Medicare is America's health insurance program for citizens or permanent residents age 65 or older. Some patients younger than age 65 can also qualify for Medicare, including those who have disabilities and those who have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig's disease). Medicare helps pay for the cost of health care, but it does not cover all medical expenses or the cost of most long-term care.
The program is financed by a portion of the payroll taxes paid by workers and their employers, as well as monthly premiums deducted from Social Security checks. The Medicare program is run by The Centers for Medicare & Medicaid Services.
Medicare has four parts. Part A is hospital insurance which helps pay for inpatient services in a hospital, nursing facility or hospice, and some forms of home health care. Part B helps cover doctors' services and many other medical services and supplies not covered by hospital insurance. Part C, or Medicare Advantage, allows patients to receive all of their health care services through one of the provider organizations listed under Part C. Part D is prescription drug coverage.
Medicare and Medicaid are two different programs. Medicaid is a state-run program providing hospital and medical coverage for low-income residents, and each state has its own eligibility rules and coverage benefits. Some people qualify for both programs. Information about the Medicaid program is available from local medical assistance agencies, social services or welfare offices.
Considering the high cost of medical care, Medicare provides patients with great financial savings. An average monthly premium of approximately $32 offers two levels of coverage, standard and catastrophic. After a $250 deductible, Medicare pays 75% of the cost of covered medications up to a yearly cost of $2,250. There is extra help for people with limited income and resources. Approximately one third of people with Medicare coverage will qualify for extra help and Medicare will pay for almost all of their prescription drug costs.
Once yearly out-of-pocket prescription costs exceed $3,600, which often happens in the event of serious health problems such as AIDS, cancer or heart disease , catastrophic coverage takes effect and Medicare covers up to 95% of the remaining drug charges for the rest of the year. Many health plans will offer more coverage, smaller deductibles or premiums lower than $32. Most patients with limited income and resources will pay only a few dollars for each prescription. |
