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Suddenly Sixty: MediCare

WHAM! What was that? It was the age of 65 hitting you in the back of the head. And why? Because you are in your mid-60’s and smack at the age of MediCare! With all of the political hoopla about MediCare for All, its good to pause and reflect on the milestone and on the meaning.

Having decided to stick with my current healthcare while I am working, it is worthwhile pondering what the costs will be for me and my family when I decide to be fully part of my age-related healthcare. There are, of course, four parts to this Federal insurance plan: in-patient hospital insurance coverage (part A), out-patient medical insurance coverage (part B), MediCare Advantage plans, which offers and alternative way to receive benefits (part C), and prescription drugs insurance coverage (part D).

Generally speaking, the different parts of MediCare help cover specific services and specific insurance plans. Most people who elect to go on MediCare choose to receive their benefits for parts A and B through “Original Medicare,” which is the traditional fee-for-service program offered directly through the US federal government. (It is sometimes called Traditional Medicare or Fee-for-Service (FFS) Medicare.) Under Original Medicare, the government pays the health care provider directly for the services you receive. Recipients can see any doctor and go to any hospital that accepts MediCare payment for services (most hospital do).

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In Original MediCare:

  • You go directly to the doctor or hospital when you need care. You do not need to get prior permission/authorization from MediCare or your primary care doctor.
  • You are responsible for a monthly premium for Part B. Some also pay a premium for Part A.
  • You typically pay a coinsurance for each service you receive.
  • There are limits on the amounts that doctors and hospitals can charge for your care.

If you want prescription drug coverage with your Original MediCare, in most cases you will need to actively choose and join a stand-alone MediCare private drug plan (PDP). Thankfully, our family has been able to thrive without many prescription medicines over the years. We will pray that that skein of successes will continue for years to come.

Unless you choose another form of payment and insurance, those 65 and older will have Original MediCare. However, instead of Original Medicare, you can decide to get your MediCare benefits from a MediCare Advantage Plan, also called Part C or Medicare private health plan. Each MediCare Advantage Plan must provide all Part A and Part B services covered by Original Medicare, but they can do so with different rules, costs, and restrictions that can affect how and when you receive care.

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It is important to understand your MediCare coverage choices and to pick your coverage carefully. How you choose to get your benefits and who you get them from can affect your out-of-pocket costs and where you can get your care. For instance, in Original MediCare, you are covered to go to nearly all doctors and hospitals in the country. On the other hand, MediCare Advantage Plans typically have network restrictions, meaning that you will likely be limited in your choice of doctors and hospitals. However, MediCare Advantage Plans can also provide additional benefits that Original MediCare does not cover, such as routine vision or dental care, which are seen as coveted parts to many plans, particularly those with families.

Speaking of families, children can stay on their parents’ family healthcare plans until their 26th birthday. So, as couples and singles have children later and later in life, the coverage of our families gets more and more important.

And the costs? Well, what is good health worth to you? How about coverage when you need it? Those will be the choices I have to face when the time comes to get fully enrolled and paying premiums for MediCare. I am glad I can push it off the actual plan cost calculation for a few more years. Perhaps a sane Federal government will be in place when that occurs.

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And MediCare for all?

At a cost of approximately $34 trillion over the next decade (which is over and above the $16 trillion the US government will be spending for MediCare during the same time period), the proposals of Bernie Sanders and Elizabeth Warren are far too costly for most citizens, particularly those who like their current healthcare providers. A more moderate healthcare model is in order. Remember: $34 trillion = $34,000,000,000,000 (that is 12 zeros after the number 34).



[1] http://www.crfb.org/papers/choices-financing-medicare-all-preliminary-analysis