This program covers care that is considered medically necessary. You become eligible for this coverage when you turn 65 years old, or if you are under 65 years old and have certain disabilities. If your disability qualifies you for Social Security Disability Insurance (SSDI), you will gain Medicare coverage after receiving benefits for two years. Enrollment in Medicare will automatically begin on the 25th month that you receive a SSDI check. You are considered disabled by Social Security standards if:
- You cannot do work that you did before;
- You cannot adjust to other work due to your medical condition(s); and
- Your disability has lasted or is expected to last for at least one year or to result in death
You will not be required to wait two years if you have Amyotrophic Lateral Sclerosis (ALS), and Medicare coverage will begin on the first month that you receive a SSDI check. A final way to receive coverage under 65 is having end-stage renal disease (ESRD), also known as kidney failure. Please see this site for additional information on receiving coverage with this condition.
What does Medicare cover?
A short stay in a skilled nursing facility will be partly or fully covered if you satisfy these conditions:
- You have recently stayed in the hospital for at least three days
- You are admitted to a Medicare-certified nursing facility within 30 days of this hospital stay
- You need skilled care, such as skilled nursing services, physical therapy, or other types of therapy
Only if you meet these conditions will you be eligible for coverage, which will not exceed 100 days. The first 20 days will be fully covered, but from day 21 to day 100 Medicare will only cover expenses in excess of $140 per day. So, if your expenses for day 32 are $180, you will be expected to pay $140, and Medicare will cover the remaining $40 balance. After the 100th day, you will need to pay 100 percent of the costs associated with your care.
When a doctor determines that home care services are medically necessary to treat an illness or injury, Medicare will cover the following services:
- Part-time or intermittent skilled nursing care
- Physical therapy, occupational therapy, and speech-language pathology that your doctor orders that a Medicare-certified home health agency provides for a limited number of days only
- Medical social services to help cope with the social, psychological, cultural, and medical issues that result from an illness. This may include help accessing services and follow-up care, explaining how to use health care and other resources, and help understanding your disease
- Medical supplies and durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers. For durable medical equipment, you pay 20 percent of the Medicare approved amount
If your doctor reorders these services every 60 days because they are medically necessary then they will continue to be covered by Medicare without limitation.