Medicare is a social insurance program administered by the United States government. It is set up as a single payer health care system which means that all service providers such as doctors, labs, hospitals, therapists etc, get paid from one central fund. In this case, that fund would be administered by the Social Security Administration under the supervision of the Centers for Medicare and Medicaid Services. Medicare is funded through imposed payroll and income taxes.

Medicare came into existence with the Social Security Act of 1963, when signed by President Lyndon Johnson as a way to provide medical coverage for citizens of the age 65 or older as well as those with special conditions who may qualify for these benefits before the age of 65. People who have had permanent resident status in the United States for 5 consecutive years are also eligible if over the age of 65. Those younger then 65 qualify if they are disabled and collecting social security benefits. There are some caveats to this, but this is a general requirement explanation.

Up until 2006, Medicare came as a two part health insurance plan, with those parts being called Medicare Part A, which covers in-hospital stays and Medicare Part B, which covers most other outpatient and general medical care costs, with many exceptions. In 1997, Part C was added called Medicare Advantage. This was essentially an option to add services, at a premium, through private health plans that would cover what Medicare did not. This plan comes with limits to how much can be spent per day, per month and per year. In 2006 another part was added to Medicare, called Medicare Part D. This provides for medications not covered in Part B, or Part C. It is designed and administered by private health companies and coverage is not standardized, meaning different plans will cover different groups of medication. Finding the right one can be a bit of a challenge and all of these plans come with copays, premiums and out of pocket expenses that must be met along the way.

Given how spotty Medicare coverage is on the whole there are policies called Medigap coverage that help fill in the gaps left by Medicare. Medigap policies or Medicare Supplement Policies are standardized by the Center for Medicare and Medicaid Services, but sold and administered by private health care companies. Because those who have Medicare coverage are usually retired persons with fixed income the cost of having to purchase and maintain a Medigap policy can be cost prohibitive. Some will qualify for Medicaid assistance, but most do not. More information can be found at <a rel=”nofollow” onclick=”javascript:pageTracker._trackPageview(‘/outgoing/article_exit_link’);” href=”http://www.themedigapinfocenter.blogspot.com”>The Medigap Information Center</a>.

Getting a Medigap policy is important if the following services need to be covered: Specific types of Rehabilitation

Long Term Assisted Living Care

Long Term Convalescent Care

Skilled Nursing Facility after the first 20 days of stay

Hospital stay for fewer then the covered 3 day minimum of Medicare Part A

What is covered by Medicare all parts can be quite confusing, and things are always subject to change. There are books given by the government as well as the Medigap policy issuer that help explain what is covered and what is not. There are also some great books published that work on behave of the insured and provide wonderful resources for advocacy when needed.

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