Saturday, July 13, 2024

What Is Medicare In Simple Terms

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What Do Medicare Parts A B C And D Mean

Understanding Medicare: Medicare In Simple Terms

Who is this for?

If you’re new to Medicare, this information will help you understand the different parts and what they do.

There are four parts of Medicare. Each one helps pay for different health care costs.

Part A helps pay for hospital and facility costs. This includes things like a shared hospital room, meals and nurse care. It can also help cover the cost of hospice, home health care and skilled nursing facilities.

Part B helps pay for medical costs. This is care that happens outside of a hospital. It includes things like doctor visits and outpatient procedures. It also covers some preventive care, like flu shots.

Parts A and B together are called Original Medicare. These two parts are run by the federal government. Find out more about what Original Medicare covers in our Help Center.

Part C helps pay for hospital and medical costs, plus more. Part C plans are only available through private health insurance companies. Theyre called Medicare Advantage plans. They cover everything Parts A and B cover, plus more. They usually cover more of the costs youd have to pay for out of pocket with Medicare Parts A and B. Part C plans put a limit on what you pay out of pocket in a given year, too. Some of these plans cover preventive dental, vision and hearing costs. Original Medicare doesnt.

You can see a list of the Medicare Advantage plans we offer and what they cover.

Socialism Examples: Countries Declared As Socialist

Countries aren’t defined as socialist if they haven’t declared themselves as such in a constitution or through their national name. Therefore, throughout history, socialism may have been practiced in many countries, but the country itself has not been labeled as socialist. However, a few countries to declare themselves socialists include:

  • Republic of India
  • People’s Republic of Mozambique

Examples Of Socialism: Definition And Features In Simple Terms

You’ve probably heard of socialism, but do you know what it is? The term socialism refers to any system in which the production and distribution of goods and services is the shared responsibility of a group of people. Still confused? Get a clear definition of socialism, along with socialism examples and features.

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Looking To The Future

Medicare faces a number of critical issues and challenges, perhaps none greater than providing affordable, quality care to an aging population while keeping the program financially secure for future generations. While Medicare spending is on a slower upward trajectory now than in past decades, total and per capita annual growth rates appear to be edging away from their historically low levels of the past few years. Medicare prescription drug spending is also a growing concern, with the Medicare Trustees projecting a comparatively higher per capita growth rate for Part D in the coming years than in the programâs earlier years due to higher costs associated with expensive specialty drugs.

To address the health care financing challenges posed by the aging of the population, a number of changes to Medicare have been proposed, including restructuring Medicare benefits and cost sharing raising the Medicare eligibility age shifting Medicare from a defined benefit structure to a âpremium supportâ system and allowing people under age 65 to buy in to Medicare. As policymakers consider possible changes to Medicare, it will be important to evaluate the potential effect of these changes on total health care spending and Medicare spending, as well as on beneficiariesâ access to quality care and affordable coverage and their out-of-pocket health care costs.


There’s Medicare Part A Part B Part D Medigap Plans Medicare Advantage Plans And So On We Sort Out The Confusion About Signing Up For Medicare

New to Medicare  Benefits Tutor

Heading into retirement brings a slew of new topics to grapple with, and one of the most maddening may be Medicare. Figuring out when to enroll in Medicare and which parts to enroll in can be daunting even for the savviest retirees. There’s Part A, Part B, Part D, medigap plans, Medicare Advantage plans and so on. And what the heck is a doughnut hole, anyway?

To help you wade into the waters of this complicated federal health insurance program for retirement-age Americans, here are 11 essential things you must know about Medicare.

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Why We Need Health Care Reform Explained

The health insurance and health care industries are for-profit industries. As such, they put their profit before your health. In many ways, it is left up to the law to regulate their practices. Understanding the law requires an understanding of the health insurance and health care industries as well as a lot of research and experience.

The complexity of the law and the 3 trillion dollar plus U.S. healthcare system both defy any simple explanation. Suffice it to say: We need health care reform to help America focus less on convenience and profit and to encourage America to focus more on wellness, prevention, and health.

Trumps Repeal Plan Explained

Republicans had attempted to repeal the law about 50 times during Obamas Presidency, and Trump won on a promise of making healthcare great again. What does this mean in practice?

In simple terms:

  • The 50+ repeal attempts and a few related lawsuits meant that some provisions, like Medicaid expansion, didnt cover as many people as they were supposed to.
  • Changes under Trump included getting rid of the mandate to get coverage. There were more changes planned, but a bill was unable to be passed. For more, see TrumpCare vs. ObamaCare.
  • There is a Supreme Court case that declared that law unconstitutional that is making its way to the Supreme Court. Nothing changes for now, but it could impact the law after the legal process plays out.
  • In short, there have been a few changes due to Republican efforts to repeal both under Trump and Obama, but mostly the ACA has remained intact.

