Medicare Limits

Along with Medicaid, Medicare was signed into existence as part of the Social Security Act of 1965. Medicare provided a source of affordable health care for senior citizens across the United States. Original Medicare, Parts A and B, offer benefits for a large number of services, including inpatient and outpatient hospital services, preventive care, home health and hospice. However, Medicare does not cover every kind of health care need and comes with many restrictions.

Skilled Nursing Care

• Medicare has no benefit for long-term, custodial nursing home care. It will not provide any help paying for stays in nursing homes or assisted living facilities. However, if a short-term stay in a skilled nursing or rehabilitation facility is medically necessary, you may get benefits through Medicare. The patient must have had a qualifying inpatient hospital stay of at least three consecutive days prior to admission and still have some days of hospital care left in their Part A benefit period. You must also need the skilled nursing facility stay for the condition which was treated or began during your qualifying hospital stay.

Alternative Medicine

• Some patients prefer non-invasive, natural treatment for their health conditions. Many of these types of alternative therapies are available in the United States, such as acupuncture, herbal therapy, naturopathy and holistic medicine. While a Medicare beneficiary is not banned from using them, Medicare will not cover any treatments considered alternative to mainstream medicine.

Inpatient Hospital Limitations

• While Part A is known as hospital insurance, it does have its limitations. You will not receive benefits if a Medicare Utilization Review Committee or Quality Improvement Organization does not approve your stay. Private duty nursing or private rooms are not covered unless found medically necessary. Inpatient hospitalizations are covered by benefit period, which begins when you are admitted to the hospital and ends when you have not received any more care for 60 consecutive days. Patients must pay deductibles and co-pays during each benefit period, based on the length of their hospital stay. If you exceed 150 days of care during a single benefit period, you are responsible for all costs yourself.

Home Health

• Original Medicare offers benefits for home skilled nursing care, durable medical equipment for home health care and occupational, speech or physical therapy. But you cannot simply decide to get all your medical treatment at home. Patients must meet certain conditions before being approved for home health benefits. A doctor must confirm that you need to receive your medical care at home and create a specific plan for it. You must also be home bound, a condition in which leaving your residence is either impossible or a major effort. You will not receive home health benefits if you need full-time skilled nursing care. You must also receive all services from a home health agency approved by Medicare.