Healthcare is essential to every person’s life, and it becomes even more crucial for seniors. As people age, their healthcare needs change, requiring more frequent medical attention. This is where Medicare comes in, providing essential healthcare coverage for seniors in the United States.
Medicare is a federal health insurance program that was introduced in 1965. It provides healthcare coverage for people aged 65 or older, people with disabilities, and people with end-stage renal disease. The program is divided into four parts: Part A, Part B, Part C, and Part D. Few people know what Medicare is, much less what it can do for them, so we will discuss the details in this article.
A Background on Medicare
Medicare was introduced in 1965 as a part of the Social Security Act and was signed into law by President Lyndon B. Johnson. The program was introduced to provide healthcare coverage to people aged 65 or older, people with disabilities, and people with end-stage renal disease. Before the introduction of Medicare, many seniors could not afford the medical care they needed. Healthcare costs were often prohibitive, and private insurance companies were reluctant to offer coverage to seniors because of the high cost of medical care. As a result, many seniors were left without access to essential medical services and treatment.
The introduction of Medicare changed this. The program provided healthcare coverage to seniors, regardless of their ability to pay. It covered many medical services and treatments seniors needed, including hospital stays, doctor visits, and prescription drugs. It also offered preventive services, such as annual wellness visits and screenings for various health conditions.
With this in mind, seniors have different options for Medicare, including:
Part A: Hospital Coverage
When you sign up for Medicare, you will be automatically enrolled in Part A, covering your hospital stays, hospice care, and skilled nursing care you may require after discharge. This can include rehabilitation in a nursing home or other facility to help you recover from a stroke, broken hip, or other similar episodes. In most cases, you won’t need to pay any additional fees for Part A because you have already made contributions to the Medicare system through the tax deductions on your paychecks.
However, Part A is not free because it requires a significant deductible fee each time you are hospitalized, currently set at $1,600 for 2023. You can purchase a Medigap or supplemental policy to cover this fee and other out-of-pocket expenses. However, Medicare will cover most of the hospital services you require for the first 60 days, with a few exceptions, such as a private room which will not be covered. As a U.S. citizen or permanent resident, you can still enroll in the program by paying a Part A premium if you haven’t worked enough to meet the eligibility criteria for Medicare.
Part B: Doctor and Outpatient Services
Medicare’s Part B covers outpatient services such as doctor visits, lab tests, medical equipment, and ambulance transportation. However, unlike Part A, it comes with additional costs, so it may be better to delay signing up if you have other insurance through your job or spouse’s plan. But if you don’t have any additional insurance and don’t sign up for Part B initially, you may have to pay a higher monthly premium throughout your time in the program.
In 2023, the federal government charges a monthly fee of $164.90 for Part B. If you earn over $97,000, your premium may be higher. You’ll also have to pay an annual deductible of $226, covering 20% of doctor visits and outpatient services expenses. If you receive Social Security, the fee will be deducted from your monthly payment.
Part C: Medicare Advantage
Medicare Advantage is a private health insurance option that replaces the government-run original Medicare. It is a comprehensive plan that includes different parts of Medicare. If you opt for Medicare Advantage, you must still enroll in Parts A and B and pay the Part B premium. Additionally, you must select a Medicare Advantage plan and enroll with a private insurer.
The government mandates that Medicare Advantage plans must provide the same coverage as original Medicare but may also offer additional services like dental and vision care. The Centers for Medicare & Medicaid Services have recently allowed these plans to cover even more extras such as home modifications, meal delivery, and transportation to medical appointments. Many Medicare Advantage plans include coverage for prescription drugs, so you must carefully review the plan descriptions to see which additional benefits are covered. These plans are typically either HMOs or PPOs.
Telehealth
To address the COVID-19 crisis, Medicare has temporarily broadened its coverage of telehealth services. Patients can now use several devices, such as smartphones, tablets, and computers, to connect with their healthcare providers. Medicare has lifted rules that limit who can perform telehealth consultations during the pandemic. Nurse practitioners, physician assistants, and physical and occupational therapists can now conduct these sessions. However, patients may still be required to pay a fee for telemedicine visits, but healthcare providers can waive or lower this cost.
Part D: Prescription Drugs
Part D of Medicare covers certain prescription drugs and requires purchasing a plan through a private insurance company. This plan can have various costs, including premiums, copays, and deductibles. These costs may be either a flat fee or a percentage of the prescription cost.
In 2023, if the combined amount you and your Part D insurance plan have paid for drugs equals $4,660 or more, you will be accountable for paying 25% of the cost for any additional prescription drugs you purchase for the rest of the year. You might become eligible for catastrophic coverage if your medication expenses exceed a certain amount, which is 5% of the cost of each drug.
Conclusion
Medicare is an essential program that provides health coverage to millions of Americans over 65 and those with certain disabilities. For this reason, anyone who qualifies for Medicare should take advantage of this program and enroll as soon as they become eligible. This way, they can ensure they have access to necessary medical services and prescription drugs without facing financial burdens.
If you need Medicare services for seniors, Magnolia 65 can help you! Medicare benefits seniors, so we will work with you to ensure you get the best option for you or your loved one. Reach out today for a consultation!
Magnolia65, an insurance agency, is licensed in Louisiana and Mississippi.