America’s population is aging. The cost of caring for aging adults is increasing in both time and money. Two programs are in place to assist with the provision of health care for older adults. One is Medicare, which is available to individuals 65 years of age and older as well as to people under 65 with certain disabilities, including those with End-Stage Renal Disease.
The Medicare system, with its guidelines, provider networks, rules and regulations, supplemental plans and other details, can be confusing. It is important that Medicare beneficiaries and their families and caregivers understand what benefits and coverage Medicare provides.
Medicare was created in 1965 as a form of health care coverage for qualifying individuals. A qualifying individual:
- Is 65 years of age or older and has worked 40 or more quarters in Medicare-covered employment, or
- Is 65 years of age or older and has a spouse who has worked 40 or more quarters in Medicare-covered employment, or
- Is a person under age 65 with certain disabilities or End-Stage Renal Disease.
Medicare covers some 44 million older adults and disabled Americans.
Medicare is administered by the Centers for Medicare & Medicaid Services (CMS). For many Americans Medicare is their only source of health insurance. It is not, however, all-inclusive in its coverage. It also has premiums, deductibles, and other costs associated with it.
There are several parts of Medicare that are important for individuals and their caregivers to understand. These include the choices an individual makes regarding Medicare coverage. These decisions involve whether to enroll in Original Medicare, which includes two parts, Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), or Medicare Advantage, which includes Medicare’s Managed Care Plans. Beginning in 2006, Medicare introduced Medicare Part D, voluntary prescription drug coverage offered through private companies.
