Here’s A Quick Way To Understanding Medicare

Medicare is a social insurance program available to all citizens. Its funding is provided on a single-payer basis, meaning that the person receiving the benefits has contributed to the program through taxes throughout their lives. Some exceptions to this rule are people suffering from certain disabilities. It first appeared in the late 50’s under President Eisenhower, and was enacted by Congress under President Lyndon Johnson.

Who is eligible for Medicare?

The vast majority of Medicare benefits recipients are people over 65 years-old, the main demographic for which Medicare was originally put in place for. However, the modern version also covers younger residents with certain disabilities. Other conditions like ALS (Lou Gehrig’s Disease) and end stage renal disease are also covered, regardless of the age of the beneficiary.  

The Medicare Program in a Nutshell

There are four main parts of Medicare: Part A, B, C and D. Part A deals with hospital stay insurance, part B with medical insurance, C with medical advantage plans and D with prescription drug plans. It’s important to note that Medicare does not cover the entire cost of hospitalization, medicine or other medical services – for the most part, it only covers 50%, the rest having to be covered out of pocket or through additional insurance plans.

In order to apply for the most basic plans, Part A & B, you will have to either visit the Social Security office, or go to www.socialsercurity.gov. You can also contact them at 1-800-772-1213. Enrolment for Part A is, for the most part, automatic for most people. However, to get Part B you will have to, in most cases, enroll yourself. There are also instances where you may not want Part B, and you will have to follow a simple procedure to drop it. Enrolment in Part B is not possible if you’re not enrolled in Part A of Medicare. For those receiving disability benefits, enrolment in Part A and B is done automatically after 24 months of receiving them first. Part A and B is applied automatically to people receiving retirement benefits.

Pros, Cons, Wait Times and Comparison with Private Healthcare

From an idealistic standpoint, Medicare is a great healthcare plan as it is mandatory from the State’s perspective to offer it to aged citizens or people suffering from certain disabilities. Its funding comes from universal taxes, so there’s no extra you need to pay for the program once you reach 65 or qualify based on disabilities or certain conditions. However, as mentioned before, Medicare does not cover the entirety of treatment, medical services or hospitalization.

In comparison to private health insurance plans, Medicare can be more inefficient, but more manageable from a finance standpoint. Private insurance is not as transparent as Medicare, meaning patients rarely know what the cost for certain coverage is. What’s more, Medicare cannot be denied to patients based on preexisting conditions. One issue with Medicare is that wait times are on the rise, and compared with private insurance, this really stands out most of the time. Delays in treatment and/or investigations lead to a significant number of complications for the patient.

In the end, Medicare is a state-sponsored, single-payer health insurance program, and from that perspective, it is not only a positive aspect, but a necessary one as well. And while it can be improved, there’s still a case to be made about how much that improvement can be stretched without it becoming unfair towards people who don’t want it or prefer private insurance plans.