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    A Quick Introduction To The Affordable Care Act

    ObamaCare, officially called the Patient Protection and Affordable Care Act, is a health care reform law signed in 2010 by President Barack Obama. The general goal of the law is to improve the quality, access, and affordability of healthcare and health insurance.

    Some of the laws provisions started immediately, most of the major ones went into effect in 2014, and the rest continue to roll out until 2022.

    The law itself is rather long and contains a number of provisions aimed at less than exciting things like improving the quality of care at hospitals, getting rid of waste and abuse in Medicare, curbing costs over time, and putting calorie counts on the menu at fast-food restaurants .

    In other words, people are typically discussing ObamaCares coverage provisions,cost assistance, and mandates when they discuss the law.

    With that in mind, the next section contains a quick summary of the laws major provisions.

    FACT: ObamaCare was a nickname given to the Patient Protection and Affordable Care Act. It is also called the Affordable Care Act, PPACA, or ACA. No matter what people call it, the content of the law is the same.

    Am I Eligible For Medicare

    Passport Health Plan Medicare Terms and Definitions

    To receive Medicare, you must be eligible for Social Security benefits.

    Part A Eligibility

    Most people age 65 or older are eligible for Medicare Part A based on their own employment, or their spouse’s employment. Most people have enough Social Security credits to get Part A for free. Others must purchase it.

    You are eligible for Medicare Part A if you meet one of the following criteria:

    • You are eligible for Social Security or Railroad Retirement benefits, even if you do not receive those benefits.
    • You are entitled to Social Security benefits based on a spouse’s, or divorced spouse’s work record, and that spouse is at least 62 years old.
    • You have worked long enough in a federal, state, or local government job to be eligible for Medicare.

    If you are under 65, you are eligible for Medicare Part A if you meet one of the following criteria:

    • You have received Social Security disability benefits for 24 months.
    • You have received Social Security benefits as a disabled widow, divorced disabled widow, or a disabled child for 24 months.
    • You have worked long enough in a federal, state, or local government job and meet the requirements of the Social Security disability program.
    • You have permanent kidney failure that requires maintenance dialysis or a kidney transplant.
    • You are diagnosed with ALS or Lou Gehrig’s disease.

    Part B Eligibility

    If you are eligible for Part A, you can enroll in Medicare Part B which has a monthly premium.

    Will I Need To Prove My Age?

    Automatic Enrollment

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    Quality Of Beneficiary Services

    A 2001 study by the Government Accountability Office evaluated the quality of responses given by Medicare contractor customer service representatives to provider questions. The evaluators assembled a list of questions, which they asked during a random sampling of calls to Medicare contractors. The rate of complete, accurate information provided by Medicare customer service representatives was 15%. Since then, steps have been taken to improve the quality of customer service given by Medicare contractors, specifically the 1-800-MEDICARE contractor. As a result, 1-800-MEDICARE customer service representatives have seen an increase in training, quality assurance monitoring has significantly increased, and a customer satisfaction survey is offered to random callers.

    Characteristics Of People On Medicare

    Many people on Medicare live with health problems, including multiple chronic conditions and limitations in their activities of daily living, and many beneficiaries live on modest incomes. In 2016, nearly one third had a functional impairment one quarter reported being in fair or poor health and more than one in five had five or more chronic conditions, . More than one in seven beneficiaries were under age 65 and living with a long-term disability, and 12 percent were ages 85 and over. Nearly two million beneficiaries lived in a long-term care facility. In 2016, half of all people on Medicare had incomes below $26,200 per person and savings below $74,450.

    Figure 1: Characteristics of the Medicare Population

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    Who Is Eligible For Medicaid

    Medicaid eligibility is based on income, but some populations also have to meet asset limits. Medicaid eligibility is also based on immigration status for most types of Medicaid coverage, a person must be either a United States citizen or have lawfully resided in the U.S. for at least five years in order to qualify.

    The Affordable Care Act expanded eligibility and eliminated asset tests for some populations, including children, pregnant women, and adults under the age of 65. For these populations, eligibility requirements are based on an ACA-specific version of modified adjusted gross income , with income limits that vary by category and state. Under Medicaid expansion rules, a single adult under the age of 65 is eligible for Medicaid in most states with an income of $17,774 in 2021 . But income limits tend to be higher for children and pregnant women. So its quite common for families to find that some members of the family qualify for Medicaid while others do not.

    And for people age 65 and older, as well as people who are blind or have disabilities and are receiving income from the Social Security Administration, Medicaid eligibility is still based on both income and asset/resource limits. For these populations, the rules can vary by state to see details. Seniors and disabled people with limited financial assets and income can be enrolled in both Medicare and Medicaid.

