, , , ,

I recently accepted a job offer from a one of the biggest healthcare insurance companies in the country (Blue Cross and Blue Shield) after being laid off from a much smaller health insurance company called Total Health Care, which is located in downtown Detroit. I work in the Medicare Advantage (Medicare Part C) department. Before this opportunity arrived upon my door step, I only worked with commercial plans, and that was in the realm of marketing for them. So Medicare and Medicaid was completely alien to me. Shortly after being employed with my current employer, i developed a deep appreciation for Medicare services and benefits deliver towards one of our vulnerable segments of our society, the elderly. In this short blog i will attempt to explain the history and the benefits of government based services.

History of Medicare:

Governmental healthcare programs has been a topic of contention dating back to the days of President Teddy Roosevelt. Its been political decisive for the country for many decades. Many on the right side of the spectrum believe healthcare insurance programs that are controlled by the government can create a “slippery slop” that leads to universal healthcare, which would wreck the healthcare market place. ThePresident that is credited with idea of a national health plan is Truman. President Truman wrote a letter to Congress on November 19, 1945 informing them that he wanted to create a national healthcare fund for all American. This plan was suppose to cover individuals for hospital services. Unfortunately, his plan laid in limbo for 20 years until President Kennedy took up the mantel of nation healthcare coverage.

President Kennedy came across an interesting study which found that “56 percent of Americans over the age of 65 were not covered by health insurance” (Anderson, 2016). This study sparked his passion for helping the elderly. Shortly afterwards he created a push for a national healthcare plan. His assassination prevented him from realizing his dream. President Johnson was finally able to birth Medicare into existence on July 30, 1965. Today, Medicare continues to grow, it now serves 55.5 million Americans by providing them with health coverage, that they might not of been able to afford if it wasn’t for the hard work of previous Presidents. The retirement of the baby boomer generation has created an explosion of benefits being paid out. Kaiser Family Foundation stated that benefits paid in 2013 amounted to 583 million, with was almost 14% of the federal budget for that year. Medicare is now broken down into four different parts. Part A, B, C (Medicare Advantage) and Part D.

Medicare Part A:  

When you hear the term Original Medicare, it is referring to Medicare parts A and B. Medicare A is hospital insurance. This covers Medicare inpatient care, including care received while in a hospital, a skilled nursing facility, and, in limited circumstances, at home. It is free if you have worked and paid Social Security taxes for at least 40 calendar quarters (10 years); you will pay a monthly premium if you have worked and paid taxes for less time.

Medicare Part B:

Medicare part B is the medical insurance coverage. This cover services that are deemed medically necessary from medicare. This includes outpatient services, lab tests, mental health coverage,  x-rays, and durable medical equipment (DME). You have a monthly premium for this.

Medicare Part C:

Medicare part C is a provided by a private health insurance agency. It is known as Medicare Advantage. The health plans come in two different options, HMOs and PPOs. Medicare Advantage follows the same billing guidelines as original Medicare, this means they providethe same benefits as parts A and B. The incentive for enrolling in Medicare Advantage is the enhanced benefits they come with. Contact your local Medicare Advantage provider for list of enhanced benefits. You will also have a monthly premium for this option.

Medicare Part D:

This is prescription drug coverage.  Medicare’s drug benefit (Part D) offers outpatient prescription drug coverage for anyone with Medicare. It is only available through private companies. For this benefit you have to be enrolled in a Medicare Advantage plan or a stand along prescription drug plan (PDP).