Medicare is a federal health insurance designed for American citizens or
permanent residents whom are sixty-five and older, with a few notable
exceptions. American citizens with end-stage renal disease (failing
kidney), amyotrophic lateral sclerosis (ALS) or other disabilities may
qualify to Medicare assistance. Anyone who has paid Medicare taxes,
usually through income taxes, for at least ten years is automatically
eligible for Medicare after turning sixty-five. Those eligible to
receive Social Security disability benefits prior to turning sixty-five
are also qualified for Medicare. Enrollment in the program is free for
the first seven months following sixty-five and fees are incurred
thereafter.
Medicare is funded by a federal trust fund, paid for by Americans are
charged 2.9% of their adjusted gross income. However, generally the 2.9%
is split between employer and employee so as each party pays 1.45%;
self-employed laborers or independent contractors usually deduct half
the 2.9% on their income taxes.
Medicare is split into four basic sections: A, B, C, D.
Medicare Part A is also designated as Medicare Hospital Insurance (HI).
It is, in the professional vernacular, “premium-free.” Former tax-paying
Americans, or Americans with tax-paying spouses, are automatically
eligible after turning sixty-five.
Medicare Part A covers inpatient hospital care in health centers such as
critical access hospitals, nursing facilities, long-term hospitals and
home health care centers. The caveats stack up high, however. Inpatient
hospital stays cover supplies, equipment usage fees, a semi-private
room, meals etc. Posh amenities like room telephone lines or
private-duty nursing is not included. Medicare only pays for home health
care if the agency is certified and the patient shows continual
improvement. Morbidly, terminally ill patients in hospice care must
prove they have less than six months to live.
Medicare Part B is labeled “Supplementary Medical Insurance.” Users pay a
monthly fee ($96.40 in 2009) and must meet an annual deductible
($135.00). For the money, patients are covered by twelve standardized
plans under Federal law – theoretically. Not all states offer all twelve
programs and not all providers offer all available plans in their
respective states. Generally, those under Medicaid’s insurance do not
need Part B.
Medicare Part B covers two types of services: those designated as
medically-necessary and those labeled as preventive services. Medically
necessary services are those required to diagnose or treat a condition
and those to meet required medical standards. Preventive services are
used for those conditions in which early diagnose and treatment is
likely to get the best response, such as treatments for HIV, Hepatitis
B, diabetes and breast cancer.
Medicare Part C masquerades until several different names: Medicare +
Choice, Medicare Advantage, MA Plans, etc. Part C helps patients get a
personalized plan under the provision of private insurance providers,
such as Health Maintenance Organizations (HMOs), Preferred Provider
Organizations (PPOs), Special Needs Plans (SNPs), and more. A Medicare
Part C plan covers all services usually covered by Part A and Part B,
and may cover extra amenities. But as the economists say, “TANSTAFL:
there are no such things as free lunches.” A Medicare Part C plan is
paid by the Part B premium plus an extra monthly premium for
out-of-pocket expenses.
The finale: Medicare Part D, alias Prescription Drug Plan, enacted in
2003 and in affect as of January, 2006. To qualify for a Part D program,
a patient must be enrolled under Part A and/or Part B, or Part C. Part D
offers two prescription drug coverage programs: PDPs and Medicare
Advantage Plans. Both programs pay for prescription drugs. Initial
coverage extends to $2,830. The patient then strikes out on his own
until $4,550 is reached, in which Medicare foists the most of the
financial burden onto its own shoulders. These plans are administered by
private insurance companies, and are paid for by a monthly premium and
annual deductible.
Medicare is a befuddling labyrinth and an expensive government hobby.
But feed Medicare well, and it usually returns the favor. That’s why 44
million seniors have it; that’s why millions more will.
