Medicare health insurance program for seniors and the disabled.
Medicare is the primary federal government benefit that is used to provide health insurance to individuals over the age of 65 as well as the disabled. It not only can help senior citizens and people with a disability, but it also provides care to anyone with End-Stage Renal Disease, or ESRD, which is a kidney issue. There are various “Parts” to Medicare and each provides a unique type of service to patients.
This benefit was never intended to pay every medical or dental bill in its entirety but rather it covers a portion of the enrolle needs. The person that is enrolled into Medicare will not only be responsible for their portion of the cost, but there is also a monthly premium that they will need to pay each month which is income based. It is not a form of free health insurance, but rather Medicare was intended to serve as a low cost option to anyone that needs it.
Below you will find out how each “Part” works and what it pays for. Each one of the components will come with a separate, unique fee that is due. So there will always be a cost involved to the person that is enrolled.
Information on what Medicare provides
There are four main components to this entitlement program. Each will provide some type of assistance to the patient. As far as who can apply to them, each is available to senior citizens and/or the disabled. So these Medicare Parts are not restricted based on any other criteria. Even if it turns out the cost of these plans is prohibitive to a disabled person or senior living on a fixed income, they can still learn more on and apply for free healthcare.
More details on each section is below. Regardless there will always be income and/or disability requirements. Also, in general, the family needs to pay some of their bills and Medicare also contributes; so it is a shared entitlement type program.
Medicare Part A for Inpatient Care
Anyone that needs hospital insurance should be using Part A. It will help pay for some of the costs associated with inpatient care. With the cost of hospital bills continue to increase at a rapid clip each and every year, this one expense alone has been known to crimp a budget.
Medicare Part A is flexible in that it pays for different types of medical providers or facilities. The government will pay for some of the expenses incurred, and the patient also needs to pay a daily fee. The types of faculties covered include, but are not limited too, patient rehabilitation facilities, critical access hospitals, and inpatient centers that provide long-term care as well. When there is an emergency situation, Part A is the most frequently used of the health insurance plans that are part of Medicare.
There are many instances in which a disabled person or senior has special needs. Or if someone has been diagnosed with ESRD they too may need specialized medical care. If and when this is needed the federal government will help pay for the bills associated with that requirement as well.
There may be Medicare Part A benefits that can pay for a portion of the costs incurred at a nursing facility. Or if the person is too old, or not feeling well enough, then financial assistance can help pay for hospice as well as related home health care services. This means if that a caregiver (or even a nurse) is needed to care for the patient, Medicare Part A can pay for some of those expenses.
Insurance from Part B
General medical insurance is provided by Medicare Part B. When someone thinks of the more traditional form of health insurance that an employer provides, or what is bought from a private or Affordable Care Act “Exchange”, this is what Part B is similar too. The federal benefit will normally pay as much as 80% of the total bill, while the participant is responsible for the remainder. It also often covers hospital as well as clinic costs.
As with all of these programs, the client will need to pay a monthly premium for this government entitlement. The rates will vary, but they will tend to increase each year along with the general rate of inflation if not higher. As noted, the Medicare Part B insurance plan will pay for as much as 80% of any bill that is covered. But of course the beneficiary needs to understand what is and is not allowed, as only some treatments are paid.
Medicare Part B is also the primary form of preventative health care for the elderly. It will help pay for physicals, doctor exams, equipment such as wheelchairs, some medications, and other services that will allow the person to maintain their health. Even once a diagnosis of a condition has been made, Part B will help pay the medical bills so the condition does not get worse, including outpatient care.
Private health insurance plans from Medicare Part C
Medicare Advantage Plans, also known as Part C, is when a person with a disability or senior citizen buys their insurance from a private company. It is a form of private marketplace health insurance. There are many providers, both national and regional, that offer this service and can even be considered a form of competition to the federal government. The prices vary widely as does the amount of coverage provided, but it can be an option.
This private health insurance companies need to enter into an annual contract with the federal government. There is a bidding process in place, and not all companies do this. So potential customers may need to shop around a bit to find a provider.
Medicare Advantage Plans are very comprehensive in what is offered. They usually include Part A and B referenced above as well as other benefits. So they provide the patient what the federal government does and much more. As an example, Medicare Part C/Advantage Plans will normally pay for prescription medications as well. That extra help can really benefit senior citizens, who often struggle to buy them. There are many other affordable medical insurance plans available as well.
Some of the Part C plans will also cover dental care. This is not common though. If a an applicant over the age of 65 is seeking this type of insurance, they should shop around and review all of the companies in the marketplace. If the price of dental insurance is outside of their budget, or if a senior needs other options, find a listing of programs that can offer free dental work.
Medicare Part D prescription drug assistance
The last component is Medicare Part D. This will only provide Prescription Drug Coverage to individuals that enroll. This is also run by private health insurance companies, but it can be combined with Part A and B above. So this is for those individual that are looking for an “a la carte” service. They can select Part D for their medications, then Part A or any combination. Or they can pay for only one of these benefits. This Medicare component pays for some of what a low income family needs as far as medications go.
For patients that have a very low income, they can apply for Medicare Extra Help, which is a component of Part D. This is a financial aid program for clients. Since a senior citizen may be living on a limited, fixed income (such as a pension or social security) or a disabled individual may only have SSI, they often struggle to buy the medications they need. If this happens, find how Medicare Extra Help can assist them.
Medicare Part D plans vary based upon the provider. They pay for different type of medications, including generics and/or brand name drugs. If a patient, such as someone with a mental or physical disability, has certain medications they need (or think they will in the future), they should ensure what plan they enroll into addresses their needs.
For more information on qualifications, try the Medicare Rights Hotline. This is a service service for anyone to call. Otherwise, applications can be submitted locally at a state social service office. For general questions on Medicare, or for referrals to local application sites, dial 1-800-633-4227 for information.