Medicare – Getting the Care You Need When You’re Over 65

Medicare is a health insurance program that helps older people pay for health services. It is funded by the federal government, which provides detailed information about the program at www.medicare.gov. In 2018, about 57 million people received Medicare coverage. Of all the people covered, 48 million were 65 or older and 9 million were younger but suffered certain permanent disabilities.

Insurance companies or healthcare institutions in some countries (Medicare in the US) help cover the costs of specific services:

Part A: Inpatient hospital care, palliative care, skilled nursing facilities (under certain circumstances)

Part B: Medical services and services of other health care and outpatient providers, including certain medical equipment

Part C: Medicare Advantage Plans (a type of Medicare health plan offered by a private company that has a contract with Medicare to provide benefits)

Part D: Prescription drugs

Although Medicare is funded and regulated by the government, its daily operations are managed by private companies. Medicare administrative contractors handle Parts A and B, while private insurers handle Medicare Advantage (Part C).

Medicare eligibility criteria

In general, people are fit if

  • They are 65 years old or older
  • They are undergoing dialysis or have undergone a kidney transplant
  • They are under 65 and certain disabilities
  • Suffer from amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease)
  • People under 65 and who meet the requirements to be covered by Social Security Disability for at least 24 months may be eligible for Medicare.

Deductibles and copayments

Medicare only pays for services it deems appropriate (covered services). For each covered service, Medicare has what is called an allowable charge, which is the maximum amount that Medicare will allow insurance to charge for a service. However, Medicare does not pay the total eligible costs for covered services. The first time a certain service is needed, the person in question must usually pay a small fixed amount (known as a deductible) before Medicare pays anything. If the person needs the same service again after a certain time has elapsed, they must pay another deductible. After the deductible, in general, a certain percentage of the costs (co-payment) must also be paid each time a service is used. For example, in 2018, the deductible for outpatient services (such as a doctor’s visit) is $ 183 per year, and the copayment for each use of most outpatient services is 20% of the eligible charges. This provision means that people pay the first $ 183 dollars of their outpatient bills. Then, the rest of the year, they pay 20% of the eligible charges each time they use a service, and Medicare pays 80%. At the end of the year, the process begins again, and another deductible must be paid for the services used in that year. The rest of the year, they pay 20% of eligible charges each time they use a service, and Medicare pays 80%. At the end of the year, the process begins again, and another deductible must be paid for the services used in that year. The rest of the year, they pay 20% of eligible charges each time they use a service, and Medicare pays 80%. At the end of the year, the process begins again, and another deductible must be paid for the services used in that year.

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