Step 1 – No matter what you hear, the number one method of finding a physician is through word of mouth. In fact, it may even prove beneficial to choose someone whom has been referred to you by a friend or family member. Starting the process, knowing a patient will provide you with insight into the practice, and an idea of what to expect from the physician. Be sure to ask specific questions from the person making the recommendation to best determine whether the physician is worth looking into further.

Step 2 – Even though it’s old fashioned at this point, pull out the old yellow pages and leaf through until you find the physician section. Additionally, you’ll want to be able to decide which type of physician you will be seeking, such as a pediatrician, cardiologist, gynecologist, chiropractor, etc.

Step 3 – Hop online and search for board-certified specialists in your area. Specify the city in which you live, state, and the words “certified doctor” into the entry line. While this search will initially provide you with a number of results, you can easily narrow it down by adding additional terms as you move along. Additionally, there are a number of quality directories available online, which provide reviews, ratings, and other pertinent information to help you make a decision.

Step 4 – Call up your local hospital and speak with them in order to obtain a list of licensed area physicians.

Step 5 – Head over to your state medical board and ask for a list of recommendations. These associations commonly provide people with a variety of resources to help in their search. They also have the ability to show you current records pertaining to complaint histories, and the specifics of the cases. You can even use this resource to check up on the recommendations you’ve gathered prior.

Step 6 – Once you have a solid list of candidates in front of you, pick out your top three choices and contact them to set up a meeting. Many of these practices will provide prospective patients with an initial consultation free of charge. Use this as an opportunity to gain a firsthand look at the practice and the physician themselves. Evaluate how you interact with each other, and make sure you feel comfortable.

Step 7 – After your meetings are through, sit down and go over all of the information you’ve obtained. Compare each candidate and choose one that best fits your ideal vision of what a physician should be to you.

If you have recently moved to a new city, finding a good local doctor is important. For more information, visit http://www.doctorreviewsonline.com.

Article Source: http://EzineArticles.com/?expert=Andrew_Stratton

1. International Accreditation

The Joint Commission International is a non-profit organization that sets the standards for the quality and safety of hospital services. Other certifying bodies are the International Organization for Standardization (ISO 9000) and the International Society for Quality in Health Care. Hospitals accredited by these organizations, as well as by their own national counterpart of these organizations, have gone through rigorous testing and are in strict compliance with the high standards of quality service and facilities.

2. Qualified Medical Practitioners

International hospitals employ doctors who have passed their board exams, either in their home country or abroad. Many doctors in medical tourism destinations have earned their degree and were trained in prestigious medicine schools in the United States or Europe.

3. No or Minimal Language Barrier Concerns

Good communication between patient and healthcare provider is a huge factor in expediting the treatment and recovery process. Your hospital of choice should have hospital staff that understand and speak your language or, at the very least, should have translation services provided by an international patient department. And you also have to remember that your medical records and any remarks coming from your physician back home are written in English.

4. Hospital Quality Indicators

Examples of these are the mortality rate, nurse-to-patient ration, and Staph (Staphylococcus) infection rate. Some hospitals publish these pieces of information on their websites, while others don’t so you need to call them to learn more about their indicators. Take these figures and compare them with one of the internationally-accredited medical tourism hospitals.

5. The Local Reputation

A good medical tourism facility nurses a good reputation as a healthcare provider with the locals who received medical care from it. If you have contacts in your choice of destination, ask them what people think of the hospital. They will most likely provide an accurate view of the facility, including those who have not received medical care from it.

Free Medical Tourism Guide

To find out more about medical tourism hospitals and which is right hospital for the medical treatment you are considering call Debson Medical at 1-877-900-3327 for a free, no-obligation consultation or visit the Debson website at: http://www.debsonmedicaltourism.com and download their popular free guide.

Debson Medical Tourism is a medical tourism facilitator specializing in the provision of medical health services, including pre- and post-operative care, care management, travel, and vacation planning.

Article Source: http://EzineArticles.com/?expert=Zoumanan_M._Debe

The Destination

India is often the most popular site for medical tourism because of its very competitive and comprehensive healthcare services being pegged at the cheapest of prices. Other Southeast Asian nations making waves in the health tourism business are Thailand, Malaysia, the Philippines, and Singapore. Closer to home are European countries who have recently broken into the business. Belgium and Spain are very well known for their cosmetic surgery industries, while France has long nurtured a reputation for weight loss and obesity treatments. It is imperative that you check the specialization of the country you wish to travel.

