Medicare is the primary medical insurance for enrollees except where Congress has legislated otherwise. Part A provides basic protection against the costs of a hospital stay, post-hospital care in a nursing home, home health services, and hospice care. This should not be an issue for Medicare enrollees since the coverage terms did not change. The Part B deductible and co-pay do not apply to home health care services. This criteria pushes care to the least expensive site, e.g. a nursing home rather than a hospital.
Custodial care is a major exemption from coverage.
Enrollment in Medicare Part A does not require a premium payment, unless the individual age 65 and older lacks the connection to the Social Security system needed for automatic enrollment. For lower income individuals, the state Medicaid programs may pay this Medicare Part A enrollment premium. Medicare benefits are available until death or for up to two years after the end of disability. These entities are insurance companies that have contracted to administer the Medicare claims process for particular benefits on a regional basis. Medicare does not have a prior approval process for determining coverage before service delivery.