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What is Medicare and What Does it Cover

by Richard

The health insurance program known as Medicare exists to ensure that all U.S. citizens and certain permanent residents over the age of 65 can access health care services paid for by government-funded sources. The program is primarily funded through payroll taxes collected from employees and employers according to income levels, with the Social Security Administration administering enrollment and collection of fees on behalf of Medicare beneficiaries. This blog post provides a more profound and analytic understanding of Medicare and the components it covers.

History of Medicare

Medicare officially began in 1965 in response to a national health care crisis that involved the rationing of medical services. The original Medicare program covered only hospital care, and was established at a one-time cost of $9 billion. The states initially managed the program. It relied on community hospitals for the majority of the funding. Still, due to an increase in costs and efficiency issues, Medicare shifted from being entirely state-run to becoming more federalized with more centralized decision-making.

Currently, it is safe to say that Medicare is the most well-known and recognized government health insurance program in the U.S. This is primarily because it has been around for so long and has evolved significantly over its history. What was started as a national program that covered hospital care has now grown to cover a broad range of services, including physician services, prescription drug coverage, home health care, inpatient mental health treatment, and outpatient mental health services.

Components covered by Medicare

1. Hospital care

When it was first established, Medicare covered only hospital care. Today, hospitals that participate in the program have to have a minimum of 100-bed capacity and meet specific standards for quality of care. The services covered under this component of Medicare include inpatient and outpatient hospital care, including care for rehabilitation and skilled nursing, as well as short-term post-hospital stays.

The cover is significant in this situation because when one is admitted to a hospital, the hospital has to return a claim for reimbursement. The reimbursement amount is typically based on length of stay, so the longer someone stays in the hospital, the more likely it becomes that he or she will be responsible for medical bills. When patients stay in the hospital for longer than expected, they can run up thousands of dollars in medical debt and experience difficulties paying their bills.

2. Inpatient medical care

Within the past decade, Medicare has added inpatient drug coverage to its benefits package, meaning that seniors enrolled through Medicare do not have to pay copayments or coinsurance costs associated with prescription drugs when they are received while staying in a hospital. Additionally, Medicare covers inpatient medical and mental health services at skilled nursing facilities, which are typically located on the outskirts of larger cities and often provide specialized inpatient psychiatric care.

This component provides significant financial relief to millions of senior citizens and disabled individuals who experience chronic illness. Many seniors cannot afford long-term stays in the hospital, and according to Medicare’s website, over 80% of hospitals have reported that Medicare covers a majority of their patients.

3. Physician services

When a person is admitted to a hospital, he or she usually receives an initial assessment by a physician. Suppose the condition requires care that cannot be provided at the hospital. In that case, the individual may then be transferred to an appropriate facility or location in order to obtain services from a physician. This component of Medicare ensures that individuals who are admitted to hospitals and receive medical care will have access to physicians and other health care professionals.

4. Prescription drugs

Most people do not realize that Medicare covers the cost of prescription drugs, even though these costs might be significant. Typically, Medicare provides a 20% co-pay on covered prescription drugs, but the beneficiary must pay at least $100 of the cost of the drug. In addition, beneficiaries pay deductibles and co-insurance requirements for other services provided to them when they receive medical care at a hospital.

5. Home health care

The home health care component of Medicare is often overlooked and undervalued, but it is significant because it provides substantial improvements in the quality of life for millions of patients. Home health care includes all medical services administered at a patient’s home, including visiting nurses, homemaker services, medication management, skilled nursing care, and rehabilitation therapy.

Benefits of Medicare

When evaluating the entire healthcare system in the US, it is evident that there are profound benefits that emanate from the Medicare program. The primary benefit of Medicare is that it provides a significant amount of financial relief for millions of Americans who are unable or unwilling to purchase private health insurance. For example, suppose a 65-year old man was denied insurance coverage by his employer but was able to purchase a private plan on the open market and does not qualify for Medicaid or another government-funded public health care program. In that case, he can purchase a Medicare plan from sites like ClearMatch Medicare.

Another benefit of Medicare is the ability it provides to older people and the disabled to maintain their health and achieve financial security. The home healthcare benefit of Medicare is an excellent example of how Medicare provides significant benefits to individuals with chronic health conditions, which may be expensive and debilitating. Home healthcare also allows seniors to remain in their homes, which helps prevent them from having to relocate or live somewhere unfamiliar or having to move away from loved ones or close friends.

In conclusion, Medicare is beneficial because it provides financial relief to millions of Americans who are unable to afford to purchase health insurance. Its continued use has been significant in enhancing the healthcare system of the United States.

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