Medicare Covergage: What You Need to Know

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.