Medicare is a federal administered package that provides medical insurance coverage for the elderly, more specifically people aged 65 and above. However, younger individuals who suffer from permanent kidney failure or are disabled are eligible as well.
Medicare covers almost every aspect of health care cost, but is it not an absolute programme. Specifically, Medicare provides coverage in acute diseases such as heart attacks, in which the recovery period is usually short and not permanent in nature. However, it does not include cost incurred resulting from chronic conditions such as chronic arthritis, or care provided in nursing homes or assisted living facilities.
Simply speaking, Medicare provides benefits in 4 parts- A, B, C and D. Care associated with residing in a particular facility, such as hospital, nursing homes or hospice are classified under Part A, with this package being premium-free for the majority. However, beneficiaries are usually required to fork out a monthly premium for Part B, which involves cost incurred for outpatient hospital care, consultation fee for doctors, as well as physiotherapy.
Meanwhile, Medicare beneficiaries are entitled to receive health insurance policies from health care organizations such as HMOs and PPOs. At the very least, they must offer similar benefits as that of the Original Medicare Plan provided in Parts A and B. In addition to basic coverage, Part C are allowed to provide supplemental benefits such as vision and dental care. The demerit of Part C plan are it limits a patient’s choice of health care professionals to those who are part of their organization, in order to cut costs. If a patient’s family health care practitioner is not being part of the network, this constitutes a considerable disadvantage.
Lastly, prescription drug benefits are being covered in Medicare’s Part D, but majority needs to pay additional premiums monthly for prescription drug coverage.
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