Like everything else having to
do with things insurance and governmental the answer is
yes...and no...
Disclaimer: The following
information applies to Original Medicare. Those who are
insured under a Medicare Advantage plan (HMO or PPO) will
have to consult with their individual plan, because every
one is different.
With the obvious exception
of annual deductibles and co-pays, and as long as the
medical provider participates in original Medicare, there
is no annual or lifetime limit on the dollar amount
original Medicare will cover for physicians or the dollar
cost of hospital care. Certain therapies and tests are not
Medicare approved, so check with your physician to make
sure Medicare has approved the procedure. If the
participating physician accepts Medicare assignment and
charges more than the Medicare approved amount you will
not have to pay the difference.
Medicare will cover up to
60 days in the hospital during any one "Benefit
Period." (follow the link for a more in-depth
discussion of benefit periods). Benefit periods can be
renewed indefinitely if you follow the rules. You have an additional 60
hospital days, called Lifetime Reserve Days, which can be
used once and which will never be available again. So,
there are limits to what Medicare will pay for
hospital care, but for you it is counted in days, rather
than in dollars.
There are limits to what
Medicare will cover for medications under Part D. There
are thousands of Medicare D plans, and each one is
different.
Medicare has gone back and
forth, and at the time you read this there may be caps on
the allowable dollar cost of outpatient (not in a
hospital) physical therapy, speech therapy, or
occupational therapy you may have. Because the rules keep
changing you will have to check with your outpatient
rehabilitation facility for the latest.
Medicare home care and
hospice care (nurse, therapist, etc.) does not have dollar
caps for the patient, but there are rules about who can
have home therapy or hospice services.
Skilled nursing after a
hospitalization of at least three days, not counting the
day of discharge, is covered at 100% for the first 20
days. If the patient qualifies to continue rehabilitation
after the first 20 days there are fairly hefty co-payments
required for days 21 through 100. There is no guarantee
any patient will qualify for 100 days of rehabilitation
care, and most don't.
Medi-Gap (Medicare
secondary insurance policies) will often cover the
deductibles and co-payment amounts. Check your policy, if
you have one.
This is a very bare-bones
summary of the most often used original Medicare benefits.
For in-depth information the
Medicare website has lots of answers.
