The Medicare program provides health insurance benefits to people 65 or older, to young people with disabilities, and to people with end-stage renal disease. Medicare offers you medical insurance coverage and helps you pay your hospital bills. Among the most critical aspects of the Medicare program is that it's available to everyone despite of age or ability to pay. Therefore, many people rely on it for their healthcare needs. Under Medicare, you can get free in-patient care at a hospital or other qualified institution. The program also covers many long-term care costs before and after your death.
Eligibility for Medicare is determined by meeting specific criteria set by law. Effective April 1, 2005, Medicare covers the costs of certain "medically necessary" services for people with chronic medical conditions. The complete Medicare program which is also known as the "original" Medicare program, guarantees coverage for in-patient care and some home health services at hospitals, skilled nursing facilities (SNFs), hospices, and other approved institutions. The federal government pays for these services at rates established by law. Medicare also covers some services provided in doctor's offices, outpatient physical and occupational therapy centers, hospices, and similar facilities.
Medicare Part A (also known as Original Medicare) covers in-hospital care and some home healthcare costs for people 65 or older who are not eligible for Medicaid. Medicare Part B (also referred to as Original Medicare Supplementary) pays deductibles and co-payments for doctors and outpatient medical services. It also pays a monthly premium to help cover these costs if you need more money to pay the total amount yourself.
In the United States, private insurance companies offer health insurance policies to the elderly and disabled through Medicare Advantage plans. These plans are required to cater to all Part A and Part B services that traditional Medicare covers, and the "medically necessary" benefits listed in the Patient Protection and Affordable Care Act under section 1899C, discussed above. However, they often include additional coverage such as dental or eye care, preventive checkups for seniors without a history of regular checkups, or extended coverage for hospital stays.
If you are eligible for Medicare, your health insurance company must pay for all your benefits. However, only some insurance companies agree to provide such coverage. If your insurance company does not cover in-patient care, you will have to pay for the amount not covered out of pocketjust as if it were a medical bill. A medical provider may require a co-payment or deductible before providing this service.
Medicare Advantage plans began offering an increasing number of services that traditional Medicare was not covering. Medicare Advantage plans also began covering some free preventative care/screenings (such as flu shots) that were never offered previously by traditional Medicare. These preventive services are now covered under Medicare Part C (Medicare Advantage). This increased availability of services has led to plans marketed directly to seniors that may not be eligible for Medicaid because they have too much income. The Federal Government does not regulate these private plans, and many adopt unscientific coverage guidelines.
Medicare Advantage plans may charge extra to cover services the insurer is not required to cover under Medicare. These costs generally go through to beneficiaries' healthcare providers and can add up if many services are involved. If you don't have a Medicare Advantage plan, you pay deductibles and co-payments for doctors and outpatient medical services. You will also be responsible for a monthly premium to help cover the costs of these items if you need more money to pay the total amount yourself.