The Healthcare Facility

Getting medical treatment abroad entails that you make sure you receive treatment in an up-to-date and well-equipped medical facility. Renowned healthcare organizations issue accreditation certification for hospitals that meet high standards. The health and medical departments of most governments also have the task of overseeing that their hospitals and clinics are safe for the treatment of their people’s health. Be sure to arm yourself with information about the foreign healthcare facility where you wish to receive treatment.

The Medical Practitioner

Many surgeons, dentists, cosmetologists, and other medical practitioners who offer their services to foreigners were trained in the United States or the United Kingdom. Check if they are members of leading medical associations in these countries and in their home countries. It is also important that you meet with your chosen practitioner, either personally or through telecommunications technology, before you fly to the destination so you can consult with him and ask questions.

The Practicalities

If you are receiving medical treatment abroad, then you will need the proper travel documents and other essential items to allow you to travel and have a smooth and problem-free trip. A medical tourism facilitator often arranges all these for you, including passport and visa processing, scheduling flights, hotel reservations, local transportation, meals, and recreational activities. It’s also advisable that you familiarize yourself with the local customs of the country you are flying to, and other things we take for granted, such as the climate.

Free Medical Tourism Guide

To find out more about getting medical treatment abroad, we recommend you visit the Debson Medical Tourism website at www.debsonmedicaltourism.com and download their popular free medical tourism guide.

Debson Medical Tourism is a company specializing in the provision of medical health services, including pre and post-operative care, care management, travel, and vacation planning.

Article Source: http://EzineArticles.com/?expert=Zoumanan_M._Debe

Every EOB you contains information about services you received from that specific provider during a particular visit. A provider is anyone who supplies healthcare and/or other medically related services and products. A provider may be a physician, dentist, clinic, hospital, pharmacy, lab, physical therapists or other health care professional. Looking at your EOB, you should see the name of the provider or facility that filed the claim for reimbursement listed. A service is a procedure or product rendered by a provider to a patient. A service could range from a basic physician visit to radiology services to surgical care or medical equipment. The date on which you received services from a provider is called the service date.

Billed Amount

This represents the cost of the services you received and the amount the provider sent to your insurance company. It should be the largest figure on your EOB.

Network Discount

This is the amount by which a providers bill is adjusted as a result of a negotiated rate agreed upon between the provider and the insurer, and is not always listed on an EOB. This only applies to in-network providers.

Allowed Amount/Covered Amount

The allowed amount is the amount of payment a provider has agreed to accept for the service, treatment or product under the terms of a negotiated contract with an insurance company. This applies only to in-network providers. The allowed amount may also be the maximum amount the insurance company will allow for a specific service.

Insurance Amount/Paid

As you may have already guessed, this is the amount that your insurance company pays on a claim.

Deductible Amount

Your deductible indicates the portion of expenses that count toward your plan deductible and you are responsible to pay.

Patient Responsibility

This is the portion of the provider charges to be paid by the patient after the network discount, allowed amount, insurance portion and deductible amount have been taken into account. Basically, this is what you are expected to pay out-of-pocket for the services your received.

The Math

The key to understanding comes down to identifying four numbers: the provider charges (amount billed from doctor, hospital, etc.), the discount (which is based on the negotiated rate of your individual plan coverage), what insurance paid and patient responsibility.

The amount the provider sent to your insurance company as their “charge” or “billed amount” should be the largest figure on the EOB. Next, find and subtract the “discount” to arrive at the allowed amount, which is the amount your insurance company and your provider agree is the fair amount to be paid. If you do not have a discount amount displayed, simply locate the allowed amount on your EOB.

Now look at the amount your insurance paid. It can be anywhere from $0 to the full allowed amount. Subtract what the insurer paid from the allowed amount. What’s left is the patient responsibility. To double check the math, add together the amount the insurance paid and the patient responsibility, it should equal the allowed amount, sometimes referred to as the negotiated rate.

Remember, the patient responsibility may NOT be the balance owed to your provider, depending on if the insurance company reflects your payments already to the provider (such as co-pays, pre-payments and any other payments you have submitted). If payments you have previously made are NOT reflected on the EOB, you will need to subtract your payments from the patient responsibility amount to figure out the balance owed to the provider.

