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Health & Safety

Medical Coverage For Seniors – Helpful Guide For Understanding Medicare

Doctor CartoonMedicare is known as the social insurance program that is run by the US government. It provides health insurance coverage for persons who are 65 years of age and beyond, persons who are under 65 but have a permanent disability, or persons who satisfy other special criteria. While The Medicare program is based on a single payer healthcare system but has some differences. In the typical Medicare plan, the coverage extends to only 80 percent of medical costs, while the leftover 20 percent has to be paid either from the patient's own pocket or from a private health insurance company.

Medicare Eligibility

The biggest criteria for eligibility is that a person has to be at least 65 years of age and a legal resident of the US for at least 5 years to receive Medicare benefits. Persons who have disabilities but who are less than 65 years of age might also be eligible if they already get Social Security Disability Insurance benefits. If persons have particular medical conditions that might also help them meet eligibility for Medicare. Those persons who are 65 and older are required to pay a monthly premium to stay in Medicare if their husband or wife has not paid Medicare taxes in the past 10 years.

Benefits of Medicare

Part A

Doctor Cartoon - Checks OutThe first benefit of Medicare is Part A, which covers hospital insurance. More specifically, Part A includes coverage for inpatient hospital stays that include a semiprivate room, doctor's fees, tests and food. Part A also includes coverage for short stays in a skilled nursing facility for convalescence, provided that criteria like the length of any prior hospital stays and the quality of the care being skilled are met. 100 days is the longest that Part A will cover a patient for a stay in a skilled nursing facility.

Part B

Part B relates to medical insurance. It assists in paying for some products and services that Plan A fails to cover, typically on an outpatient basis. Part B can be deferred if a spouse or the beneficiary is still working; in this way, Plan B is entirely optional. X-rays, doctor and nursing services, restricted ambulance transportation, outpatient hospital procedures, renal dialysis and blood transfusions are some of the things that Part B provides coverage on.

Part C

Part C is Medicare Advantage plans, which means that Medicare recipients have the choice of getting their benefits through private insurance plans. These plans were made more desirable to Medicare recipients by way of the addition of prescription drug coverage, thanks to the passing of 2003's Medicare Prescription Drug Improvement and Modernization Act. Under this plan, Medicare pays the private health plan a specified amount of money each month. Many Part C plans offer their members dental and vision coverage that Parts A and B fail to offer.

Part D

Part D started on January 1, 2006, and it makes anyone who already has Part A or B eligible for it. Persons who want this Part D benefit have to enroll in a prescription drug plan that is stand-alone or a Medicare Advantage plan that features prescription drug coverage. The Medicare program does approve and regulate the Part D program. However, it is a program that is both designed as well as administered by private health insurance companies.

  • Benefits of Medicare: This website explains the different benefits that come with different parts of Medicare.

Out of Pocket Costs

Doctor on Motorcycle CartoonA person will face out-of-pocket costs even under Medicare, especially if they have the Part A or Part B plans. Neither plan fully pays for a person's medical costs, and premiums, deductibles and coinsurance are all obligations that the person has to pay for independently. A premium is a type of risk management that Medicare uses to hedge against any uncertain losses. A deductible is how much money Medicare enrollees have to pay out of their own pockets before their coverage actually kicks in. Coinsurance is when Medicare participants have to split the cost of their healthcare under the program with their insurer.

Additional Medicare Related Resources

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