The National Health Insurance Program, known as Medicare, is a powerful social support tool designed to improve the social security of certain clients, as far as social security stays one of the greatest values for the people and social policy. Until now, the situation in health insurance in the United States is such that the private insurance segment is not able to fully provide the affordable health care and treatment needed. Therefore, the federal government is expanding funding for the programs, such as Medicare, which are relevant to modern requirements.
So, the Medicare program was created primarily to provide services to American citizens of retirement age and for those who get Social Security benefits, which are related to the organization of their treatment and health care. Most often, the Medicare is used in order to receive some kind of preventive health care services, undergo inpatient treatment or to be able to call a doctor at home to perform some kind of therapeutic procedure. Also the Medicare line of support may provide a diagnostic examination, or spending a short period of time in a nursing home.
For different cases, the Medicare program provides various plans that have certain areas of coverage and features. Therefore, it is important for people using Medicare services and options to understand the difference between various Medicare plans. To speak about the structure, Medicare has four parts that cover different health care segments, from hospital admissions to prescription drugs and payments.
Basically, the types of plans by Medicare are Part A, Part B, Part C, Part D and the Medigap as an additional option. Each type works in its own segment and the Medigap works as the supplemental type. Further – in more detail about each of the Medicare plans and their coverage.
What Part A Covers
In general, the so-called Part A of the Medicare program covers hospital admissions and basic health care items. This part helps pay for care services of hospitalized patients in the hospital or in a skilled nursing facility after discharge. Part A of the Medicare program also allows people to pay for some home health care and hospice services. Medicare Part A is eligible for people 65 years of age or older who are the citizens or lawful permanent residents of the United States.
It is important to note that Medicare insurance under this plan is only covered if the patient is admitted to the hospital as directed by a physician, urgently, for an acute condition, or on a planned basis. The Medicare program also provides benefits for such medical services, as:
- blood transfusions;
- equipment such as wheelchairs and walkers;
- full hospice care;
- some of the home health care items.
Patients who receive Social Security benefits can use Medicare Part A for free. This option is also available to those people who have not reached the retirement age of 65 but have been receiving and eligible for Social Security disability benefits within the past two years. Hospitalization for 60 days inclusive does not require additional payments from the client and is guarantelly covered by Medicare.
What Part B Covers
Medicare Part B has broader coverage and more options for health insurance benefits. Basically, Medicare Part B helps pay for doctor consulting and other professional services, outpatient care, home health care services, durable medical equipment, and some preventive care services. The list of items covered by Medicare Part B may also include a rather wide range of various tests and laboratory screenings, such as cancer, diabetes and psychological disabilities testing.
Moreover, such care services as ambulance and emergency, vaccinations for influenza and hepatitis, additional supplies for diabetics, necessary medical equipment, and more are also covered by this type of Medicare. It is worth mentioning that all people who are eligible for free Medicare hospital support according to Part A can get Medicare Part B health assistance after paying a monthly premium.
If you are not eligible for free Medicare Part A insurance, you can only buy Part B if you are older than 65 and have been an American citizen or have been a permanent resident of one of the states during the recent five years. It is always recommended to consult with the insurance professional about additional coverage options under the Medicare program, additional options of Medigap and Medicare Advantage and Social Security benefits.
What Is Not Covered by Part A and Part B
As previously stated, Medicare provides coverage
for a wide range of medical cases and services. However, there are cases that cannot be covered by this form of Medicare insurance or the Medigap additional coverage. Among them, for example:
- most of the dental treatment of various profiles;
- acupuncture and related procedures,
- ophthalmological treatment and examinations;
- all types of cosmetic surgery (that is, those for which there are no urgent indications).
It’s also worth noting that Medicare does not cover long-term medical care. For special cases that involve a long-term stay of the patient in a medical facility and subsequent support from specialists, it is strongly recommended to reconsider the insurance offers of each Medicare part and choose the appropriate one. It is always a good idea to consider all the current circumstances of the health care case and use the needed Medicare coverage part or Medigap. At the same time, Medicare does not exclude the patient’s cooperation with other private insurance coverage.
If a patient uses Medicare Part A and Part B benefits that the federal government pays for, such type of medical insurance coverage is called Original Medicare. If the working benefits are provided by the Medicare Advantage Organization or another Medicare-approved private company, such coverage type is called Medicare Advantage. Many Medicare Advantage plans provide additional services and can reduce extra medical costs and significantly impact the total budget for the medical treatment.
So, the patient can be enrolled in a Medicare Advantage health plan, in case Part A or Part B are used. With this plan, the patient doesn’t need the Medigap supplemental coverage because Medicare Advantage plans provide the same benefits as Medigap supplemental coverage. This includes, for example, paying for extra hospital days after you all basic limits of Medicare days are used, though the medical treatment should be prolonged for some objective reason.
Extra benefits, which are not covered by Medicare Part A and Part B, are covered by Medicare Advantage or Part C (including, for example, dental, ophthalmologic, hearing and other special treatment), and Medicare Part D, which is used in most cases as the prescription drug coverage. It is important to know that Medicare Part D is an optional plan, but many people use it to have some special medication orders from a doctor, such as, for example, infusions or injections, as well as prescription drugs, if needed.