EXAMPLE:

Billed Office visit $155.00

Allowed Amount $ 93.03 (Network Discount $61.97)

Plan Pays $83.73 (Insurance Paid)

Patient Responsibility $ 9.30

Visit http://MedicalBillConsultants.com for more information and learn how they can advocate in your behalf with you medical providers.

Rich Davis is a partner with Medical Bill Consultants, Tarzana, Ca. Medical Bill Consultants provides medical bill review service to consumers of medical service who question the high bills they receive. Medical Bill Consultants works on a flat fee rather then a high contingency providing money back guarantee. Visit their site http://DiscountMyMedicalBill.com for more information.

Article Source: http://EzineArticles.com/?expert=Rich_Davis

These things range from laser eye surgery centers to wart removal centers and other things like that.

Before you use one of these places for which ever type of surgery you require, here are several questions you should ask the doctors involved before you have the surgery. In some cases these questions could very well save your life.

The first question to ask your doctor is whether or not they have hospital privileges to perform the procedure that they will be performing on you in the office center. Hospitals only grant hospital privilege to doctors who have undergone a lot of scrutiny. Generally speaking you only want to use a doctor who does have hospital privileges. Failure to have these privileges may be an important red flag for you to keep in mind.

The next question to ask is how many similar procedures has the doctor performed. Surgery is like anything else in life, the more often you do it the better at it you get. You should only use surgeons who have done the operation many many times in the past with successful results.

The next question to ask is whether or not the office is prepared for emergencies. At the very minimum the office should have a crash cart that is equipped with a defibrillator. Life support equipment is also a plus. When it comes to this sort of thing, more is obviously better.

The next question to ask is whether or not the doctor has an ongoing relationship with a specific ambulance company. This is important because especially in a large city, ambulance drivers have to be familiar with the location of the office in order to find it quickly. They also need to know the quickest routes from the office to the hospital and without an ongoing relationship they might not know it. Seconds count after all.

Finally you should ask whether or not the office has been accredited. Depending on the services they’re offering different agencies may be involved in certification and accreditation. Don’t be shy about asking to see these certificates of accreditation. Most doctors will have these hanging on the wall in the reception room anyway but it never hurts to ask and no doctor should feel bad about you asking.

So there you have several questions you should ask your doctor before having surgery in an off hospital facility of any kind. When it comes to this sort of thing, the more questions you ask the better because this is your health we are talking about, and nothing is more important than that.

J.P. Morton has been an article writer online for well over 10 years. When he’s not writing articles, he has a good time running a stainless steel grills web site where he also reviews tec gas grills for your grilling use.

Article Source: http://EzineArticles.com/?expert=J._P._Morton

The debate on healthcare reform today revolves on how they could fix the waste in hospitals, doctor delivery, etc. But there is evidence to suggest that nothing is going to get fixed till the people who are requesting healthcare, the patients, have a direct stake in how much costs. The very best evidence of this I heard was from Steve Forbes (wouldn’t you know). Now I do not agree with Steve Forbes all the time but this is simply an observation he made. There are at least 2 healthcare areas where people have to pay as they go and shop by price and value.  One of the areas is plastic surgery and one is Lasik. I did the research on Plastic Surgery and low and behold the average procedure had an inflation rate between 2001 and 2007 is around 2%. That’s right 2% during a period where standard healthcare costs are rising annually over 10%.  I’ll bet you will find the same low inflation rate in Lasik.  Why are these two areas cost controlled so well? The main difference from your family physician is that the patient has to pay directly for these two procedures out of their own pocket.  Because of this people vote every day with their dollars for better outcomes with less cost. And MOST of the outcomes of the 1000’s of procedures done every day are just what the patient wanted.

There is a second significant difference between those to areas of medicine and the mainstream illness areas, those two items are fully discretionary.  You don’t have to have them to survive.  It is for that reason that we have the desire to fund healthcare for everyone.  It is also for that reason that I am not advocating we should go to a fully personal pay healthcare system.  What I am advocating, from the evidence, is somehow creating an individual stake in the cost.  Patients need to CARE how much it costs when they select a Doctor, Hospital or procedure and make good value decisions on that basis.  Patients can be trusted to make good decisions most of the time. And the collective intelligence of our entire country will then be turned to fixing the problems because everyone needs healthcare and every time they need it they will be focused on getting the most efficient and effective care.

Here is the evidence:

From http://www.ineed2know.org/plastic-surgery-costs.htm I got the average 2002 costs.

