What is Medicare?

Medicare is the national health insurance plan for seasoned citizens (those being sixty-five years of age and up). However, the age limit is not set in stone as there are certain people below the age of sixty-five that can receive Medicare benefits if they have qualified disabilities/illnesses; some of which include Lou Gehrig’s Disease and End Stage Renal Disease (ESRD). Medicare is a great system that provides the elderly with financial aid and security in their declining years. The Centers for Medicare and Medicaid Services (CMS) is the federal agency that administers Medicare and provides approximately 40 million Americans with this coverage.

Medicare breaks down into two broad sections simply known as Medicare Part A and Medicare Part B. Medicare Part A more specifically is known as hospital insurance and Medicare Part B is known as medical insurance. In Part A, one is covered for inpatient hospital care, critical access hospital care, hospice care (a special way of caring for people who are terminally ill, and for their family; it includes physical care and counseling, skilled nursing facilities, and some home care). Part B covers most things that Part A does not extend to such as doctor bills, lab fees, x-rays, supplies that are medically necessary, and physical therapy.

The Medicare system practices good risk management in that they take measures of prevention. Preventative care costs are covered through the Medicare policy (e.g. mammography for breast cancer screening, pap smears for cervical cancer screening, tests for colorectal cancer screening, bone mass measurements for osteoporosis, diabetes self-management and blood glucose monitoring, and flu and pneumonia vaccinations). Catching problems before they occur not only is healthier for the patient, but is also more cost efficient for the government. The surgeries, treatments, consulting, and prescriptions that are needed for example a cancer patient, can run into the hundreds of thousands of dollars, however if that person were to get tested and find cancer cells before they mutate more, they can be eradicated quickly for maybe only a few thousand dollars.

The wonderful thing about Medicare Part A, is the fact that for most people about sixty-five years of age, it is now free. Free meaning Medicare taxes were already taken out of their paychecks during their working career. If you are over the age of sixty-five, and are either receiving, or are eligible for Social Security, or Railroad Retirement Board benefits, then you do not have to pay anything for Part A coverage (in some cases, people may have to pay for Part A). The cost of Part B is relatively low at $66.60 per month for 2004. Everyone who is eligible for premium-free Part A coverage, automatically qualifies for Part B coverage.

There are different ways to receive benefits through Medicare. There is the Original Medicare Plan, a pay-per-visit health plan that patients to go to any doctor, hospital, or other health care provider who accepts Medicare (however they are susceptible to a deductible). Medicare pays its share of the Medicare-approved amount, and the patient pays the remaining share (coinsurance). Medicare + Choice Plan (Medicare Plus Plan) is a health plan offered by a private company and approved by Medicare. The two types of Medicare + Plans are a Medicare managed care plan and a Private Fee-for-Service plan.

In addition to just Medicare, there is Medigap (Medicare Supplemental Insurance) that most people get along with their Medicare policy. Medigap is sold by private insurance companies and they fill "gaps" in Original Medicare Plan coverage. There is also Medicaid which is actually a joint federal and state effort (that may vary state by state) to help offer benefits to families that have low income and/or limited resources. Lastly, there is long-term care which can be considered as a “variety” of services that help people who are chronically ill or diseased. These people may need help with health or personal needs and activities of daily living over a period of time. Long-term care can be provided at home, in the community, or in various types of facilities, including nursing homes and assisted living facilities. Most long-term care is simply custodial care and Medicare does not pay for this type of care. These other programs are few of the many that were created to facilitate people of all needs.

Despite all benefits mentioned, Medicare does not cover the following: acupuncture, dental services, cosmetic surgery, hearing examinations, hearing aids, physical exams, eye exams, dentures, custodial care, convenience items, over-the-counter drugs, services rendered by relatives.