U.S. Medicare Health Insurance Information

Author: Disabled World (DW)
Updated/Revised Date: 2025/03/06
Category Topic: U.S. Medicare System (Publications Database)

Page Content: Synopsis - Introduction - Main - Subtopics

Synopsis: Medicare is a health insurance program for persons age sixty-five or older, persons under the age of sixty-five years with certain disabilities. Medicare Part A Insurance assists in covering inpatient hospital care to include critical access hospitals, and skilled nursing facilities; although it does not cover either custodial or long-term care. Medicare Part A Insurance assists in covering hospice care, as well as some home health care.

Introduction

U.S. Medicare was established in 1965, authorized under Title XVIII of the U.S. Social Security Act, and is available to people who fall into three categories. Most people become eligible for Medicare by virtue of attaining age sixty-five.

Focus

U.S. Medicare is a health insurance program for persons age sixty-five or older, persons under the age of sixty-five years with certain disabilities, as well as people of any age with End-Stage Renal Disease. U.S. Medicare has three kinds of insurance within the program:

• Part A involves Hospital Insurance.
• Part B involves Medical Insurance.
• Part D provides a level of Prescription Drug Coverage.

Medicare is associated with the U.S. Social Security Administration.

Part A Hospital Insurance

The majority of people do not pay a premium for Part A Hospital Insurance because either the person themselves or a spouse has already paid for the coverage through their payroll taxes while working. Medicare Part A Insurance assists in covering inpatient hospital care, to include critical access hospitals, and skilled nursing facilities; although it does not cover either custodial or long-term care. Medicare Part A Insurance assists in covering hospice care, as well as some home health care. Persons with Medicare Part A Insurance must meet specific conditions to receive these benefits.

Part A covers:

• Inpatient hospital services, up to 90 days per "spell of illness"
• Skilled nursing facility services for up to 100 days per spell of illness following a 3+ day hospital stay
• Home health care, up to 100 visits per spell of illness following a 3+ day hospital stay
• Hospice care
• Inpatient psychiatric care, for up to 190 days during a beneficiary's lifetime
• Blood (after the beneficiary pays for the first 3 pints (1.42 liters) per year)

For each "spell of illness," beneficiaries have a $912 deductible for an inpatient hospital stay of 1-60 days and daily coinsurance starting the 61st day. If they use a skilled nursing facility for more than 20 days in a spell of illness, they must pay $114 per day for days.

Part B Medical Insurance:

The majority of people do pay a monthly premium for Part B Medical Insurance. Medicare Part B Insurance assists with coverage of doctors' services, outpatient care, as well as some additional medical services that Medicare Part A Insurance does not cover; for example, some services of physical and occupational therapists, or some home health care services. Medicare Part B assists in paying for covered services and supplies when they are deemed medically necessary.

Part B covers:

• Physicians' services, including office visits and a one-time physical examination for new beneficiaries
• Durable medical equipment (e.g., wheelchairs, oxygen) and supplies
• Outpatient hospital services
• Outpatient mental health services
• Clinical laboratory (e.g., blood tests, some screening tests, etc.) and diagnostic tests
• Outpatient occupational, physical, and speech therapy
• Home health care not preceded by a hospital stay and visits over the 100-day Part A limit
• Some preventive services (e.g., mammograms, diabetes screening)
• Blood (after the beneficiary pays for the first 3 pints (1.42 liters) per year)

Beneficiaries have an annual deductible of $110. In addition, most Part B services require coinsurance of 20 percent of the Medicare-approved amount.

Medicare Part D Prescription Drug Coverage

The majority of people will pay a monthly premium for Medicare Part D Coverage. Beginning on January 1, 2006, Medicare Part D Coverage became available to everyone with Medicare coverage to assist with prescription drug costs. Private companies provide the insurance; beneficiaries can choose among drug plans and pay a monthly premium. As with other forms of insurance, if a person decides not to enroll in a plan when they are first eligible, they may pay a penalty should they decide to join at a later time.