From www.boardcertifiedplasticsurgeon.com/cosmetic_surgery_costs.html for the 2007 costs.

I selected just a few of the very frequently used procedures, reported are the Doctors cost.  There are far more of all of the procedures done in 2007 than in 2002. One of the issues reported as a cause of the tremendous healthcare cost rise is much more demand stressing hospitals and doctors. Well, there’s lot’s more demand here and the average inflation of these procedures appears to be just about what the average national inflation rate has been.

2002 Eyelid Surgery was $2,455 average cost and in 2007 it was $3,134, an annual inflation of 4.6%.

2002 Breast Augmentation was $3,436 and in 2007 it was $3,816, a mere 1.8% inflation rate.

Botox in 2002, $422 in 2007, $501 an annual increase of 3.1%.

Breast Implant Removal, $2,084 vs. $2,380 for 2.4%.

Finally a Face Lift actually showed a negative 1% inflation, 2007 cost was more than 6% less than 2002.

Again I’m not saying that we should completely go to a no insurance pay as you go but I am saying that if we all had a stake in the cost of our healthcare we would vote EVERY DAY for better outcomes and less money and low and behold we would get it.

About The Author

Our government has recognized that it is very important to care for its elderly citizens. That is the reason why Medicare health insurance was created. Anyone age 65 or older is eligible for this government health care plan. For many that are eligible, Medicare can be very confusing because it has many parts.

To put it simply, Part A covers any costs for impatient hospital care. Most of those who pay Medicare taxes from paychecks receive Part A for free and automatically.

Part B includes some doctors’ services and outpatient care-but it is not free. Part B requires a minor monthly premium.

Part C deals with various health care options, like HMOs, that are approved by Medicare but are not related. Part C allows for a private insurance company, through a government contract, to reside over all of your Medicare benefits. Part C also requires additional costs that can vary widely.

Part D was created to cover prescription drugs. This plan is controlled by private companies that are Medicare-approved. It is also optional and costs more money.

The “original” Medicare plan was comprised of only Parts A and B. Later, the “advantage” plans of Parts C and D were added, and with a higher cost. Parts C and D had to be created because parts A and B did not pay for everything.

Medicare has created Medicare supplement plans to ensure that all costs can be paid and it is a type of private insurance. Most of the costs these plans cover are deductibles and co-payments that can add up very quickly for seniors on fixed incomes. The supplement plans have been termed “Medigap” because the plans were created to cover the “gaps” in costs for procedures that are not always included in Medicare. Medicare supplement insurance is standardized and regulated by the U.S. government. You can obtain a supplement plan through insurance companies and you must choose which insurance company you want by the price of their supplement plan. This is true because each plan covers the same things-no matter what insurance company you receive it through.

“Medigap” insurance is regulated by the Federal government and insurance companies must also follow state laws. Due to different laws, the plans can vary slightly state by state. To add to the complexity of Medicare, there are 12 different types of standardized Medicare supplement insurance. They are designated letters of A through L, so it can take a great amount of time to figure out which supplement plan fits your needs.

Sadly, many Americans do not receive health insurance. This dilemma is often due to high insurance rates and prolonged, or even small, illnesses that can clean out an underinsured person’s savings. This results in medical bills that may never be paid off. The key is to have a plan in these situations. Even with the outrageous healthcare costs in this country, it is vital to plan properly if you were to need medical attention. No insurance that is truly affordable will ever be able to cover all healthcare costs. So, you must evaluate your circumstances and your anticipated needs. Due to the fact that medical needs may come up suddenly, it is recommended that you obtain Medicare supplemental insurance.

About The Author

Tom Carolan

Buying Shopping for health insurance can leave many people confused. Knowing which insurance company to choose or which insurance plan is the best may seem daunting impossible. But once you know the basics of health insurance, choosing the right health insurance plan is simple easy.

This article will provide some of the most basic and helpful tools and explanations for health insurance shoppers. First, it is important to learn about helps to understand the different types of health insurance plans and their benefits and drawbacks. Plans differ in the amount you pay out-of-pocket, which doctors you can visit, and how the your insurance bills are paid. Besides just helping you choose the most efficient and cost-effective plan, we’ll teach you about another way you can save on health insurance: a Health Savings Account. Additionally, it is important to learn about dental insurance as well. Many health insurance plans do not include dental insurance under their benefits, so we’ll go over how to shop for and obtain separate dental coverage. Then it is important to learn about ways you can save on health insurance. There are several ways you can save including Health Savings Accounts and Discount Cards. LastlyAnd finally, don’t forget to compare plans before you make your decisionwe’ll explain why it’s so important to put your new knowledge to good use by comparing health insurance plans.

