Medicare
Medicare is a single-payer national health insurance program.
On average, Medicare covers 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 will vary depending on the scope of healthcare a Medicare enrollee requires.
These out-of-pocket costs might include deductibles, copays, and costs of uncovered services, i.e., long-term, dental, hearing, vision care, and supplemental insurance premiums.
FACTS:
- Provides health insurance for 65+ year-old Americans who have paid into the system through the payroll tax
- Younger individuals with a disability status determined by the Social Security Administration
- Individuals with end-stage renal disease & amyotrophic lateral sclerosis
- Funded by a combination of payroll taxes, premiums, and surtaxes from beneficiaries & general revenue
- Administered by the Centers for Medicare & Medicaid Services of the U.S. Federal Government
- Established in 1966 under the Social Security Administration
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
- Trustees call this alternative Managed Medicare
- Allows patients to choose plans with at least the same benefits as Parts A & B—most often more
- Offers an annual out of pocket spend limit which A & B lack
- Beneficiary MUST enroll in Parts A & B first before signing up for Part C