Medicare is the health coverage program run by the United States government’s Centers for Medicare & Medicaid Services (CMS). Certain eligibility requirements must be met before an American citizen is eligible for Medicare services. Covered services, under the Original Medicare Plan, fall under four classifications.
Medicare Part A helps cover inpatient hospital bills, as well as skilled nursing facility services, hospice, and home healthcare. Generally speaking, long-term care, also known as custodial care, is not covered by Part A. Such care is supportive rather than medically necessary, since it only offers support services to people who need assistance with day-to-day living activities like bathing, dressing, and toileting. In some cases, Medicaid will pay for long-term care services.
Medicare Part B helps cover outpatient doctor visits and services. Preventive care and tests are also some of the services covered by Part B. These include diabetes and glaucoma screenings, bone density tests, certain vaccinations, and cardiovascular screening. Part B also covers mammograms, pap tests, pelvic exams, and colorectal and prostate screenings. Diabetes and smoking cessation counseling are also covered.
Medicare Advantage Plans, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), are what make up Medicare Part C. Other Medicare Advantage Plans cover special needs, private fee-for-service, and medical savings account plans, as well as including Medicare Part A and B. Private companies manage these kinds of Medicare services, once they have been approved by Medicare to do so. Prescription drug coverage is usually included under Part C, in addition to general health coverage. In some cases, more services are actually covered by Part C than under the Original Medicare Plan.
Medicare Part D covers prescription drugs. Medicare beneficiaries who are 65 or older typically need more prescriptions than younger people, so Part D is very important for managing their prescription costs. Also, those with psychiatric disabilities who receive Medicare services often are prescribed psychotropic medication that can cost many thousands of US Dollars each year. Many have income at or below the poverty level because of their inability to be involved in substantially gainful employment. In their case, Part D is a necessity for individual, and more broadly, social stability.
In general, as long as a person has at least Part A and Part B with Original Medicare coverage, he or she can purchase a Medigap policy. This kind of policy covers any deductibles, co-payments, and coinsurance not covered under Original Medicare services. Some Medigap insurances also cover certain medical services that an individual might need if he or she becomes seriously ill or injured while abroad.
Medicare also offers the patients it covers online Personal Health Records (PHRs), which they can access any time, anywhere. A PHR is an individualized file that contains such information as the patient's medical conditions, including allergies, and a list of recent doctor visits and hospital admissions. Medications the patient regularly takes are also part of this record. With PHRs, patients control who, other than themselves, has access to their medical information.
Americans who are 65 or older are automatically eligible for Medicare. Individuals of any age who have been determined to be disabled under Social Security rules and definitions, or people of any age who are suffering with end-stage renal disease, are also eligible. For disabled Social Security recipients under the age of 65, there is a waiting period of up to two years before they can take advantage of Medicare services.
