Medicare is a nationwide health insurance scheme in the United States for elderly individuals and persons with certain illnesses such as amyotrophic lateral sclerosis end renal stage disease. The scheme began in 1966 and was administered by the Social Security Administration (SSA) then but now is being administered by the Centers for Medicare and Medicaid Services (CMS). Medicare has provided health insurance services to over 59.9 million persons including elderly individuals and younger persons. Medicare is responsible for the Original Medicare and the Humana Medicare Advantage plans 2022.

Services provided by Medicare

Medicare is generally categorized into four Parts: A, B, C and D.

Part A

This covers medical (hospital) expenses which only include inpatient and formal admittance; skilled nursing which is only provided three days after formal admittance and not for custodial care; and hospice services. An individual only qualifies for the nursing home stay if the patient is not receiving rehabilitation but has some other illness that requires skilled nursing monitoring. The care must be skilled and not some custodial, long term care or non skilled activities inclusive of ADL or activities of daily liking like cooking, cleaning and personal hygiene.


Part B

This covers outpatient services and most professional administered prescription medications or drugs. Once the patient meets up to their deductible, Medicare then covers 80 percent of the set rate for services provided while the remaining the 20 percent is catered for by the patient. It includes services such as outpatient physician services, X-rays, laboratory tests, influenza vaccinations, diagnostic tests, pneumonia vaccinations, renal dialysis, blood transfusions, out patient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant,  hormonal treatments chemotherapy and other out patient medical treatments given in a doctor’s office.

It also helps with DME or durable medical equipment inclusive of canes, wheelchairs, walkers, mobility scooters, lift chairs, prosthetic devices like breast prosthesis after mastectomy and artificial limbs, one pair of glasses after cataract surgery and oxygen for home use. It is important to note that the equipment covered is not limited to the ones listed above.

However, it provides 100 percent coverage on services targeted towards prevention such as annual mammogram screenings, osteoporosis screenings and other screenings for prevention.

Part D

This covers majorly self administered medications or drugs.

Part C

This included in an alternative called Medicare Advantage or Managed Medicare. It allows individuals to select health plans with the same coverage of Parts A and B services and most times the services of Part D and a yearly out of pocket spend limit that Part A and. B services do not have. It also includes added benefits that Part A and B do not provide such as dental, body check up and visual examination. The services also waives the three day wait period of the Part A service.

Conclusion

Medicare services have been used for many decades and are also made available in other countries and not just in the United States. It is also available in countries like Australia and Canada.