For senior citizens and others with medical conditions in the U.S., access to health insurance is essential. But prior to the Medicare program’s existence, these policies were much harder to come by. In 1965, only 54% of the nation’s population had health insurance coverage. By 2013, however, approximately 98.4% of seniors had health insurance.
Medicare isn’t only for those who qualify due to age. This coverage also extends to those with disabilities. Of the 55.3 million Medicare beneficiaries in the U.S. during 2015, 46.3 million received Medicare due to age while 9 million received Medicare coverage due to disabilities. In either case, being able to enroll in a national program like this has allowed American citizens the opportunity to obtain the services and the medications they need without paying exorbitant costs out-of-pocket.
That said, the Medicare program is not always easy to understand. There are several parts of Medicare, each designated by its own letter and meant to cover different services. Medicare parts A and B, which are known together as Original Medicare, are the only components administered directly by the federal government. While parts A and B do not cover all healthcare costs, they do cover a number of services that beneficiaries need.
Medicare Part A is sometimes referred to as “hospital insurance.” It covers hospital stays, home health services, skilled nursing facility care, and hospice care. For those who were in the workforce for 10 years and paid Social Security taxes for 10 years (40 calendar quarters), this coverage is free. Those who have worked and paid taxes for a shorter period of time have to pay a monthly premium for this coverage.
Medicare Part B is used for more common medical services like doctors’ visits, preventative care, outpatient treatment, and even medical supplies. But unlike Part A, Part B isn’t free for anyone. Beneficiaries must pay a monthly premium for this coverage. In addition, patients may have to pay for 20% of certain services (such as physical therapy or some doctors’ appointments) or equipment (such as wheelchairs, commode chairs, and diabetes supplies) even after they reach their deductible.
What’s actually covered by Original Medicare is determined by three main bodies: federal and state governments (through legislation), local organizations (i.e., whether products/services are considered medically necessary), and the Medicare program itself. That means that some products and services are excluded from Original Medicare coverage. For instance, neither Medicare Part A or B covers prescription medications. That’s why many seniors and those with disabilities determine they need additional coverage to help shoulder these costs.
Medicare Part D is one policy that offers outpatient prescription drug coverage. In 2008, approximately 25.4 million Americans were enrolled in Medicare Part D programs. It’s important to note that Americans who have enrolled in a Medicare Advantage Plan (also known as Part C) cannot enroll in Part D, as Medicare Advantage already comes with prescription drug coverage.
Some beneficiaries may find that Medicare Part D doesn’t provide all of what they need. Supplemental policies, aptly known as Medigap, can help close the coverage gaps and ensure overall costs are more manageable. Both Medigap plans and Medicare Part D plans are purchased through private insurers, rather than through the federal government.
Understanding the many components of Medicare can be a daunting task, but it’s essential to know what’s covered under certain policies -- and which of your healthcare providers are within your network. Medicare Parts A, B, and D can help countless Americans make healthcare more accessible and affordable, assuming you do your research and fully comprehend your coverage.
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