What is Medicare?

In this era of rapidly rising medical, pharmaceutical and insurance costs, the American people and Congress are talking a lot about Medicare. Medicare is the federally-funded medical plan for Americans age 65 and over that covers medical expenses such as doctor’s visits, hospital stays, drugs and other treatment. The need for a medical program for senior citizens became evident in the 1950s, but it was not until 1965 that Congress passed the laws that established Medicare. The law was amended in 1972 to include people with disabilities and end-stage renal disease.

with many government programs, wading through the Medicare jungle can be confusing at best. Even insurance agents may not know all the ins and outs of dealing with Medicare, what it will cover and what it will not, or which doctors accept Medicare and which won’t. It’s a true labyrinth.

Essentially, all Americans are eligible for Medicare when they turn 65. There is an initial enrollment period for seven months after one’s 65th birthday, when one can enroll in Medicare for free. After the enrollment period, someone who decides he wants Medicare may be subject to enrollment fees and penalties. Special enrollment periods may apply, but these are also complicated to navigate. Then, the senior citizen must decide whether to enroll in Medicare Part A only, which offers basic Medicare coverage, or also in Part B, which offers supplemental coverage. Some seniors who are covered by their company’s group health insurance, or their spouse’s, may decline to enroll at all, or may just decide to enroll in Part A since it is cheaper.

Some Medicare coverage is administered by HMOs, which means a private company is paid by the federal government to administer Medicare. The debate over HMOs has raged for several years. Some seniors may receive better care under an HMO, while for others, the benefits may not be as good as a federally-managed plan. It all depends on the HMO and the state where the senior lives. Each state has a different way of dealing with Medicare.

Medicare reform issues have plagued Congress for several years, and a reform bill with a prescription drug benefit was passed in 2003. Because of the changing needs of senior citizens and rising medical costs, this is an issue that Congress will probably continue to wrestle with for many more years. It is difficult to create a “one-plan-fits-all” system.

A senior citizen picking his way through the Medicare jungle will probably need help. This may come in the form of an educated insurance agent or through classes that are available in many communities. There are also numerous resources on the Internet to help a senior citizen find her way. Medicare is complicated — with many exceptions, provisions, rules, limitations, and so forth — making it seemingly impossible to unravel. The wise senior citizen will get assistance long before the time comes to enroll in Medicare.