Types of Health Insurance Plans

Health Maintenance Organization (HMO) Plans

Generally, HMOs have low or even no deductible and the co-payments will be relatively comparatively low as well. You pay a monthly premium that gives you access to coverage for doctor appointments, hospital stays, emergency care, tests, x-rays and therapy. You will have to choose a primary care physician (PCP) within your insurance provider’s network of physicians, and in order to see a specialist you need to receive a referral from your PCP. Under an HMO plan, only visits to doctors and hospitals with the insurance company’s network of providers are covered; you’ll have to pay for visits if you go to an out-of-network doctors or hospitals your insurance will not cover the costs.

Preferred Provider Organization (PPO)

Plans Under a PPO plan, you will use the insurance company’s network of doctors and hospitals for any services or supplies you need. These healthcare providers have been contracted by the insurance company to provide services at a discounted rate. Generally, you will be able to choose doctors and specialists within this network without having to choose a primary care physician or get a referral. Before the insurance company will start paying for your medical bills you will usually need to pay an annual deductible. Also, you may have a co-payment for some services or be required to cover a percentage of the total medical bill.

Point of Service (POS) Plans

A POS plan is a combination of the features offered by HMO and PPO plans. You are required to choose a primary care physician, whose services are not usually subject to a deductible, but your PCP can refer you to out-of-network specialists whose services will be partially covered by your insurance company. Additionally, POS plans usually offer coverage for preventive healthcare, which includes regular checkups. Your PCP will be able to give you referrals for any specialists. If these specialists are out-of-network you will need to pay out-of-pocket and then apply for reimbursement from the insurance company. With a POS plan you will benefit from some of the savings of an HMO and will have greater flexibility in choosing healthcare providers, similar to PPO.

Dental Insurance

It is important to get a dental insurance plan along with your health insurance plan. In order to keep your teeth and gums health you need regular visits to the dentist. Without dental insurance, the cost of dentist appointments will be much higher making it difficult to keep up with the payments. Dental insurance is similar to health insurance in that each month you pay a premium, which entitles you to certain dental benefits. Benefits include checkups, cleanings, x-rays, and other dental services. There are plans that may cover dental implants, oral surgery and orthodontia, but they will be more expensive. Like health insurance, plans are categorized into indemnity and managed-care plans. If you choose an indemnity plan you will have a broader choice of dental care providers to choose from. You won’t have to choose one primary dentist and generally, you won’t need to acquire referrals. In order for the insurance company to cover your dental expenses you will need to send them a claim before they reimburse you for covered services. As a result, you will have to pay more out-of-pocket with an indemnity plan, but you will have more flexibility in choosing which dentists you visit. On the other hand, managed-care plans will provide you with a dental provider network and you will need to visit dentists within this network in order to get coverage for these services. With a dental care network, the insurance company has arranged pre-negotiated rates that you will receive when you visit these dentists. With a managed-care plan, the dentists will submit the claim for you, lowering your out-of-pocket expenses.

Save on Health Insurance

Health Savings Account

Health Savings Accounts (HSA) are tax-free savings accounts designed to help consumers pay for healthcare services while limiting premium expenses for unwanted benefits. The plans have lower premiums and higher deductibles than other insurance plans because they offer fewer benefits and require you to use the money in your HSA to pay for certain qualified medical services. However, if you don’t need to visit the doctor frequently and don’t anticipate requiring regular medical attention, HSA plans are a cost-effective method of insuring against the worst without paying for coverage you won’t use. In order to open an HSA, you’ll need to have an HSA-compatible health insurance plan. You may only use the funds in your HSA to pay for qualified medical expenses. Usually, your HSA plan will have a deductible that, once met, requires your insurance company to pay for any additional qualified medical expenses for the rest of the year.

