As just about everyone knows: Medicare is a health insurance program sponsored by the government covering Americans 65 and older and individuals under 65 with disabilities. It provides a health insurance card registered under parts A, B, C & D. To qualify for the Medicare health plan program, applicants need to meet eligibility requirements. Under 65, individuals should have been receiving Social Security Disability Insurance benefits for two years or have End-Stage Renal Disease.
Medicare is managed by the federal agency, The Centers for Medicare & Medicaid Services. The agency is part of the federal budget and gets the funding from the premiums deducted from the annual income under Medicare taxes. There are two Medicare Trust Funds; Medicare’s Hospital Insurance and Medical Insurance Trust Fund.
Medicare’s Hospital Insurance is funded by income taxes and employers’ payroll taxes under the benefits of Social Security. At the same time, the Medical Insurance Trust Fund is financed through people’s premiums enrolled under Part B and Part D and general tax revenue.
Medicare Part A
Part A of Medicare covers inpatient hospital services and acts as hospital insurance. People covered under this Medicare part include 65 and above, individuals with disabilities under 65, and those living with End-Stage Renal Disease. Individuals covered under Part A don’t pay premiums; they are paid under their payroll taxes. Here are some of the services covered under Part A.
1. Inpatients Hospital Care
This is any care issued by the doctor for admission as per the hospital requirements. This includes anything that the hospital needs to admit you as an inpatient.
2. Home Health Care
These services are offered at the patient’s home for an injury or illness and are as effective as the care the skilled nursing facility gives. The services offered under home health care include injections, nutrition therapy, and monitoring of the illness and sores.
3. Hospice Care
This is a service offered when the treatment is no longer working for the patient and the family is willing to stop them. The services covered include medical supplies, equipment, nursing care, and doctor services. The services can be provided by a social worker, counselor, nurse, home health aide, and doctor.
Skilled Nursing Facility Care
These services can only be provided by skilled nurses, technical personnel, and therapy staff. The services include tube feeding, wound care, and occupational therapy.
Medicare Part B
Part B covers preventative services and outpatient care, and doctors’ services. It covers services not covered by Part A, such as ambulance services, partial hospitalization, mental health services, and medical equipment. Individuals pay for the monthly premiums. Here are some services covered in Medicare Part B.
1. Preventative Services
These services are given to people to detect diseases early for effective treatments before the illness escalates. They include depression screenings, glaucoma tests, lung cancer, and diabetes screening.
2. Therapy Services
A Medicare-Certified therapist offers these services. The services offered include speech, occupational therapy, and physical services.
3. Mental Health Services
The doctor must confirm any inpatient treatments for these patients, and services provided can cover part of hospitalization.
4. Durable Medical Equipment
These are equipment used for the long-term and are used at home. They include wheelchairs, canes, nebulizers, scooters, and walkers. Medicare only covers the equipment if the Medicare plan covers the DME suppliers and patients’ doctors.
5. Ambulance Services
The ambulance services are provided in case of emergencies and trauma when the patient is required to be given necessary medical services by doctors or skilled nurses.
Medicare Part C
The services under Part C are offered by a private insurance company authorized by Medicare, including all the health benefits substituted for Original Medicare. Some of the plans covered here are cheap than original Medicare and have many providers. The plans include Part A, Part B, and at times Part D.
Medicare Part C is also known as the Medicare Advantage Plan. The requirements of joining the Medicare Advantage Plan, the beneficiary must be covered under Medicare Part A and Part B. The package comprises Medical insurance, hospital insurance, and Medicare prescription drug. It is a must that the Medicare Advantage Plan should cover all the services covered by the original Medicare, except for medical services that are not necessary. A beneficiary can be charged differently for the specific services the Medicare Advantage Plan determines.
Medicare Part D
Medicare part D is an optional prescription drug coverage program under Medicare. It is also known as Prescription Drug Plans and is managed by the private insurance companies authorized by Medicare. They cover generic drugs and brand-name prescriptions. It also helps beneficiaries pay for their prescription drug costs, helping them cover their out-of-pocket expenses.
To join the Prescription Drug Plan, one must have Part A and Part B. And for beneficiaries to qualify for prescription drug coverage, they must have the Medicare Advantage Plan and Medicare Prescription Drug Plan. Medicare drug plans have a formulary document that describes the list of the drugs covered under the plan for each individual. The formulary has at least two drugs listed in each category.
Medicare Parts A, B, C & D are the main parts of Medicare. It helps pay for medical and hospital expenses such as medical and hospital services, inpatient care, and home health care. Medicare Part D helps beneficiaries pay for their prescription drugs. Payroll taxes and general revenue finance Medicare and beneficiaries must meet requirements to join each Medicare Part.