How Does Medicare Work?
Medicare is a public-private partnership. It is run by the Centers for Medicare and Medicaid Services(CMS-previously HCFA) within the Department of Health and Human Services. Much of the day-to-day work is done by intermediaries (for Part A) and carriers (for Part B). These are generally commercial insurers. There are two parts of the Medicare program: Part A – Hospital Insurance (HI) Part A helps to cover the costs of hospital, skilled nursing facility, home health and hospice care. Part A benefits are provided automatically to all individuals who are eligible. Part A is financed primarily by payroll taxes based on covered work, both before and after one becomes eligible for benefits. • Deductible of $764 per each Benefit Period (1998) • Copayment of $191 a day for the 61st through the 90th day, per Benefit Period (1998) Part B Supplementary Medical Insurance (SMI) Part B helps to cover the costs of physician and outpatient services. While Part B coverage is optional, 95 percent of th
How does Medicare work? Answer: Medicare uses what s called the “outpatient prospective payment system” to pay for most outpatient services covered by Medicare Part B in the Original Medicare Plan. The Medicare benefits system: • Covers outpatient services you receive in a hospital or a community mental health center • Determines how much you pay and how much Medicare pays for outpatient services. Depending on the type of service you get and where you get the service, your out-of-pocket costs may change from year to year, even for the same service. • Lowers your out-of-pocket costs over time. This will save you money. Under the Medicare benefits payment system, you get outpatient services the same way you would get them with other types of health insurance. You can receive services from any hospital or community mental health center that participates in the Medicare program.
In 1965, Congress established a federally-funded health insurance program that provided healthcare benefits to senior citizens (65 years of age or above), disabled people (younger than 65) and folks of any age with end-stage renal disease (permanent kidney failure). CMS (The Centers for Medicare and Medicaid Services) is the name of the organization, which manages Medicare. But it is the Social Security Offices, which enroll applicants to join this program and also provide detailed information about it. Medicare has been designed to act as an adjunct to other kinds of health care insurance coverage. Most of the Americans qualify for Medicare as soon as they turn 65, but they need to have contributed in the form of “Social Security Taxes” for at least ten years. Medicare coverage can be categorized into four parts namely Part A, Part B, Part C and Part D. Medicare Part A is commonly known as “Hospital Insurance or HI” and provides basic health care coverage.
Medicare is our country’s health insurance program for people age 65 or older. In some cases, people younger than age 65 can qualify for Medicare. Those who have disabilities and those who have permanent kidney failure or amyotrophic lateral sclerosis (Lou Gehrig’s disease). The program helps with the cost of health care, but it does not cover all medical expenses or the cost of most long-term care. Medicare is financed by a portion of the payroll taxes paid by workers and their employers. It also is financed in part by monthly premiums deducted from Social Security checks. The Centers for Medicare & Medicaid Services is the agency in charge of the Medicare program. The Centers for Medicare & Medicaid Services (CMS) administers Medicare, the nation’s largest health insurance program, which covers nearly 40 million Americans.
