Further, in order to be covered by Medicare, the stay at the nursing home must include care that requires skilled nursing. In other words, Medicare will not cover custodial, non-skilled or long-term care that includes activities of daily living, such as cooking, cleaning and hygiene. A stay at a skilled nursing facility under Medicare is limited to one-hundred days per ailment. Medicare will pay for the first twenty days in full. The remaining eighty days requires the patient to pay a co-payment of approximately $124.00 per day. Under Medicare Part B, Medicare will provide medical insurance to a qualified individual. This coverage includes physician and nursing services, x-rays, laboratory and diagnostic testing, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital treatment, some ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments and other outpatient medical care treatments as administered in a physician's office. However, medication administration is only covered by Part B if it is administered by a doctor during the course of an office visit. Under Medicare Part B, a qualified individual may also receive assistance with durable medical equipment, including canes, walkers, mobility scooters and wheelchairs so long as they have a properly diagnosed mobility impairment. Prosthetic devices, including artificial limbs, post-mastectomy breast prosthesis, eyeglasses after a cataract surgery, and home use oxygen are also covered by Medicare. As a limitation to benefits, Medicare benefits per Part B are subject to medical necessity. Thus, Medicare provides complex rules governing the management of benefits. Regularly advisories are published that serve as guidelines to what is and what is not covered and what criteria should be utilized in determining coverage.

Under the provisions of Medicare Part C, qualified individuals were given an opportunity to become part of a Medicare Advantage plan. The essence of...

Any individual who is eligible to receive benefits under either Part a or Part B is automatically eligible to receive benefits under Part D. However, in addition, to be eligible for Part D coverage, an individual must first enroll in a stand-alone Prescription Drug Plan or the Medicare Advantage Plan that included prescription drug coverage. The plans are actually administered by private health insurance companies and are only designed and administered by Medicare. Further, unlike Medicare Part a and Part B, under Part D coverage is not standardized. Instead, the individual plans decide which drugs or classes of drugs that will be covered and at what level they will be covered. Therefore, a plan can decide not to cover some drugs at all. More so, Medicare itself has specifically excluded some prescription drugs from coverage, including benzodiazepines, sought suppressants and barbiturates. If an individual plan covers any of the specifically excluded drugs, these costs may not be passed on to Medicare.
Because Medicare is a complex system that covers some, but not all healthcare treatment, it is important that a healthcare professional, such as a nurse, assists with educating qualified individuals on the coverage they can expect to receive. This will assist with a smoother facilitation of the Medicare benefits and a better understanding of the expenses the individual can expect to pay out of pocket.

Bibliography

Marrelli, Tina M. (2001): Handbook of Home Health Standards and Documentation Guidelines for Reimbursement. Elsevier Health Sciences.

Matthews, Joseph L., Dorothy Matthews Berman. (2007): Social Security, Medicare and Government Pensions: Get the Most out of Your Retirement and Medical Benefits. New York: NOLO.

Vogel, Ronald J. (1999): Medicare. Anne Arbor: University of Michigan Press.