Dental Insurance

Health insurance typically does not cover dental services, but in order to keep your teeth and gums healthy, you need regular visits to the dentist. Without dental insurance, regular dentist appointments can prohibitively expensive. Make sure your mouth is covered by shopping for both health and dental insurance. Dental insurance is similar to health insurance in that each month you pay a premium, which entitles you to certain dental benefits. Benefits include checkups, cleanings, x-rays, and other dental services. There are plans that may cover dental implants, oral surgery and orthodontia, but they will be more expensive. Like health insurance, plans are categorized into indemnity and managed-care plans. If you choose an indemnity plan you will have a broader choice of dental care providers to choose from. You won’t have to choose one primary dentist and generally, you won’t need to acquire referrals for special services. In order for the insurance company to cover your dental expenses you will need to send them a claim for reimbursement. You’ll end up paying more out-of-pocket with an indemnity plan, but you will have more flexibility in choosing which dentists you visit. By contrast, managed-care plans limit you to the doctors and services within a dental services network, and you will need to visit doctors within this network in order to get coverage for their services. Within the dental care network, your insurance company has arranged pre-negotiated rates that you will receive when you visit dentists in the network. Your dentist will submit your insurance claim for you, keeping your out-of-pocket expenses lower than with an indemnity plan.

Compare the Plans

Comparing insurance plans is an important step in buying health insurance. It will save you money in the long run if you take the time to compare premium prices, out-of-pocket costs, plan benefits, the network of physicians available with different plans, and the quality of insurance providers. If you have a favorite physician, make sure your health insurance covers visits to him or her. If you don’t need to see the doctor very often, don’t pay a high premium for low office visit copayments. Health insurance plans are designed to address specific healthcare needs, and you’ll save money and get the most effective coverage by comparing plans to find the health insurance plan that best fits your budget and lifestyle.

About The Author

Julie Madison

Florida has got a boom in Medical and health care facilities within state. It has hundreds of fantastic medical centers, high level of services in medical and world class care facilities. Through modern equipments and state of the art technologies medical centers are providing the best health care to the people in the state Florida. Furthermore it has medical and bio tech industries throughout its metropolitan areas.

Medical Centers should have:

* Medical centers facilitating in almost all types of diseases and medical problems.
* Proper health care resources addressing different aspects of health and medical facilities are governed by the government.
* Medical Centers are equipped with up-to-date laboratories and imaging facilities.
* Instant Medical Care is one of the good Health Care Providers and providing their services in almost all major hotels and theme parks and important locations.
* The doctors and providers are highly educated and well trained.

Health Care Facilities:

* Ambulances have the preliminary medical equipment and first aid medications.
* Patient safety and Risk management plans in the hospitals and care units are enforced by the government.
* HIPAA laws are also enforced in different aspects of caring the patients.
* Mobile clinics are also operating and equipped with most of the desired facilities.

Medical Insurance:

* There are several organizations working in the field of health insurance.
* Florida’s health insurance plans are little complicated and sometimes are difficult to obtain.
* The health insurance plans are normally comprised of two major categories; Individual and Group health insurances.
* There are some new health insurance reforms and as these will be implemented these will for sure facilitate the small employers and older people.

Two categories of people are eligible: those “automatically” eligible, which means coverage is free and they don’t have to pay a premium; and those who must pay a monthly premium. People in either category must be a citizen or legal resident of the United States and at least age 65 or disabled. Those who are age 65 or older and eligible for Social Security, Railroad Retirement or civil service retirement, or dependents or survivors benefits are eligible for Medicare Part A without paying any premium. People who are under age 65 but have been eligible for Social Security disability benefits for 24 months or who have permanent kidney failure are also eligible for free Part A coverage.Those who aren’t eligible for free Part A coverage at age 65 can buy into Part A by paying a monthly premium. For someone who has 30 to 39 Social Security or civil service work credits, Part A coverage costs $244 a month; for those who have fewer than 30 work credits, Part A costs $443 a month. You can find out how many credits you have by checking the annual earnings record Social Security sends you or by going online at the Social Security website.

