Medicare is the national health insurance program in the United States. If a person is 65 or older he or she can get Medicare insurance coverage. The Centers for Medicare and Medicaid Services manage Medicare and divide services into parts A, B, C and D. Medicare Part A helps pay if a person needs hospital care. Medicare Part A covers inpatient treatment, limited medical care at home, skilled nursing facility (SNF) stays, and some home health visits (Centers for Medicare and Medicaid Services. Medicare program: General information). Inpatient treatment at the hospital includes services such as nutrition, nursing services, physical therapy and medications. Medicare Part B covers some of the costs of doctor visits, medical equipment, diagnostic examinations and preventive cervices (Kaiser Family Foundation). Medicare Part D covers the costs of prescribed medication which is especially relevant if costly drugs for outpatient treatment are needed.
Medicare Part C or Medicare Advantage covers the services of Parts A and B, and even, in some cases, D. Depending on the plan a person chooses, it may also cover prescribed medications, dental and ophthalmology services. Most of these plans work through doctors “online” or the attending physician who manages a person’s treatment.
There are some services that the original Medicare program usually does not cover. Sometimes a person has private insurance that can pay for these services, or he pays for them out of his or her pocket. These services include plastic surgery, prostheses, glasses or contact lenses, adjusting or checking hearing aids, long-term care, most dental services as well as day-today foot care (Kaiser Family Foundation). Moreover, in case of serious injuries, if the hospital needs to get special blood for a patient, it may not be covered by Medicare.
Medicare and Medigap are private insurance options that cover a wider range of services than those provided by basic plans A and B Medicare. Medicare Advantage plan is “a private health plans, such as a health maintenance organization (HMO) or preferred provider organization (PPO)” (Kaiser Family Foundation, 2019, para. 6). Medigap is the program of additional (to Medicare) health insurance among the elderly financed out of their personal funds. It is issued only by private insurance companies licensed by the state government. The medigap system reimburses expenses for medical services, the payment of which is not provided for by the federal state Medicare program. Medigap does not pay for certain types of medical expenses such the cost of glasses, hearing and cosmetic operations, dental care, services of a psychiatrist, a nurse to care for a patient to maintain vital functions, medications not prescribed by a doctor. The difference between Medigap and Medicare Advantage lies in the choice of clinics and treatment options available for a person. While Medicare Advantage is usually less costly, Medigap allows a wider choice of clinics and more flexibility in treatment.
Personally, I would not enroll into Medicare Advantage or Medigap plan because I find them too costly for a limited number of services they provide. Indeed, they usually do not cover such essential parts of treatment for an older person as oral care or glasses and hearing aids. The plans are helpful in case expensive operations or very costly medication is needed since there is a limit of money a person pays for these services with these plans. In other cases, I believe it would be better for me to spend money on visiting a good dentist or ophthalmologist than to enroll into these plans.
When I am 65, I will enrol into Medicare coverage programme. My likely out-of-pocket coverage costs in the given case are presented in table 1.
Thus, my total costs are likely to be about $10000 a year excluding the medication I will need to buy in the outpatient treatment period. Medicare Part D may cover the medication costs and the price of it will depend on the plan and pharmacy I choose. Moreover, oral care that most older people need is not included in the calculations. Additional costs should be considered in case I need to visit a dentist. My out-of-pocket costs are more than I expected because the knee replacement is rather costly. However, since it is a planned operation I believe I can save the money for it and outpatient treatment after the operation. In addition, I will enroll into Medicare plan D that will allow me to cover the cost of medication I need in outpatient treatment.
References
Blue Cross Blue Shield Association. Web.
Cubanski, J., & Boccuti, C. (2015). Medicare coverage, affordability, and access. Generations, 39(2), 26-34.
Kaiser Family Foundation. (2019). An overview of Medicare. Web.
Medicare.Gov.
Centers for Medicare & Medicaid Services. (2019). Medicare current beneficiary survey.
Centers for Medicare and Medicaid Services. (2019). Medicare program: General information. Web.