Function Of Medicare
MEDICARE is a government aided program, which has been formulated and designed to provide health insurance options at affordable prices to people of the age of 65 and more. It definitely acts as a supplement to the health insurance coverage programs.
Benefits are also provided to disabled individuals below the age of 65 suffering from Renal Disease. However the coverage provided has limited compared to those provided to older individuals.
Most citizens become eligible for Medicare at the age of 65, even if they do not become eligible for Social Security. Moreover they also need to have paid social security taxes, for atleast 10 years. Social Security taxes are generally debited from the check or business earning whenever taxes are filed.
On the other hand in case of Medicare, once an individual turns 65, have a time frame of 7 months to enroll into the program at no additional costs.
Health care benefits
Medicare Health Benefits are comprised of the following 4 distinct parts:
- PART A
- PART B
- PART C
- PART D
Medicare Part A
This plan is in broad terms known as Hospital Insurance (HI) and offers basic coverage. It provides hospital insurance benefits for seniors. It covers:
- In-patient hospital care
- Skilled Nursing Care
- Hospital Care
- Medically-necessary Home Health Care Services
If one is eligible for Medicare, one would generally be able to enjoy Part A premium-free, since payment has already been done through Social Security taxes.
However for other facilities such as office visits one needs to avail Part B or C.
Medicare Part B
This is also known as the Medical Insurance (MI). The plan covers those medical services which are not covered under PART A.
Some of the services covered are as follows:
- Out-door hospital care
- Diagnostic Tests
- Physical and occupational therapy
- Medical Equipments
However this category does not cover routine checkups, but does offer free one time checkup done during entrance into the program.
A monthly premium needs to be paid along with co-payments and deductibles. Your income decides the premium to be paid.
Medicare Part C
Also known as the Medicare Advantage Plan, this plan is formulated to allow private health insurance providers to offer insurance solutions to Medicare beneficiaries. A pre-approved plan is offered, which is designed in such a way that they definitely include all benefits under Part A and B. Under this category, additional benefits like vision and dental is also offered.
One important feature in this case, is that the private insurers bind the participants within a limitation in terms of choice of care providers. The participants need to choose their providers from within the network. This though has certain disadvantage also has advantages related to costs.
Medicare Part D
Prescription Drug Plan is the other name for PART D. This is a new inclusion into the Medicare program. Under this plan Medicare gets in touch with insurers who provide coverage on drugs or medicines.
An extra premium needs to be paid for the prescription drug benefits, which varies from insurer to insurer and state to state.
Medicare: The Original Plan
The Original plan refers to benefits covered under PART A and B. The benefits available under this plan are limited and do not cover all requisite costs that a senior might need.
The gaps which can be identified in such coverage are covered by a separate health insurance plan known as the “Medicare Supplemental Plan” or "MediGap Insurance". MediGap is provided under federal rules by private insurance companies.
