Basic introduction to Medicare Pt 1

Medicare is the national health insurance program that entitles all recipients of social security who are either over 65 years of age or who are permanently disabled. In addition, persons receiving old-age pensions and those with end-stage renal disease may receive Medicare benefits.


Medicare is not a social program and should not be confused with Medicaid. The assets and income of a Medicare beneficiary need not be taken into account when determining the benefit or eligibility payment. The procedures of Medicare as a national program should not differ significantly from state to state.


Cover under Medicare is similar to private insurance companies: they pay part of medical care cost. The beneficiary often requires deductibles and coinsurance (partial payment of initial and follow-up costs).


Medicare includes two major protection components: they are Part A and Part B. The Part A covers for hospice care, inpatient hospital care,  in-patient care within a qualified care facility, and home care services. Part B covers medical care and services provided by physicians and other physicians, home care, durable medical equipment, and some outpatient nursing and home care services.


Part A of the program is largely funded by state payroll taxes paid by employers and employees into social security. Part B is funded by monthly premiums paid by Medicare beneficiaries and general federal revenue. In addition, Medicare beneficiaries themselves are sharing the cost of the program through co-payments and deductibles, which are required for many of the benefits listed in Parts A and B.

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An increasing number of beneficiaries are funding their health services through managed care plans. Medicare’s Managed Care benefits are different from the traditional Fee-for-Services Medicare system, but coverage should generally be the same. In general, a Medicare-managed care plan manages the medical treatment of a student by a physician (referred to as a “gatekeeper”) who must authorize the patient’s referral to the specialized treatment. (For some Medicare managed care plans, beneficiaries may go directly to a specialized care provider for an additional premium without the consent of the gatekeeper.) A beneficiary may choose to receive Medicare insurance and care through a managed care plan. After the decision has been taken, the beneficiary is entitled to receive all of his care through the plan to obtain Medicare insurance. Beneficiaries may change their minds, unsubscribe from their managed care plan and return to “original” Medicare.


These plans are currently referred to by the administration as a “Medicare Advantage” plan. They are to offer options to finance Medicare health insurance. Options include the “coordinated care plans,” that is inclusive of managed care plans and medical savings accounts, private service plan fees, and other options. The beneficiaries should only enroll in such plans after careful consideration and reflection.


Medical Approval and Rolling


Eligible to participate in Medicare are persons who are entitled to social security from the age of 65 and persons entitled to disability benefits for at least 24 months.


Eligible persons may also be persons entitled to a retirement pension or a RBC, as well as persons suffering from end stage renal disease or ALS.


Certain employees in federal, state, and local governments who are not eligible for old-age or disability benefits from social insurance may qualify for Medicare benefits if they have worked for a sufficient period of time, and the part of “Medicare” part of Medicare Part A of their FICA benefits. Federal employees were subject in January 1983 to the hospital insurance of FICA.