Almost all care provided by hospitals is covered by Part A. This includes:

• A semi-private room (or a private room if it’s medically necessary or if a semi-private room isn’t available)
• Special care units (like intensive care and coronary care)
• Operating room charges
• Nursing services (though not private-duty nursing)
• Drugs, supplies, and appliances provided in and by the hospital
• Special treatments (like radiation and chemotherapy)
• Lab and diagnostic tests (like X-rays and CAT scans)
• Rehabilitation (physical, speech, and occupational therapy)

Remember, though, that being “covered” doesn’t necessarily mean medical expenses will be fully paid. Most participants will still have significant hospital costs that Part A doesn’t pay.Part A doesn’t cover care from doctors who treat patients in the hospital. Those doctor bills — such as from a surgeon, radiologist, oncologist, or primary care physician — are covered instead by Medicare Part B. Nor does Part A cover emergency room care; that, too, is covered under Part B.If travelling abroad, be aware that Part A covers care only in hospitals in the United States, including Puerto Rico, the U.S. Virgin Islands, Guam, and American Samoa. Even emergency hospital care while traveling outside the country isn’t covered.There are some hospital inpatient costs Part A doesn’t cover. Private-duty nurses or a private room aren’t covered unless they’re ordered by a doctor who deems them medically necessary. And personal convenience items, such as television and telephone, aren’t covered if the hospital bills them separately.Finally, it’s important to recognize that Part A pays only for medically necessary care, and only if it must be delivered on an inpatient basis. In other words, if you could receive the same treatment in a doctor’s office or an outpatient clinic, Part A might not pay for it in the hospital. Likewise, there’s no coverage for elective surgery. Also, even if Part A covers a hospital stay, it might stop coverage if you remain there after the hospital is ready to discharge you — if, for example, because no one has arranged care for you at home.

One of the most common mistaken ideas about Medicare is that it pays for long-term nursing home care. It does not. Medicare Part A covers only short-term skilled nursing or rehabilitation facility inpatient care, and only under very limited circumstances. It also covers limited stays in a psychiatric facility.For patients who require a stay in a skilled nursing or rehabilitation facility, strict rules apply for Part A coverage. For example, within 30 days prior to entering the nursing or rehab facility, a patient must have had a hospital stay of at least three days. A doctor must certify that the patient needs daily, skilled nursing care or rehab services, and, even then, coverage lasts only as long as that daily skilled care is needed to recover. For each hospitalization, there’s a maximum of 100 days nursing or rehab facility coverage.Inpatient care in a psychiatric facility is also limited under Part A. Participants have a lifetime coverage total of only 190 days in a mental health care facility. Care for psychiatric or other cognitive problems for an inpatient in a regular hospital, though, is subject to regular Part A hospital coverage limits, not this special 190-day total.

Hospice is specialized care for someone who’s in the late stages — a prognosis of six months or less — of a terminal illness. Hospice focuses on maximizing comfort and quality of life during the patient’s final days. Once someone chooses hospice care, it means he or she gives up treatment for the terminal illness or condition. Hospice care is usually delivered at home, with specially trained nurses and aides providing maximum pain relief and close attention to patient comfort. If a doctor certifies that a patient is eligible for hospice and he or she chooses it, Part A will pay for the care provided by a Medicare-certified hospice.

If a patient spends at least three days in the hospital, Part A will cover home healthcare for a short time after discharge. (Without that hospital stay, short-term home care can be covered by Medicare Part B. Part A covers home care only if, and as long as, a patient is confined to home and needs part-time skilled nursing care or physical or speech therapy. If a patient only needs someone to help with daily activities — like bathing, dressing, eating — Part A won’t cover home care. If a patient qualifies for part-time nursing or therapy, Part A can also cover some additional help from a part-time aide, as well as medical supplies and equipment. Care must be provided by a Medicare-certified home health agency, and individual caregivers aren’t covered.

For home care, Part A pays 100 percent of the agency’s charges, except for durable medical equipment — like rental of a wheelchair or hospital bed — provided by the home care agency, for which Part A pays 80 percent.

If at age 65 you meet eligibility requirements, Medicare will automatically enroll you in Part A. Medicare will send you an enrollment card and information two to three months before your 65th birthday.If you aren’t already receiving Social Security or other retirement-related benefits when you turn 65, you can enroll in Medicare Part A at any local Social Security office. If you delay enrolling after you turn 65, your coverage will be retroactive to six months before the month when you do enroll (though not earlier than your 65th birthday). If you’re eligible to enroll because of disability rather than reaching age 65, your coverage is retroactive for a year from the date of enrollment.

Medicare Part A is run directly by the federal government’s Centers for Medicare and Medicaid Services (CMS), part of the Department of Health and Human Services. Its website provides information about Medicare Part A, and staffers answer questions by phone at the toll-free number, 800-633-4227. If you are already in the hospital, contact the hospital’s ombudsman, who’s trained in Medicare issues and whose job is to help patients sort out problems.

About The Author

Joseph L. Matthews