Original Medicare Plan

Medicare is the health insurance program administered by the federal Centers for Medicare & Medicaid Services (CMS) for people 65 years of age or older, people of any age with permanent kidney failure, and some disabled individuals under age 65. Although Medicare may pay a large part of your health care expenses, it does not pay for them all. Some services and medical supplies are not fully covered. A book titled Medicare and You is available each year free from any social security office. The handbook provides a detailed explanation of Medicare.

Medicare is divided into two types of coverage, Part A and Part B.

Medicare Part A (Hospital Insurance) helps cover your medically necessary inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. You must meet certain conditions to get these benefits.

Medicare Part B (Medical Insurance) helps cover your doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

Specific Limitations Under Medicare

Medicare was not designed to pay all your health care expenses. It does not cover long-term care expenses. Medicare provides limited coverage for skilled nursing care and for home health care.

Skilled Nursing Care Limitations

Medicare pays limited benefits in a skilled nursing facility approved by Medicare if you need skilled nursing care as defined by Medicare. Medicare does not pay for personal care such as eating, bathing, dressing, or getting in or out of bed. Most nursing home care is not covered by Medicare! For more information, contact the Office of the Commissioner of Insurance and ask for the Guide to Long-Term Care (oci.wi.gov/pub_list/pi-047.htm).

Home Health Limitations

Medicare pays limited benefits for home health care services that are considered "medically necessary" by Medicare. Medicare does not pay for personal care such as eating, bathing, dressing, or getting in or out of bed. Most home health care services are not covered by Medicare! For more information, contact the Office of the Commissioner of Insurance at 266-0103 (In Madison) or 1-800-236-8517 (Statewide) and ask for the Guide to Long-Term Care (oci.wi.gov/pub_list/pi-047.htm).