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Medicare Information

Medicare is a federal health insurance program.  The Social Security Administration enrolls people in Medicare and provides information on Medicare.  Medicare is available to people sixty-five years of age or older, regardless of income, to adults of all ages with permanent disabilities who receive Social Security Disability (SSD) benefits (not SSI) and to people who have permanent kidney failure.

The Health Care Finance Administration (HCFA), which runs the Medicare program, automatically mails Medicare cards to individuals with disabilities 24 months after SSD payments begin.  Any person eligible for Medicare Part A is automatically enrolled in Part B.  Part B has a monthly premium charge, but you may stop Part B if you do not choose to pay the monthly charge.  Both parts A and B have deductibles, co-payments, and co-insurance payments.

Part A - Hospital Insurance
Hospital insurance that pays for inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care.

Part B - Medical Insurance
Medicare medical insurance that helps pay for doctor services, outpatient hospital care, durable medical equipment, and some medical services that are not covered by Part A.   Durable Medical Equipment is medical equipment that is ordered by a doctor (or, if Medicare allows, a nurse practitioner, physician assistant, or clinical nurse specialist) for use in the home.  A hospital or nursing home that mostly provides skilled care can not qualify as a home in this situation.   These items must be reusable, such as walkers, wheelchairs, or hospital beds.   DME is paid for under both Medicare Part B and Part A for home health services.

Some examples of durable medical equipment under Part B:
  • wheelchairs
  • hospital beds
  • walkers
  • oxygen equipment
Some examples of medical services and supplies:
  • home health care
  • speech, physical and occupational therapies
  • surgical dressings
  • splints and casts

Assistive technology (AT) devices or services are not specifically listed as health care benefits under Medicare. However, some benefits provided under Medicare may include AT devices and services.

Under Medicare Part B, an AT device may be covered if it is "medically necessary" as prescribed by a physician, considered by Medicare as durable medical equipment (including wheelchairs), medical equipment, and supplies a prosthetic device.   An AT service could be covered under Medicare Part B, if it is "medically necessary" health care, which would include care given by physical, occupational, or speech therapists or home health care providers.

Medical necessity must be documented by the physician's prescription and improve the individual's condition or restore functioning and be part of a treatment plan directly related to the individual's diagnosed medical condition.  An evaluation or assessment of the individual's AT needs is a critical part of the documentation required to receive AT funding.  The evaluation must look at the individual's needs from a medical perspective, should recommend AT that will improve the individual's condition or ability to function, and be the basis for the physician's prescription.  Language in the documentation must focus on the medical necessity for AT, should use Medicare terminology when possible, and discuss diagnostic and functional criteria.

Payment: Medicare generally pays 80% of the "reasonable cost" of any medical service including AT devices and services.  The easiest way to receive Medicare payment for an AT device or service is to have your physician or health provider file the Medicare claim.  If the claim is denied, there are strict time lines for appeals.  Call the Medicare Hot Line (see below) to get information on how to appeal.

Additional Information:

Dept. of Health and Human Services, Social Security Administration

Baltimore, Maryland 21235    (800) 772-1213

Medicare Hot Line (for appeals)   (800) 638-6833

Medicare Part A Information   (800) 848-0106

Medicare Part B Information   (800) 542-4250