A Primer On Medicare Summary

Tyler Joseph
6/11/15
A Primer on Medicare Summary

As the Medicare program approaches its 50th anniversary, it continues to provide health and financial security for people ages 65 and older and younger people with permanent disabilities. This health insurance covers over 55 million people, helping individuals to pay for many vital health care services, preventive services, and post-acute care. Though this program offers a lot, it did not begin like this. Numerous changes have been made over time in order to expand benefits, strengthen quality, and improve access and coverage for low-income individuals, giving this program the prestigious name it holds today. The benefits that Medicare offers are divided into four parts, Part A-D. Each section

People age 65 and older qualify for Medicare if they are U.S. citizens or permanent legal residents with at least five years of continuous residence. Most people who are eligible for Part A do not need to pay premiums for covered services. However, people age 65 and older are required to pay a monthly premium to receive Part A benefits if neither they nor their spouse made payroll contributions for 40 or more quarters. Medicare Part B is voluntary, but more than 90 percent of beneficiaries with Part A are also enrolled in Part B. For most individuals who become entitled to Part A, enrollment in Part B is automatic unless the individual declines enrollment. Individuals may choose to enroll in Part C if they are entitled to Part A and enrolled in Part B. Lastly, to get Part D benefits, beneficiaries must enroll in a stand-alone prescription drug plan or Medicare Advantage prescription drug

Depending on what section you’re enrolled in depends on how much the individual will pay. For Part A, beneficiaries do not pay a monthly premium but are required to pay a deductible before Medicare coverage begins. In 2015, the Part A deductible for each “spell of illness” is $1,260 for an inpatient hospital stay. Beneficiaries are generally subject to coinsurance for Part A benefits, including extended inpatient stays in a hospital ($315 per day for days 61-90 and $630 per day for days 91-150). Beneficiaries enrolled in Part B are generally required to pay a monthly premium ($104.90). Plan C enrollees generally pay the monthly Part B premium and many also pay an additional premium directly to their plan. Lastly, Part D enrollees pay a monthly premium, along with cost-sharing amounts for each brand-name and generic drug prescription. As far the cost of expenses that Medicare pays for their services, Medicare benefit payments totaled $597 billion in 2014; one-fourth was for hospital inpatient services, 12 percent for physician services, and 11 percent for the Part D drug benefit. Medicare also is second largest in terms of the share of federal spending on each program. Federal spending spent $3.5 trillion dollars last year, Medicare took up 14% of that. Both beneficiaries and Medicare paying for these services can be