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Medicare is the federal health insurance program for older adults. In this article, we’ll offer an overview of Medicare and explain how it relates to nursing home abuse.

Key Takeaways

  • Medicare is the federal health insurance program for people over 65, younger people with disabilities, and people with end-stage renal disease
  • Medicare has four different Parts covering different services
  • Medicare is funded by the U.S. government and administered by the Centers for Medicare and Medicaid Services (CMS)
  • Medicare only covers short-term stays in nursing homes
  • Both short-term and long-term nursing home patients are cautioned to be aware of the risk of nursing home abuse

What Is Medicare?

Medicare is the federal health insurance program for:

  • People who are 65 or older
  • Certain younger people with disabilities
  • People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)

Medicare has four different parts covering different services:

  • Medicare Part A (Hospital Insurance) - Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care
  • Medicare Part B (Medical Insurance) - Part B covers certain doctor's services, outpatient care, medical supplies, and preventive services
  • Medicare Part C (Medicare Advantage) - Medicare Advantage covers services provided by Medicare parts A and B and adds prescription drugs, dental, vision, and hearing
  • Medicare Part D (prescription drug coverage) - Part D helps cover the cost of prescription drugs (including many recommended shots or vaccines)

Who Funds and Administers Medicare?

Medicare is funded by the U.S. government primarily by payroll taxes under the Federal Insurance Contributions Act (FICA).

It was created by Congress in 1965 as an amendment to the Social Security Act. Today, Medicare is administered by the Centers for Medicare and Medicaid Services (CMS).

Who Is Eligible for Medicare?

Anybody who has lived in the United States legally for at least five years and is 65 years old or older qualifies for Medicare coverage. Enrollment in Parts A and B is automatic for anybody who receives Social Security benefits. Part D coverage is optional and requires enrollment.

People under 65 years old qualify for Medicare if they receive Social Security Disability Insurance (SSDI). It typically takes 24 months after the receipt of a first SSDI check to become eligible for Medicare. This requirement is waived for people with amyotrophic lateral sclerosis  (ALS) or permanent kidney failure. 

Anybody with ALS automatically qualifies for Medicare regardless of age. 

Medicare Coverage of Nursing Homes

Medicare Part A pays only for short-term stays at nursing homes if the patient was formally admitted to the hospital for at least three consecutive days beforehand for the same illness or a condition related to it. A doctor must also certify that the patient needs daily skilled care at a nursing home. The benefit period begins the day an individual is admitted to the hospital as an inpatient or the day they become a patient in a nursing home.

Medicare will cover the following nursing home costs:

  • Medications, medical equipment, and supplies used in the facility
  • Ambulance transportation
  • A semi-private room and meals
  • Occupational therapy, physical therapy, or speech and language pathology services
  • Medical social services
  • Dietary counseling
  • Skilled nursing care

The Medicare Approved Amounts for a short-term nursing home stay are as follows:

  • $0 for days 1 to 20
  • $194.50 a day for days 21 to 100
  • All costs days for 101 and beyond

Medicare does not pay the costs of a long-term stay at a nursing home. However, Medicaid, a social healthcare program for people with low incomes, does. 

Medicare and Nursing Home Abuse

All nursing home patients staying at a facility for a short-term or long-term stay are cautioned to be aware of the risk of nursing home abuse. If you or a loved one have been a victim of nursing home abuse, contact the relevant authorities immediately. You are also encouraged to speak to a nursing home abuse lawyer for a case review, as you may be eligible for compensation for your pain and suffering.

Medicare and Social Security Disability

Medicare is a federal program that provides health insurance to individuals who are aged 65 or older, as well as to certain younger individuals with disabilities. Like Medicaid, Medicare is administered by the federal government, but it is not means-tested and eligibility is not based on income or assets. Instead, eligibility for Medicare is based on age and disability status.

Social Security is a federal program that provides financial assistance to eligible individuals who are retired, disabled, or the surviving family members of a deceased worker. Social Security is funded through payroll taxes and is not means-tested, which means that eligibility is not based on income or assets.

There is a relationship between Medicare and Social Security benefits in that most individuals who receive Social Security retirement benefits are also eligible for Medicare. In fact, most individuals become eligible for Medicare when they reach the age of 65, even if they are not yet receiving Social Security retirement benefits. Similarly, individuals who are receiving Social Security Disability Insurance (SSDI) may also be eligible for Medicare, although the timing of their eligibility may vary depending on the specifics of their disability. However, not all individuals who receive Social Security benefits are automatically eligible for Medicare, and vice versa. Eligibility for Medicare is based on age and disability status, while eligibility for Social Security is based on an individual's work history and contributions to the Social Security system.

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