Medicare began operating in 1966. This healthcare insurance system is subsidized by the Federal Government of America, which offers individuals a variety of healthcare services. This program provides healthcare insurance to individuals that are 65 years and above. It also offers coverage to people younger than 65 who are disabled or suffering from specific categories of illnesses.
Medicare, as it is, is classified into several types of plans that provide insurance coverage to eligible individuals for specific medical conditions at some charge to the assurers. Medicare brings about some degree of difficulty when accessing healthcare insurance, although it provides citizens with different healthcare insurance policies at different costs.
As it stands, Medicare provides healthcare insurance to over 60 million Americans. Additionally, it provides four kinds of healthcare insurance plans. These types of Medicare plans are:
Each part provides a different type of insurance coverage at a different cost. The part each individual is eligible for depends on several factors.
Eligibility for Medicare
For an American to qualify for Medicare, he or she must meet any of these criteria. The main criteria for enrollment are stated below.
- An individual must be 65 years old or more, a citizen of America or a person (or spouse) that has legally resided in the country continuously for five or more years, and has paid taxes for Medicare for not less than 10 years.
- An individual must be disabled (have ALS or any other disability), a citizen of America but younger than 65, and must have received benefits from a recognized body. Also, the benefits must have been received continuously by the individual for 24 months of registration before they can register in Medicare.
- An individual must be a citizen of America and require continuous dialysis for the last stage of renal failure or require a transplant. Individuals that are 65 years old or more are automatically enrolled in Part A and Part B of Medicare as long as they receive Social Security payments. However, with Part D of Medicare, the individual must enroll in the program themselves as optional.
Medicare is funded via various sources of American taxpayers’ contributions under FICA (Federal Insurance Contribution Act). All contributions collected are pulled into Medicare and Social Security deductions.
All employees within the country contribute 1.45% and 6.2% of their income into Medicare and Social Security, respectively. This amount accounts for a 7.65% deduction. The same amount is also collected from employers as counter funding.
As stated earlier, Medicare has four types, which are Part A, Part B, Part C, and Part D.
Part A Medicare provides coverage for medical bills for a variety of services. These services include hospitalization, nursing care services, other inpatient care services, and home nursing services.
However, this plan does not provide coverage for custodial healthcare and long-term healthcare services. All individuals that receive Social Security payouts are automatically qualified for Medicare Part A plan. In some cases, people are allowed to register online if they do not receive income via check.
The coinsurance and deductibles rates of Part A of the Medicare plan are highlighted below.
- Inpatient hospital care deductibles at the rate of $1,408,
- Coinsurance at the rate of $352 from day 61 to day 90, daily,
- Coinsurance at the rate of $704 for a lifetime on reserve days, daily,
- Skilled nursing healthcare facility uses coinsurance from day 31 to day 100 at a rate of $176.
A patient may use some other types of auxiliary services within a healthcare facility, which are usually reimbursed through the Part A Medicare plan.
The Part B Medicare plan is mostly used to cover for outpatient care, which includes consultation, preventive services, use of medical equipment, mental health care, and ambulatory care.
Additionally, some specific types of prescription medication are covered by this plan. Individuals that qualify for the Part B Medicare plan must pay a monthly premium of $144.69 and a deductible of $198. Individuals with a yearly income that exceeds $87,000 would usually pay more for in premiums.
This figure doubles for married individuals. Individuals that qualify for both Part A and Part B Medicare can enjoy the two services simultaneously.
The Part C Medicare (Medicare Advantage) plan provides health insurance coverage, which is equivalent to Part A and Part B Medicare combined.
The Medicare Advantage, unlike Part A and Part B plans, is purchased from private healthcare insurance companies. The Part C plan has a yearly limit for the amount of money an assurer pays for directly.
It also provides additional benefits that Part A and Part B plan usually do not provide except through supplementary insurance addons like Medigap. It also provides coverage on hearing care, vision care, and dental care. Medicare Advantage also provides insurance coverage to assurers even when they travel outside of the country.
Part D of the Medicare plan provides additional prescription medication coverage for policy owners. An individual enrolled in Part A, Part B, or both can subscribe to Part D of Medicare to take advantage of the subsidies it provides for prescription medication.
COVID19’s Effect on Medicare
The ongoing coronavirus pandemic has forced the American Government to pass a stimulus package that, amongst many things, expands the ability of Medicare plans to provide coverage for testing and treatment of COVID19 patients.
This new modification allows Medicare to include telehealth services in its coverage. It also empowers Medicare to certify home healthcare services that are provided by certified medical personnel. Finally, the pandemic has significantly increased Medicare’s contribution to COIVD19 and related medical expenses.