ABSTRACT
This chapter discusses Medicare coverage, eligibility requirements, the costs, and participant rights. Certain workers who meet the age 65 requirement are entitled to Medicare even though their employment was not covered by Social Security. Medicare Part A reimburses the costs of hospital care, short-term skilled nursing facility care, part-time home health care after a stay in a hospital or nursing home, and most hospice care. Medicare will reimburse the cost of only those services that are considered “reasonable and necessary” for the diagnosis or treatment of illness or injury. Only Medicare beneficiaries who are confined to the home, or are “homebound,” are eligible for Medicare home health care. Medicare does not directly pay hospitals, doctors, or other health care providers. Medicare Part A will pay only for medical care that is “medically reasonable and necessary.” Medicare Part B, Supplemental Medical Insurance, is voluntary medical insurance that helps pay the costs of physician and outpatient services.
