Access to Care Medicare Is

Access to Care Medicare is a publicly funded health insurance program that gives health care coverage and access to those who are either of the age sixty-five an over or who meet other special criteria. President Lyndon B. Johnson signed the Medicare Act into law in 1965 as an amendment to existing Social Security statutes. Former President Harry S. Truman was given the status as being the first Medicare beneficiary.

The Medicare system is administered by the Centers for Medicare and Medicaid Services, part of the Department of Health and Human Services. Eligibility requirements are administered by the Social Security Administration. Medicaid is finances by both payroll taxes of the wages, salaries and other compensation of an employee, and by governmental funding. Although benefit premiums are highly subsidized, the United States government spends approximately $256.8 billion annually on the Medicare program. Medicare was established in order to assist individuals with the costs of healthcare. Typically this includes retired, senior citizens.

Because the typical senior citizen requires more health care treatment at a higher costs, and they traditionally have a lower amount of disposable income, coupled with the fact that they have no employer-provided health insurance, Medicare fills in this gap by providing highly subsidized and thus affordable health insurance. A typical scenario under the Medicare system will be an individual over the age of sixty-five goes to a health care treatment provider for an ongoing condition.

Like any healthcare insurance program, the patient will show the hospital administration their Medicare card and thus will receive treatment at a discounted, or subsidized, rate. The amount not paid by the patient him or herself is paid by the government, through the Medicare system. Medicare also has a prescription drug program that was established to assist senior citizens with the rising costs of prescription drugs by subsidizing the costs of some necessary drugs.

In general, to be eligible to receive Medicare benefits, the individual or their spouse must have worked for at least ten years in a Medicare-covered employment, have reached the age of at least sixty-five years old, and be either a citizen or permanent resident of the United States of America. However individuals under the age of sixty-five may still be eligible to receive Medicare benefits if they are determined to be, according to the Social Security Administration, permanently disabled or are suffering from end stage renal disease.

In order to receive Medicare benefits under the disability exception to the eligibility requirement, the individual must be receiving disability benefits from either the Social Security Administration or the Railroad Retirement Board for at least twenty-four months. After the twenty-four-month waiting period, the disabled individual will be automatically enrolled into the Medicare program. Today, over 42.6 million American's are covered under the Medicare program. With the baby boomer generation quickly approaching the sixty-five-eligibility age, this number is expected to grow to over seventy-seven by the year 2031.

A person who is covered by the Medicare program become eligible to receive certain, specific healthcare benefits. Under the original Medicare legislation, this included both Hospital Insurance and Medical Insurance. In January of 2006, Medicare was amended to include Medicare Part D, whose provisions provide comprehensive drug coverage. Under Medicare Part a, a patient can have their hospital stays covered by Medicare.

According to the plan, Medicare will also pay for a stay in a skilled nursing facility so long as this stay is proceeded by a hospital stay of at least three days and the nursing home stay is for the purpose of something diagnosed during the hospital stay or the main cause of the hospital stay. For example, if one goes to the hospital as a result of a broken hip, then their stay at a nursing home for subsequent physical therapy of the hip will be covered.

Further, if the patient is not receiving rehabilitation-orientated treatment but is suffering for other ailments that do require the skills of a nurse, then a stay at a nursing home will be covered by the Medicare program. Further, in order to be covered by Medicare, the stay at the nursing home must include care that requires skilled nursing. In other words, Medicare will not cover custodial, non-skilled or long-term care that includes activities of daily living, such as cooking, cleaning and hygiene.

A stay at a skilled nursing facility under Medicare is limited to one-hundred days per ailment. Medicare will pay for the first twenty days in full. The remaining eighty days requires the patient to pay a co-payment of approximately $124.00 per day. Under Medicare Part B, Medicare will provide medical insurance to a qualified individual.

This coverage includes physician and nursing services, x-rays, laboratory and diagnostic testing, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital treatment, some ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments and other outpatient medical care treatments as administered in a physician's office. However, medication administration is only covered by Part B if it is administered by a doctor during the course of an office visit.

Under Medicare Part B, a qualified individual may also receive assistance with durable medical equipment, including canes, walkers, mobility scooters and wheelchairs so long as they have a properly diagnosed mobility impairment. Prosthetic devices, including artificial limbs, post-mastectomy breast prosthesis, eyeglasses after a cataract surgery, and home use oxygen are also covered by Medicare. As a limitation to benefits, Medicare benefits per Part B are subject to medical necessity. Thus, Medicare provides complex rules governing the management of benefits.

Regularly advisories are published that serve as guidelines to what is and what is not covered and what criteria should be utilized in determining coverage. Under the provisions of Medicare Part C, qualified individuals were given an opportunity to become part of a Medicare Advantage plan. The essence of this part of the Medicare system was to give qualified beneficiaries the option to receive Medicare benefits through a private health insurance plan as opposed through either Medicare Part a or Part B.

In 2006, prescription drug coverage was added to Medicare coverage as Part D. Any individual who is eligible to receive benefits under either Part a or.