The Medicare Factor in Long Term Care Planning

Medicare and Health Insurance History in the United States with a vision to provide a universal health plan, such as Medicare, the United States does not truly have a national health care plan. Even though universal health care, another name for national health care plans, has its conception in the 20th century, the United States has shied away from its inception. In fact, the United States is one of the few industrialized countries that do not offer true, the government provided universal health care.

The first private health insurance programs created nationwide was the Blue Cross plans. Originally paid by individuals on prepaid bases for certain hospitals, this was later changed to include any sponsored hospital. The individual would provide a monthly payment that ensured he cared for a specified number of days.

The Blue Shield plan was another plan created during the 1940s. It allowed the prepayment for doctor services. The plan’s creation provided an alternative to a national health care plan. The Blue Shield and Blue Cross plan eventually merged, forming what we call today Blue Cross Blue Shield.

There are varying reasons that a national health care insurance plan has not taken hold in the United States. As the American Medical Association has opposed the establishment of a national plan, the employer-sponsored insurance plan has added the catalyst to not create a national plan. Since the employers can write off the plans provided to their employees, Congress has not received any push to change the concept of employer-sponsored plans.

The closest conception of universal health care the United States institutionalized is Medicare. Medicare was created in 1965.

Then Came Medicare

So how did Medicare take hold? Though it is not a true national health care plan for everyone, only for those above 65, it is because of President Lyndon B. Johnson and a majority of Democrats in both houses of Congress that the plan came into existence.

Attempting to provide a plan comparable to the private sector, the creation of Medicare part A came into existence. By mimicking the current plans, Medicare part A provided a determined amount of hospital care. Any more care beyond what the plan stated was to be paid by the patient.

The disadvantage to a plan such as this is the increasing expense of hospital care. The costs paid by the insured are now at a level to completely destroy financially that individual. In other words, as expenses have increased with hospital care, Medicare Part A has not kept pace. Therefore, any difference in cost is paid for by the patient.

This realization gave way to catastrophic plans. These plans allow the insured to pay for some of the upfront costs up to a predetermined out-of-pocket limit. Once that is reached, the insurance pays 100% of the cost. Unfortunately, Medicare has not evolved into this type of arrangement.

To help with these cost Medicare Supplemental plans were developed.  They pay for the gaps that Medicare does not.

 

 

 

 

Understanding Medicare Supplement plans

Since 1991, Medicare supplements have remained much the same. The federal health insurance program is designed for people of the age 65 or older. The plan also extends medical care to patients with kidney failure and other disabilities. The program comprises of four parts. If you and your spouse have been working for at least ten years, then you are eligible to receive part A of the Medicare policy for free.

 

Hospital Insurance (Part A)

Based upon the state Federal laws, Part A of the Medicare coverage includes benefits of inpatient hospital admission, nursing, hospice and at home care. Also, the aspects that are exempted from service charges are decided by the state Medicare association. In fact, local care coverage is also decided by the company in each state to be able to process the Medicare. These are the health insurance bodies that decide upon the necessity of including a specific patient condition into the coverage plans thereafter sanctioning the same.

 

Medical Insurance (Part B)

The policy is available at a monthly rate as set by the current Federal governing body of the state. This part includes coverage for outpatient care, certain doctor services, preventive services, and medical supports such as supplies. Seniors are eligible to receive Part B program for free, which majorly depends on their primary income and asset levels as well. To know more about the specialist service, you could refer to Qualified Medicare Beneficiary (QMB) and Special Low Income Medicare Beneficiary (SLMB) and even country special programs cater to specific individual insurance schemes. So, you have to look into the basics of qualifying for each of these policies.

 

If you do not sign up for the policy plan when you were first eligible, it may so happen that you can join it later as long as you have opted for Part B, but in that case you will have to pay a late enrollment penalty. The monthly premium cost in such a case where you have registered for Part B plan can go as much as 10% higher for each of the 12-month month time. In case you wish to get insured under Medicare Part B policy at that time you will have to wait until the General Enrollment Period is announced. This will mean that you have to sign up for the policy from January 1 to March 31 with the coverage starting from July 1. However, you need not pay a late penalty fees if you happen to meet some specific conditions that allow you to sign up without extra charges at the time of a Special Enrollment Period.

Find more about supplement here https://www.medisupps.com/mutual-omaha-medicare-supplement-plans-2018.

Medicare Advantage Plans (Part C)

The scheme includes Medicare coverage from private insurance companies that also cover Part A and Part B benefits. There are four plans that can be obtained here – Preferred Provider Organizations (PPO), Health Maintenance Organizations (HMO), Medicare Medical Savings Account (MSA), and Special Needs Plans (SNP). For insurance coverage under the Medicare Advantage Plan, you do not become eligible for the policies under the Original Medicare. These special advantage plans mostly have prescription drug coverage included.

 

Prescription Drug Coverage (Part D)

Insurance companies and other private services both Medicare approved provide prescription drug coverage under the Original Medicare added to most of the policies such as Private-Fee-for-Service Plans, Medicare Cost Plans, and Medical Savings Account Plans.