Medicare is a national health insurance program financed by the U.S. government. It provides healthcare to people aged 65 or older who meet specific income and other eligibility requirements. Medicare is available to people who are not eligible for Medicaid, which provides health care to the poor and disabled. Nonetheless, there are some interesting facts about the system, which you will discover as you read on.

What Is Medicare?

Medicare is the national health insurance program in the United States. It’s a government-sponsored health insurance program for Americans aged 65 and over and those under age 65 with permanent disabilities. Medicare provides health care coverage to its enrollees through private insurers, Medicare Advantage programs, regional insurance alliances, and Medicaid-managed care organizations. Nonetheless, many people are unaware of the basics about Medicare and fail to take advantage of what it has to offer. President Lyndon B Johnson signed the Social Security Amendments Act of 1965 into law, creating Medicare in 1965. 

The purpose of this act was to provide health care coverage for all Americans aged 65 or older and some disabled persons who were not eligible for coverage from any other government program or private insurance at the time. Medicare has since evolved into a program covering those with specific disabilities, medically needy individuals under age 18 and anyone else over age 65, and people with certain medical conditions.

There Are Four Parts To The Scheme

Medicare has four parts in terms of coverage and cost. These parts include:

The Medicare Part A

Part A of Medicare covers hospitalization. Part A provides:

  • Inpatient hospital treatment.
  • A limited amount of time in an assisted living care facility.
  • A limited amount of home care.
  • Long-term care.

Most Medicare Portion A recipients are not required to pay a monthly bill to get coverage. In general, if you’ve worked for at least ten years and paid Medicare taxes over your working life, you are eligible for a zero-cost Part A. Otherwise, you must pay a monthly fee.

Medicare Part B

Part B is the second part of Medicare and helps people with high medical expenses.

It covers services like:

  • Visiting a doctor
  • Emergency care in a hospital
  • Prescription drugs
  • Outpatient care

There is a monthly fee associated with this aspect of Medicare, and the cost may be higher for high-income individuals. Medicare Part B enrollees can receive assistance paying their premiums through Medicaid, a separate federal program.

Medicare Part C

Medicare Part C, often known as Medicare Advantage, is a health plan that combines all Medicare coverage into one package. It’s provided by private insurance firms that have been contracted by Centers for Medicare & Medicaid Services (CMS) to deliver this package as a supplement to Original Medicare. Participation in a Medicare Advantage plan is voluntary, but you must have Original Medicare, Parts A, and B, to get this insurance coverage. If you have a Medicare Advantage plan, you may be required to continue paying your Part B payment.

Medicare Part D

Medicare Part D is a prescription drug plan implemented by the United States Government. It became a law in 2006 to improve the health care system of the United States. Part D is a government healthcare insurance plan available to those who need it. It covers outpatient prescription drugs, medical devices, and hospice care. The program is available through private insurance companies and comes with a monthly fee varying depending on the insurer. 

Extra Benefits Are Available With Some Medicare Advantage Plans

Prescription medications used at home are only covered to a limited extent under Original Medicare (Parts A and B), but most Medicare Advantage plans do. Other supplementary benefits, such as dental, eye, and auditory treatments and fitness benefits, may also be covered by Medicare Advantage plans.

Medicare Regulates Advantage Plans

Medicare Advantage plans are a type of health insurance that enrollees can sign up to receive benefits, such as medical and prescription drug coverage, through an HMO. Even though a commercial insurance firm will manage your services, you are still enrolled in the Medicare program with an Advantage plan. You still have rights and safeguards under Medicare, such as the ability to challenge a coverage judgment.

You Don’t Need To Worry About Pre-Existing Conditions

Medicare benefits are generally not affected by a medical condition managed with medication. However, certain limitations, such as mental health conditions, addiction, and chronic conditions, may affect your eligibility for Medicare coverage. If you have a pre-existing disease, such as hypertension or cancer, joining a Medicare Advantage plan is usually not a problem. End-stage renal disease is the only diagnosis that may preclude you from enrolling in a Medicare Advantage plan. However, a Special Needs Plan, like Medicare Advantage, may be available to people with end-stage renal disease.

Medicare Decisions Can Be Appealed

If you dispute a Medicare health plan’s acceptance or payment decision, you can submit an appeal. The appeals procedure comprises five stages, and if your appeal is dismissed at one level, you can usually go to a level. If you wish to go further, you should Obtain any evidence from your doctor, health care provider, or supplier that may be useful to your case. If you believe that waiting for a judgment may significantly affect your health, you can ask for a quick decision, and if your doctor or Medicare plan concurs, the provider must make a judgment within 72 hours.

You Will Not Be Covered By Your Spouse’s Medicare

You may have had health insurance in the past that covered your spouse or vice versa and children as part of a single benefit package. However, Medicare does not cover family members. Each person must fulfill the qualifying requirements on their own. If you want to apply, each individual must meet the following criteria:

  • A person must be 65 years of age or older to qualify, or a person with a disability may be eligible earlier.
  • Citizens of the United States and legal immigrants (green card holders) must have lived in the U.S. for five years to qualify for full Medicare benefits. A green card holder married to a U.S. citizen or legal immigrant needing full Medicare benefits may also be eligible.

These are just some of the exciting facts about Medicare. Medicare can be an excellent benefit for millions of seniors. However, individuals must learn the details and understand its pros, cons, and costs to make the right choices.

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I've been writing since 2008 about a wide range of topics. I also love making furniture in my spare time, and birdwatching with my wife near our home in southern England.

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