The Medicare program is a complex one. You can quickly get confused about the plans that are best for you and your needs. However, it is good that you read about it ahead of time to gain sufficient mastery of the process.
Now the question is, is Medicare welfare?
The question is Medicare welfare, is a common one. However, you should note that it is not. It is not a welfare program. Its users fund Medicare during their time of active employment. However, when they become senior citizens and start benefiting from it, they no longer have to pay. The reason is that they have already paid for it.
How Does Medicare Work?
Medicare is a health insurance scheme. It is a federal program by the United States government. The essence of Medicare is to make health services affordable to all. The program is not only available to persons older than 65. It is also accessible to younger persons with disabilities and certain diseases.
The Centre for Medicare and Medicaid Services administers the Medicare program. Many people believe that Medicare is free and that it is why they confuse it for a welfare scheme. However, this is not the case. The only aspect of Medicare that we can say is free for a lot of persons, is the Part A plan.
We consider Medicare Part A to be free because you don’t have to pay premiums, unlike the other plans. Although you won’t be paying for premiums in a Part A plan, there are other out-of-pocket expenses that you have to sort out.
Who Is Eligible For Medicare?
To become eligible for Medicare is based on several factors. If you have lived in the United States for a period of five years and up to 65 years and above, you are eligible for Medicare.
Persons who are younger than 65 years are also eligible for Medicare under certain circumstances. Where the younger person is living with a disability or has certain diseases like Lou Gehrig’s disease, such a person is eligible
Before a person with a disability can qualify for Medicare, the disability must be permanent, and he must also be receiving disability benefits for a period not lesser than two years.
Government employees and their spouses are also eligible for Medicare, even when they do not enroll in Social Security. The reason for this is that they have been paying Medicare taxes.
The Different Parts Of Medicare
Medicare has four distinct sections. They are Medicare Part A, B, C, and D. These are the various plans that cover different health care services. When you enroll for Medicare, you are at liberty to choose the program that you want.
Medicare Part A covers hospital or inpatient services. It is important to note that it does not cover custodial care or long term stay at the hospital. It also includes nursing facilities and other forms of home health services.
Medicare Part B covers outpatient services. Visits to the doctor and other forms of outpatient services are expenses that this plan includes. It covers the use of ambulances and the use of other medical equipment. It also covers the use of preventive services and services relating to mental health. It covers the cost of running diagnostic tests.
Medicare Part C is the plan, also called Medicare Advantage. You can get the plan through private insurance companies instead of the government. With this plan, there is usually a limit on the out-of-pocket expenses you can incur. It offers additional services not covered by the others.
Medicare Part D covers the cost of prescription drugs. The Part A plan is mostly free. However, for Part B, C, and D, they require the payment of premiums.
Who Funds The Medicare Program?
There are several ways of funding the Medicare program. The first one is the government using the tax payer’s money to support the program.
Employers also fund the Medicare plan of their employees during the period of working with them. Not only does your employer contribute to it, but you also does the same thing. Self-employed persons also provide a certain percentage of their income to Medicare monthly.
How To Enroll For Medicare?
Enrollment in Medicare is either automatic or self-enrolment
Automatic registration takes place when you are already entitled to Social Security or receiving the benefits of your Railroad retirement. In this manner, you will enroll automatically in Part A and Part B of the program.
Persons who are not up to the age of 65 but are suffering from a disability get automatic enrollment into Part A and B of Medicare. It also applies to persons with Lou Gehrig’s disease.
Where your enrollment into Medicare is not automatic, you would have to enroll once your initial enrolment period begins. The period is for seven months, and it starts three months before your 65th birthday.
Failing to enroll during this period attracts a penalty. The penalty is that it leads to situations where you have to pay a higher premium continuously. However, this would not be the case where you are eligible for a particular period of enrollment.
Where a person that did not meet the criteria for automatic enrollment fails to enroll within the initial period of enrollment, such a person can still sign up when it gets to the general enrollment period, that is, from 1st January to 31st March of every year.
What Does Medicare Not Cover?
Medicare coverage does not extend to long-term hospital care. In cases where a patient needs custodial care like assistance to carry out everyday tasks such as eating, bathing, etc., the expenses will have to come out of other sources of funding, but not the Medicare coverage.
The Legal And Institutional Framework Of The Medicare Program
The Center for Medicare and Medicaid Services happens to be the body that has the responsibility of administering the Medicare program. It exists as a part of the Department of Health and Human Services in the United States. However, it is the Social Security Administration that is responsible for enrollments in the Medicare health insurance scheme.
The role of the Center for Medicare and Medicaid Services requires them to not only administer the insurance program but also to eliminate cases of Medicare fraud. To ensure that the health insurance scheme is free from all cases of fraud and abuse, they have the responsibility to gather data, examine the data and use it to arrive at reports that helps to eradicate these cases of Medicare fraud.
There have been various legislative input concerning the Medicare program. It is worthy to note the role legislative activities played in introducing reforms to the health insurance scheme. The primary goal of these reforms is to reduce the cost of Medicare.
The Patient Protection and Affordable Care Act is one of such legislative inputs that has defined the scheme. It is essential to note that one of the reforms which this piece of legislature introduced was to lower the cost of accessing Medicare.
It also had the effect of reducing what physicians working under the Medicare scheme received as payment. With this reduction, the reduced cost of Medicare became an achievable feat.
Is Medicare Different From Medicaid?
It is easy to confuse both of them since they are both health insurance programs by the government. However, it is essential to note that they are different in several ways.
Medicaid is different in its operation from Medicare. Medicare only applies to persons with low income. It is a program that has the federal government partnering with the state government to assist persons whose income level is low. Medicare, on the other hand, is purely an initiative of the Federal government and focuses primarily on persons of 65 years and above as well as persons with disabilities and certain diseases.
Persons under Medicare coverage pay for some of the costs included in the health insurance services. It is not usually the case with Medicaid where the person covered does not always bear the cost, except for some circumstances that demand a small payment from them.
There is no age restriction for the Medicaid program. It applies to persons of all ages that qualify under the low-income category. On the other hand, the Medicare program is age-sensitive. The only exception to the age requirement for Medicare applies to persons with disabilities.
One key factor about Medicaid is that due to the partnership with the state government, its application in the various states differs. However, uniform federal guidelines regulate the difference in form.
Conclusion
Seeing that the Medicare health scheme is an initiative of the federal government, it is easy to confuse it with a welfare scheme. The fact that it is also similar to the Medicaid program makes it even more complicated for some to understand the difference. The question is Medicare welfare, is in the negative. It is not the same as the Medicaid, which is a welfare program that usually does not need patients to pay for anything.
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