coverage) is voluntary, if you want it, you have to pay for it. You have to pay for Part B. Don’t worry about the premium amount, it comes out of your Social Security check. The point is that it has a premium.
MR. WATSON: Medicare Part A basically covers three things. It covers
- in-patient hospitalization,
- post-hospital skilled nursing care, and
- home health care.
Skilled Nursing Care
- Must have been in the hospital for three consecutive days
- Medicare Part A pays up to 100 days
- Skilled care is in-patient nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel.
- A semi-private room (a room you share with other patients)
- Meals
- Skilled nursing care
- Physical therapy (if needed to meet your health goal)
- Occupational therapy (if needed to meet your health goal)
- Medical supplies and equipment used in the facility
- Ambulance transportation (when other transportation endangers your health)
MR. WATSON: We are not talking about a nursing home. What's a nursing home? As you will see later, a nursing home is for folks who can't take care of themselves, when they can't perform two activities of daily living (ADLs). Around the clock care. It doesn't cover that. The state (Medicaid) will pay for some of it if you're below a certain income level but, you almost have to be broke.
MR. WATSON: Now, say Grandma was in the hospital for three (3) days, she still needs medical attention. She can go to a skilled nursing care facility.
WOMAN: Like a rehab center.
MR. WATSON: That's a good way of remembering it, rehab centers. It pays for up to 100 days. She also had to be in the hospital for three consecutive days, then Medicare Part A pays in full for the first 20 days. After that she has to pay a daily amount of $200.00 (2023) for the 21st - 100th days.
- inpatient hospitalization,
- post-hospital skilled nursing care, and
- home health care