Medicare Facts

Medicare Facts That You Should Know if You Are a Medicare Participant

For people who are 65 years or older, or younger people with disabilities, or people with End-Stage Renal Disease (ESRD), Medicare plays a vital role in their lives. Medicare facts is the federal health insurance program for these kind of people. Without health insurance, their lives will be difficult and personal finances will slowly disappear. Thus, if you are a person who is looking forward for the Medicare’s benefits now or in the future, you need to learn some facts about Medicare. These facts will guide you, so you can get the most of its benefits and services. Here are some ideas:

  • In 2011, the Congressional Budget Office gave approximate 15% share of the federal budget to Medicare to provide health insurance to elderly and disabled Americans across all income levels.
  • In 2010 statistics, 50% of Medicare beneficiaries had low incomes that is below 22,000 dollars. Income that includes Social security, pension, earnings and other sources.
  • Medicare does not cover the cost of a nursing home or other long-term care services and supports. Medicare provides coverage for up to 100 days in a skilled nursing facility following an inpatient hospital stay. It also provides home health services in some circumstances.
  • Statistics show that generally there are 9 out of 10 medical beneficiaries suffer with one or more chronic conditions. In 2008, forty five percents (45%) of Medicare beneficiaries have three or more chronic conditions, such as diabetes, arthritis, or osteoporosis. The most common chronic diseases are hypertension and arthritis which affects 61 % to 64% of the Medicare beneficiaries.
  • Medicare program does not place an annual limit on out-of-pocket spending for inpatient hospital, physician visits, and other medical services covered under Medicare Parts A and B. However, starting 2011, Medicare put a limit on Part D prescription drug plans. The most out-of pocket expenses should not exceed to $6,700 per year. It will include spending for deductibles, copays, and coinsurance for outpatient and hospital-related services (Medicare Parts A and B)
  • Medicare beneficiaries are entitled to pay the same premium regardless of their income. In 2012, Medicare charges most beneficiaries the same Part B premium for physician and outpatient services – about $100 per month. However, higher-income beneficiaries with annual incomes over $85,000 and couples with annual income over $170,000 are required to pay higher. In 2012, they were required to pay between $140 to $320 per month depending on their income. For low income beneficiaries, they can apply for Medicaid eligibility.
  • Medicare spending is expected to grow slower from 2010 to 2019 compared to private health insurance companies, per beneficiary. This low growth rate is because of the 2010 health reform law. It includes reductions in annual payment updates to hospitals and other health care providers and reductions in payments to Medicare Advantage plans.
  • In 2011, 25% of Medicare population has a Medicare Advantage plan. Advantage plans is the Medicare Part D premium. Health Maintenance Organizations (HMO), and Preferred Provider Organizations (PPOs) are the plan types under the Advantage plan. It is reported to have nearly 12 million of the 49 million people under Medicare Advantage plan.
  • The new health reform law is looking forward to close the “doughnut hole” as they describe it. The doughnut hole is referring to the prescription drug or Medicare Part D that usually keep the seniors from buying it so they will not exceed to a certain amount. If you hit the doughnut hole in 2011, you’ll receive a 50 percent discount on brand-name drugs and a 7 percent discount on generic drugs. Since 2010, the new health care law has started to close the gap and will gradually decrease by 2020 up to 25 percent. The same share they pay on average prior to reaching the gap.

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