    A Quartet Of Medicare Enrollment Periods

    The Differences Between Medicare and Medicaid

    There are several enrollment periods, in addition to the seven-month initial enrollment period. If you missed signing up for Part B during that initial enrollment period and you aren’t working , you can sign up for Part B during the general enrollment period that runs from Jan. 1 to March 31. Coverage will begin on July 1. But you will have to pay a 10% penalty for life for each 12-month period you delay in signing up for Part B. Those who are covered by a current employer’s plan, though, can sign up later without penalty during a special enrollment period, which lasts for eight months after you lose that employer coverage. If you miss your special enrollment period, you will need to wait until the general enrollment period to sign up.

    Open enrollment runs from Oct. 15 to Dec. 7 every year during which you can change Part D plans or Medicare Advantage plans for the following year, or switch between Medicare Advantage and original Medicare. Advantage enrollees also can switch to a new Advantage plan or original Medicare between Jan. 1 and March 31. And if a Medicare Advantage plan or Part D plan available in your area has a five-star quality rating, you can switch to that plan outside of the open enrollment period.

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    Other Examples Of Socialism In Economic Systems

    While some countries declare themselves socialist, others include socialism in some parts of their country. View socialism within a country’s economic systems, healthcare, education, corporations, or other factions in these examples.

    Many people use the term socialism to describe behavior in which a government takes on a larger role in the economy. For example, many opponents claim that former President Barack Obama, of the United States of America, is a socialist due to his push for government-run healthcare.

    What Are The Basics Of Medicare

    Heres a quick overview of what each part of Medicare covers and how they work together:

    Part A and Part B is the federal governments Medicare program:

    • Part A covers you for hospital care and services. This includes inpatient hospital stays, surgeries, and more.
    • Part B covers two types of services: medically necessary services , and preventive services .
    • Original Medicare works with:
    • Standalone Part D Prescription drug plans
    • Or, use it alone with no additional coverage

    Medicare Advantage Part C is part of the governments Medicare program, but is offered and managed through private insurers like Cigna.

    • Includes Part A hospital and Part B medical coverage
    • Part D prescription drug coverage is usually included
    • Other coverage may include some basic dental, vision, and hearing depending on the plan and insurer you choose.
    • Part C works with:
    • Standalone Part D Prescription drug plans

    Medicare Part D Prescription Drug Coverage is part of the governments Medicare program, but is offered and managed through private insurers like Cigna.

    • Part D plans cover costs for various types of prescription drugs, depending on the plan you choose.
    • Part D works with:
    • Original Medicare
    • Medicare Supplement policies

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    Late Enrollment Penalty For Part D

    We mentioned the late enrollment penalty for Part D. Medicare requires enrollees to have creditable coverage, meaning prescription drug coverage thats at least as good as what Part D covers, in order for people to avoid the late enrollment penalty if they choose a Part D plan outside of the initial enrollment window.

    If at any point after your IEP, you go for 63 days or more in a row without creditable coverage, and then decide to get a Part D plan when an enrollment window opens up, youll likely have a penalty fee charged on top of whatever premium the plan charges. That penalty fee lasts for as long as you have Part D i.e., its permanent.

    Calculating that penalty involves some complex math. Medicare takes 1% of the national base beneficiary premium which changes each year and multiplies it by the number of full months you didnt have Part D coverage . That figure is then rounded to the nearest 10 cents and added to your Part D plans existing premium. Example:

    Because the national base premium changes each year, usually increasing, your penalty fee will probably go up each year, too. This is why its best to enroll in Part D when youre first eligible unless youre sure you have creditable coverage in place already.

    What Happens After You Leave The Coverage Gap

    Basic Medicare and healthcare terminology

    After youve made it through the Part D donut hole, your insurance plan will once again begin paying some or most of the cost of your medications. Unfortunately, you likely will still be responsible for a small portion of your medication despite reaching your yearly spending limit. In some cases, its as small as 5% of your prescription cost. Medicare calls this catastrophic coverage.

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    General Fund Revenue As A Share Of Total Medicare Spending

    This measure, established under the Medicare Modernization Act , examines Medicare spending in the context of the federal budget. Each year, MMA requires the Medicare trustees to make a determination about whether general fund revenue is projected to exceed 45 percent of total program spending within a seven-year period. If the Medicare trustees make this determination in two consecutive years, a “funding warning” is issued. In response, the president must submit cost-saving legislation to Congress, which must consider this legislation on an expedited basis. This threshold was reached and a warning issued every year between 2006 and 2013 but it has not been reached since that time and is not expected to be reached in the 20162022 “window”. This is a reflection of the reduced spending growth mandated by the ACA according to the Trustees.

    Medicares Origins And Growth

    Medicare is the federal health insurance program created in 1965 to provide health coverage for Americans aged 65 and older.

    The program administered by the Centers for Medicare and Medicaid Services was expanded in 1972 to cover people younger than 65 who have permanent disabilities, including those diagnosed with end-stage renal disease . And in 2001, Congress added amyotrophic lateral sclerosis as a diagnosis that makes a person eligible for Medicare prior to age 65. Approximately 14% of the Medicare population almost 9 million beneficiaries are under 65.

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