Coverage while traveling… Alzheimer’s screenings… Psychiatric hospital care…
Dear Marci,
It’s hard for me to move around the house in my wheelchair, and I want to widen some of my doors. Will Medicare pay for this?
—John
Dear John,
No. Medicare will not pay for modifications to your home, such as those improving wheelchair access, like installing ramps or widening doors. Also, Medicare will not cover items such as stairway elevators, grab bars, and bathtub and toilet seats. These items improve your ability to function in the home, but Medicare does not view them as meeting a medical need.
Medicare will, however, cover durable medical equipment (DME)—equipment that primarily serves a medical purpose, is able to withstand repeated use, and is appropriate for use in the home. DME includes items such as wheelchairs, oxygen equipment and hospital beds.
—Marci
Dear Marci,
I’m taking a road trip across the United States this summer. Will Medicare cover me while I’m traveling?
—Rose
Dear Rose,
If you have Original Medicare, you can travel anywhere in the U.S. and its territories (this includes all 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa and the Northern Mariana Islands) and get the medical care you need from almost any doctor or hospital. If you have a Medicare private plan (such as a Medicare HMO or PPO), you will generally only be covered for care within your plan’s service area unless you need emergency or urgent care while out of that service area.
Medicare does not cover medical care you get outside the country, except in specific instances. However, some supplemental coverage policies (known as Medigap plans) and Medicare private plans offer coverage for emergency services in a foreign country. Call your plan to find out if you are covered while traveling outside of the United States.
—Marci
Dear Marci,
I am the primary caregiver for my mother, but I will be out of town for a few days next month. Will Medicare pay for my mother’s care while I am away?
—Bernard
Dear Bernard,
Medicare will pay for respite care (a rest for caregivers) only if your loved one has a terminal illness and qualifies for the hospice benefit.Under the Medicare hospice benefit, your loved one can get respite care in a Medicare-approved hospital or skilled nursing facility for up to five days at a time. Medicare will pay 95 percent of the Medicare-approved amount for respite care.
—Marci
Dear Marci,
Does Medicare cover screenings for Alzheimer’s and dementia?
—Sun
Dear Sun,
Yes. Medicare will cover medically necessary doctor visits and laboratory tests needed to diagnose any suspected disease or condition, including dementia or Alzheimer’s disease. Some methods to diagnose dementia or Alzheimer’s disease may include:
• Consultations with a primary care physician and possibly other specialists
• A mental status evaluation to assess your cognitive capabilities
• A physical examination
• A brain scan to detect other causes of dementia such as stroke
• A psychiatric evaluation
• A positron emission tomography (PET) scan to evaluate the cause of memory disorders that cannot be determined from any other diagnostic test
Medicare will cover 80 percent for your initial mental health visit, 80 percent for medication management and 55 percent for ongoing mental health treatment, such as psychotherapy.
—Marci
Dear Marci,
I heard that Medicare will stop paying for care in a psychiatric hospital after a certain number of days. Is that true?
—Evelyn
Dear Evelyn,
Yes. Medicare helps pay for inpatient mental health services in either psychiatric hospitals (hospitals that treat only mental health patients) or in general hospitals. Your doctor will determine which hospital setting you need.
If you receive care in a psychiatric hospital, Medicare helps pay for up to 190 days of inpatient care in your lifetime. After you have reached your 190-day limit, Medicare may help pay for mental health care at a general hospital.
Your out-of-pocket costs are the same in a psychiatric hospital as they are in any hospital. If you enter a psychiatric hospital within 60 days of being an inpatient at a different hospital, you are in the same benefit period and do not have to pay the deductible again.
—Marci
Dear Marci,
I have not worked long enough to get Social Security benefits, but my wife has. Does her work history qualify me for premium-free Medicare Part A?
—Theodore
Dear Theodore,
It depends on your situation. If you develop a disability before the age of 65, and do not have enough work history, you cannot qualify for Social Security Disability (SSDI) based on your spouse’s work history.
When you turn 65, you may be eligible for free Medicare Part A based on your spouse’s work history if:
• You are currently married and your spouse is eligible for Social Security benefits (either retirement or disability). You must have been married for at least one year before applying.
• You are divorced and your former spouse is eligible for Social Security benefits (either retirement or disability). You must have been married for at least 10 years and you must be single.
• You are widowed and you were married for at least nine months before your spouse died. You must be single.
To date the federal government does not recognize domestic partners (neither opposite-gender nor same-gender) as spouses. Therefore, you cannot be eligible for Medicare based on the work history of a domestic partner.
Because Social Security and Medicare eligibility rules are complex, and there are some exceptions to the rules listed above, you should call Social Security at 800-772-1213 or, if you are a railroad worker, contact your local Railroad Retirement Board field office to get the most accurate information regarding your particular situation.
—Marci
Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To speak with a counselor, call (800) 333-4114.
