Retirement Planning
1. Most Americans over the age of 65 have the ability to enroll in Medicare part A and Medicare part B. Medicare Part A is what is known as “hospital insurance”, and “helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay). Part A also pays for some health care and hospice care”, according to the Social Security Administration.

The Medicare website outlines some specific things within each of these broad categories. For example, under hospital care Medicare Part A covers semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies.

In a skilled nursing care unit, you are covered for meals, semi-private room, skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, medications, medical social services, medical supplies and equipment used in the facility, ambulance transportation, dietary counseling, and swing bed services. In long-term care hospitals, there is some coverage under Part A, but there are also very high fees that need to be paid as co-pay, so this category is not particularly well-covered under Part A

For home health services, Part A covers a fairly extensive range of services, including part-time skilled nursing care, physical therapy, occupational therapy, speech-language pathology services, medical social services and part-time home health aide services. It is important to understand the limitations of this care, because it does not cover things like meals delivered to your home (unlike when you are in a medical facility and they feed you), and it doesn’t care full-time care or personal care.

It is also worth noting that these are the minimum levels of what can be covered, and each state might supplement these with additional coverage. That will be established on a state-by-state basis.

2. Medicare Part B is what is known as “medical insurance”. This includes things like clinical research, ambulance services, durable medical equipment, mental health (inpatient & outpatient), and limited outpatient prescription drugs.

Within these, there are details provided by the Medicare.gov website. For example, under clinical research the patient pays 20% of the cost, but this allows them to participate in clinical research trials such as diagnostic tests, surgical treatments, medicine and new types of patient care.

Part B’s ambulance coverage includes “ground ambulance transportation when you need to be transported to a hospital, critical...…communities, such along the Alaskan Panhandle, where this situation applies.

So unless one of these exceptions applies, Gaye should expect to pay the full cost of her medical coverage – she is traveling and unless that travel is going through Canada on her way to Alaska then she is unlikely to receive any help from Medicare for those expenses. Gaye, prior to traveling, would be well advised to take out travel medical insurance in order to have coverage for these types of expenses. The reason is simple – hospitals even in the US have to opt into Medicare coverage and there are no hospitals outside the US that are able to do this.

If Gaye intends to do much traveling outside of the US, she may wish to look beyond Original Medicare. There may be a Medicare Advantage plan that offers some form of travel medical coverage, but these plans can vary quite a bit with respect to what they cover, so it would be worth shopping around. But Original Medicare is not going to be of much help for Gaye should she suffer from an injury in a foreign country, especially a non-life-threatening injury like a broken ankle.…