What is Covered by Medicare?
The U.S. federal government provided health care coverage for 43 million Americans through its Medicare program in 2007, and that figure is projected to reach 77 million by 2031. With Medicare expenditures growing faster each year than the federal budget, some have already predicted the program will be insolvent by 2019 without serious reform.
History
Medicare benefits were established in 1965 through a bill signed into law by President Lyndon Johnson. In 1980, Congress enacted the first in a series of laws that would allow Medicare to be a second payer on private health insurance programs. Further expansions of Medicare benefits continued until the Balanced Budget Act of 1997, which instituted several reforms aimed at curbing federal spending by shifting some Medicare benefits to the private sector. The Medicare Prescription Drug, Improvement, and Modernization Act was a major expansion of Medicare, heralding the introduction of significant prescription drug benefits.
Types
Medicare coverage is divided into four main parts. The first two, Parts A and B, were the original legislation passed in 1965. These parts provide insurance coverage to qualified individuals for care received in a hospital, or by physicians and nurses on an outpatient basis. Part C created Medicare Advantage plans, called (MAs), as part of the Balanced Budget Act, which encourage beneficiaries to seek private health insurance to which the Medicare provides premium assistance instead of reimbursement. Medicare Part D created comprehensive drug prescription plans, or PDPs.
Features
U.S. citizens or permanent legal residents for at least five continuous years are eligible for Medicare if they are 65 years or older. Some individuals under 65 are eligible if they have been receiving Social Security benefits for at least two years. Others qualify because of their specific conditions, such as kidney failure or Lou Gehrig's disease.
Benefits
Though there are many faults with the Medicare program, there is no doubt that it provides at least some support to the millions of seniors relying on it at least in part to meet the growing cost of their health care. Like most insurance policies, Medicare charges a regular premium and annual deductible in exchange for benefits. It doesn't provide full coverage, however, requiring a copayment of 20 percent or more in most cases. At the same time, Medicare benefits are fairly broad, covering some preventive medicine, most hospital and outpatient care, and medical equipment like wheelchairs and oxygen tanks for use in the home. For details, see the Resources below.
Considerations
Because Medicare operates by establishing regulations and reimbursing private insurance companies that meet the qualifications, the details of different plans offered under Medicare can vary widely. In many cases, the annual income of the beneficiary will also affect the premiums and copays, with very low-income beneficiaries having their costs waived or covered by Social Security, and those making above a certain threshold (about $80,000 per year for an individual) forced to pay somewhat higher premiums for their coverage.
Tags: Medicare benefits, Balanced Budget, Covered Medicare, health care, health insurance, Medicare program
