The realm of potential socialized health care has been under great
debate over the last few years, particularly with the new bill that
passed in congress on Christmas Eve, 2009. But, our great nation has
tried tirelessly to provide for the young and old, healthy and ill, and
that is where Medicare comes into play. It is a government administered
social insurance program, signed into law in 1965 by President Lydon B.
Johnson, with the first Medicare beneficiary being former President
Harry S. Truman, present at the bill signing ceremony. The program is
complex, but intended for United States citizens who are seniors (those
over 65 years of age), under 65 but with disabilities, have end stage
renal disease and may need a kidney transplant, or have Amyotrophic
Lateral Sclerosis (also known as ALS or Lou Gehrig's disease). The
original plan included two parts, but more have been added on in recent
years.
Part A
Medicare Part A covers inpatient overnight hospital stays, including
semiprivate rooms, doctors fees, food, and tests. It will also cover a
maximum of 100 days in a skilled nursing facility, or hospice facility.
The first 20 days are covered completely by Medicare, while the
remaining 80 days require, as of 2009, a co-payment of $133.50 per day.
Part B
Part B Medical Insurance covers (generally) outpatient services and
supplies, including x-rays, diagnostic tests, chemotherapy, etc. Part B
also covers medical equipment, such as walkers and wheelchairs. This
part of Medicare is optional if the beneficiary or the spouse is still
working, but there is a large fee if the plan is deferred and the
beneficiary or spouse is not actively working.
Part C: Medicare Advantage Plans
The Balanced Budget Act of 1997 gave Medicare beneficiaries the option
of getting their health care provided by private insurance companies,
thus Part C came into existence. It combines Part A and Part B, adding
in coverage of prescription drugs, dental and vision care. Traditional
Medicare has a standard benefit package that any member can get from any
hospital or doctor in the country. For those that opt for the Advantage
Plan, Medicare pays a standard amount to a private insurer for every
member every month, and this is often combined with monthly premiums
from beneficiaries.
Part D: Prescription Drug Plans
Going into effect January 1, 2006 due to the Medicare Prescription Drug,
Improvement, and Modernization Act, prescription drugs are now covered
by Medicare. Anyone with Part A or Part B is eligible for Part D. A
person with Medicare, to receive this benefit, must enroll in a
stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan that
happens to have prescription drug coverage (MA-PD). The Medicare
program regulates and approves these plans, but they are actually
designed and administered by private health insurance companies. Part D
coverage is not standardized like Original Medicare (Part A and Part B).
Private companies get to choose which drugs to cover, which to provide
at no cost, and some choose not to cover certain drugs what so ever.
Medicare specifically excludes benzodiazepines, cough suppressant and
barbiturates from coverage, so private plans that include coverage of
these are not included in Part D Medicare Provisions.
