Medicare:
Medicare is a federal insurance
scheme for people who are
- aged 65 years or more
- Some people who may younger with
disabilities
- People with the last stage renal
disease (Chronic kidney failure)
Medicare is make up of following
parts such as
- Medicare Part A
- Medicare Part B
- Medicare Part C and
- Medicare Part D
How does Medicare
function:
There are two options or ways in
which it works. The ways are
- Original Medicare and
- Medicare advantage
Medicare
coverage:
Medicare coverage is generally based
on 3 main factors include
- Federal and state laws.
- National coverage decisions made by
Medicare about whether something is covered.
- Local coverage decisions made by
companies in each state that process claims for Medicare. These
companies decide whether something is medically necessary and
should be covered in their area.
Medicare Part
A:
It is part that covers hospital
insurance. Part A generally covers several hospital utilities such
as
- Inpatient hospital stays
- Skilled nursing care
- Hospice care
- Limited home health-care
services
Medicare Part
B:
It is a part which covers medical
insurance. Medical insurance include the following list.
- Doctor office visits
- Preventive services, such as
certain tests and screenings
- Flu shots
- Pneumococcal shots
- Mental health care
- Alcohol use counselling
- Chemotherapy
- Physical therapy
- Diabetes screenings, supplies, and
self-management therapy
- Durable medical equipment, such as
wheelchairs
The financing of Medicare
Part A and Medicare Part B:
- Medicare Part A
Financing: Financing for the Hospital Insurance Program is
primarily through a mandatory payroll deduction, the "FICA tax."
Currently, the FICA tax is 1.45% of earnings paid by each employee
and their employer, or 2.90% for the self-employed. The money is
paid into a trust fund that is a special account in the U.S.
Treasury. The trust fund also receives income from a portion of
income taxes levied on Social Security benefits paid to high income
beneficiaries, premiums from those who are not otherwise entitled
Medicare benefits and choose to enroll voluntarily, and interest
earnings. The taxes paid each year are used primarily to pay
benefits for current beneficiaries. The hospital insurance funds
can be used only to pay for the Medicare Part A, and Part B funds
cannot be transferred for Part A use.
- Medicare Part B
Financing: Medicare Part B is financed through general
federal revenues (72%), premiums (26%), and interest and other
sources (2%). In 2020, the standard part B premium was $144.60 per
month, but this amount increases for individuals with incomes
>$87,000 per year. The premium is usually deducted from the
Social Security benefit checks of those enrolled in Part B.