MEDICARE

Medicare is a single-payer national health insurance program. On average, Medicare covers about half of the healthcare charges for those enrolled. The enrollees must then cover their remaining costs either with supplemental insurance, separate insurance, or out of pocket. 

Out-of-pocket costs may vary depending on the amount of healthcare a Medicare enrollee requires. These out-of-pocket- costs might include deductibles & copays; the costs of uncovered services, i.e. long-term, dental, hearing, vision care and supplemental insurance premiums. 

FACTS:

  • Administered by the Centers for Medicare & Medicaid Services of the U.S. federal government 

  • Begun in 1966 under the Social Security Administration 

  • Funded by a combination of payroll taxes, premiums & surtaxes from beneficiaries & general revenue

  • Provides health insurance for Americans 65+ years old who have paid into the system through the payroll tax

  • Younger individuals are also covered that have a disability status determined by the Social Security Administration. 

  • Individuals that have end-stage renal disease & amyotrophic lateral sclerosis are also covered

 

Medicare is divided into Parts

Part A

  • Covers hospital services (inpatient, formally admitted only)

  • Skilled nursing services (only after being formally admitted for 3 days & NOT for custodial care)

  • Hospice services

Part B

  • Covers outpatient services

  • Including some providers' services services while inpatient at a hospital

Part C

  • Alternative called Managed Medicare by the trustees

  • Allows patients to choose plans with at least the same benefits as Parts A & B (most often more)

  • Often the benefits of Part D

  • Always an annual out of pocket spend limit which A & B lack

  • The beneficiary MUST enroll in Parts A & B first before signing up for Part C