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About Medicare & Medigap Coverage
Medicare Providers Mission
Because of the significant amount of out-of-pocket payments required by traditional Medicare, a booming market of private-sector insurance products has grown up around the government programs. These Medicare-related insurance products are one of the fastest-growing segments of the U.S. health insurance industry overall. And they are the part of the market on which a smart consumer should focus his or her attention. Medicare Providers mission is to help seniors understand these products and provide tools assist in the decision making process.
The market for private-sector Medicare-related coverages can be described as including:
A group of Medicare Supplemental plans - sometimes called "Medigap" insurance, though some industry professionals don't like that term - which, to various degrees, cover the things traditional Medicare doesn't.
Medicare Part C plans, which replace traditional Medicare with any of several managed-care style programs that require little or no out-of-pocket payments.
Medicare Part D plans, supplement either traditional Medicare or, in some cases, a Part C managed care plan.
In order to qualify for most Medicare-related plans, you must meet the standard Medicare eligibility requirements and live in the "geographic service area."
Medicare-related plans are regulated by each state and approved for sale within geographic service areas. In most cases, these areas are organized on a county-by-county basis; in some large urban markets, they're organized on a city or even neighborhood basis.
If you move out of your geographic service area during a plan's coverage term, you will usually have a Special Enrollment Period that allows you to enroll in another Medicare-related plan approved for sale in your new location or switch to back to traditional Medicare.
The number of Medicare Supplement, Part C and Part D plans available in a given area can be overwhelming. In some counties, there are at least 380 Supplement and Part C options available and at least 64 Part D options - meaning you have a "menu" of over 400 plans from which to choose.
Combine those numbers with the fact that the Feds aren't keen on making consumer information available in an easy-to-use format and you have a recipe for confusion. It's more than most people wantto know about health insurance. But the purpose of this web site is to give you the tools and information to make good decisions.
In the United States, Medicare is a national social insurance program, administered by the U.S. federal government since 1966, currently using about 30 private insurance companies across the United States. Medicare provides health insurance for Americans aged 65 and older who have worked and paid into the system. It also provides health insurance to younger people with disabilities, end stage renal disease and amyotrophic lateral sclerosis.
In 2010, Medicare provided health insurance to 48 million Americans—40 million people age 65 and older and eight million younger people with disabilities. It was the primary payer for an estimated 15.3 million inpatient stays in 2011, representing 47.2 percent ($182.7 billion) of total aggregate inpatient hospital costs in the United States. Medicare serves a large population of elderly and disabled individuals. On average, Medicare covers about half (48 percent) of the health care charges for those enrolled. The enrollees must then cover the remaining approved charges either with supplemental insurance or with another form of out-of-pocket coverage. Out-of-pocket costs can vary depending on the amount of health care a Medicare enrollee needs. They might include uncovered services—such as long-term, dental, hearing, and vision care—and the supplemental insurance.
The Specialty Society Relative Value Scale Update Committee (or Relative Value Update Committee; RUC), composed of physicians associated with the American Medical Association, advises the government about pay standards for Medicare patient procedures, according to news reports
"Medicare" was the name originally given to a program providing medical care for families of individuals serving in the military as part of the Dependents' Medical Care Act passed in 1956. President Eisenhower held the first White House Conference on Aging in January 1961, in which the creation of a program of health care for social security beneficiaries was proposed. In July 1965, under the leadership of President Lyndon Johnson, Congress enacted Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older, regardless of income or medical history. Before Medicare's creation, approximately 65% of those over 65 had health insurance, with coverage often unavailable or unaffordable to the rest, because older adults paid more than three times as much for health insurance as younger people. In 1966, Medicare spurred the racial integration of thousands of waiting rooms, hospital floors, and physician practices by making payments to health care providers conditional on desegregation.
Medicare has been in operation for a half century and, during that time, has undergone several changes. Since 1965, the provisions of Medicare have expanded to include benefits for speech, physical, and chiropractic therapy in 1972 (Medicare.gov, 2012). Medicare added the option of payments to health maintenance organizations (Medicare.gov, 2012) in the 1980s. Over the years, Congress expanded Medicare eligibility to younger people who have permanent disabilities and receive Social Security Disability Insurance (SSDI) payments and those who have end-stage renal disease (ESRD). The association with HMOs begun in the 1980s was formalized under President Clinton in 1997. In 2003, under President George W. Bush, a Medicare program for covering almost all drugs was passed (and went into effect in 2006).
Since the creation of Medicare, science and medicine have advanced, and life expectancy has increased as well. The fact that people are living longer necessitates more services for later stages in life. Thus in 1982, the government added hospice benefits to aid the elderly on a temporary basis (Medicare.gov, 2012). Two years later in 1984, hospice became a permanent benefit. Congress further expanded Medicare in 2001 to cover younger people with amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease).
Information above provided by Wikipedia