Medicare Frustrations

Angela Muki - Tuesday, July 16, 2013 | Comments (0)

Traditional Medicare is a national medical insurance program administered by the United States government to guarantee health insurance to Americans age 65 and over.  The cost of this insurance varies dependent upon income and the selected insurance coverage, and does not include all medical services.  The program is viewed as essential to the health of all Americans and was set in place by the federal government to insure access to needed health care.  

Prior to Medicare, individuals were denied medical insurance based solely on age.  Those who were lucky enough to have employer-sponsored insurance coverage were often eliminated from the benefit upon retirement, only to also find that the private insurance companies had no interest in offering coverage to an older, and considered riskier, individual.

Medicare was enacted and signed into law by President Lyndon Johnson in the spring of 1965 under Title 18 of the Social Security Act.  As President Johnson signed the papers formally enacting the law he said, “No longer will older Americans be denied the healing miracle of modern medicine. No longer will illness crush and destroy the savings that have so carefully been put away over a lifetime so that they might enjoy dignity in their last years”.

So it’s no wonder that too many seniors and caregivers are frustrated and surprised to find that Medicare does not cover all cost and that a beneficiary still has to pay monthly premiums, deductibles, and co-pays for many services, along with premiums for supplemental policies if selected.  Medicare does not cover services that many are accustomed to receiving in the private insurance sector:  routine dental care; vision, hearing and foot care; and long-term care.  

The rule of thumb for insurance coverage adequacy in the United States private sector is between 75 and 80 percent of a household's health care expenses.  Health care expense coverage for Medicare beneficiaries averages only 50 to 60 percent.  Because their coverage is more limited, beneficiaries face greater out-of-pocket expenses.  

Medicare does provide guaranteed health coverage.  Nevertheless, Medicare covers only about half of a beneficiaries’ total health costs.  

To read more about Medicare coverage and how it works, check the federal government’s Centers for Medicare and Medicaid Services (CMS) website and AARP’s website

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