ADMINISTRATIVE PROCEDURES
In the USA, thanks to the Medicare health program, healthcare for seniors and people with certain disabilities are heavily subsidized. Depending on income levels, the costs of healthcare could even be free. Along with Medicaid, it is a scheme used by millions of Americans. This article will examine Medicare in detail and provide an in-depth guide to the scheme.
What is Medicare?
Medicare is a federal government-run health program. It provides health insurance enabling qualified individuals to access numerous health services without paying vast sums of money. The scheme effectively allows people to purchase various healthcare packages at subsidized rates.
Medicare Eligibility
The following groups of people qualify for Medicare:
- • People aged 65 and over, or
- • People with disabilities who have earned Social Security disability benefits for at least 24 months, or
- • People with permanent kidney problems.
Additionally, to qualify, the person needs to be a:
- • US citizen, or
- • A resident who has lived in the USA for at least 5 years.
Medicare Parts (A, B, C, and D) And Supplemental Insurance
The program has 4 parts plus supplemental insurance. They are:
- • Part A (called hospital insurance),
- • Part B (called medical insurance),
- • Part C (referred to as Medicare Advantage Plan),
- • Part D (known as Medicare prescription drug coverage), and
- • Supplemental (Medigap) Insurance.
Part A and Part B are known as Original Medicare. Additionally, there is help available for low-income people who are not able to make any payments towards their healthcare.
Part A (hospital insurance) is the free segment. It enables inpatient care at a hospital and nursing centers following hospital treatment. Part A also covers health rehabilitation at home and hospice care. The federal authority provides this service without the need for any monthly premiums. Usually, to qualify, a person (or their spouse) would have paid Medicare taxes while employed. Possessing Part A does not entitle a person to 100% free hospital medical care. Depending on a person’s circumstances, they will need additional forms of health insurance in place to ensure they are fully covered.
Part B (medical insurance) allows access to doctors and other healthcare practitioners. It’s the segment that’s used in case of an emergency room visit. Part B covers aspects such as:
- • Outpatient hospital visits,
- • Healthcare at home,
- • Obtaining medical equipment (such as a wheelchair), and
- • Preventative measures (such as health screenings and vaccines).
Costs Of Part B
Unlike part A, this segment involves a monthly fee. A person must pay a minimum of $164.90 per month for 2023. The monthly premium must still be paid even if no services are used. Individuals on low incomes or receiving benefits will have access to Medicare Savings Programs to help pay for the costs associated with Plan B. Accessing Part B does not entitle a person to 100% free medical care. They will require additional forms of health insurance in place for full coverage.
Part C is run by accredited healthcare insurance companies that follow the rules set out by Medicare. Also called a Medicare Advantage Plan, it incorporates Part A and Part B. Medicare pays these companies to provide your healthcare service. They will provide the same services Medicare offers but may have different rules. For example, Part C with an insurance company could mean that a patient can only visit doctors under their umbrella.
Part C And Additional Health Coverage
Depending on the chosen company and package, they can offer additional services and coverage on top of what is available under Parts A and B. For the extra services, there are out-of-pocket costs that need to be met by the patient.
Also known as Medicare prescription drug coverage, this segment covers the costs of purchasing medication. Just like Part C, Part D is covered by businesses involved in private healthcare insurance. Part D could be bundled with Part C or as a standalone product.
Supplemental insurance is sold by private health companies. It allows people to take insurance coverage to bridge the gaps missing from Part A and Part B. For example:
- • In Part A, a person needs to spend $1600 of their own funds on admission to a hospital facility before the insurance becomes effective.
- • In Part B, a person must spend $264 annually of their own money before having the right to obtain healthcare.
Though Part A and Part B pay a large part of the costs, there are many circumstances where the patient must make some payment towards the cost of treatment. The supplemental insurance plan helps with these costs. As a general rule, it helps to pay the charges listed below:
- • Co-payments (the percentage of the treatment fee that the patient must meet),
- • Coinsurance (a fixed payment an insured individual pays on receiving various treatments)
- • Deductibles (the yearly amount an individual must spend before the insurer funds their treatment)
Supplemental insurance is unavailable to people who opted for the Part C Medicare program.
How To Enroll For Medicare?
Medicare application is straightforward. Those receiving social security payments are automatically eligible for Part A and Part B. There is no need to complete forms or wonder how to apply for Medicare online. The system will recognize eligibility, and a Medicare card will be sent by mail 3 months before a person qualifies.
To sign up for Parts C and D or to take up supplementary insurance, an application needs to be made. This link allows people to discover all the choices open to them. Alternatively, you can call Medicare at 1-800-633-4227 to speak to a representative.
Closing Remarks
The USA has some of the best health services anywhere in the world. But it is also one of the costliest places to seek out healthcare. However, thanks to programs such as Medicare, treatment costs are affordable and within the financial means of many elderly and disabled people.