What you need to know about Medicare

Medicare is the national health care program aimed at people who are over 65 years of age, people who receive Social Security Disability, for the first two years of a transplant part A only), and various other situations that may arise when deemed necessary. But this does not mean all medical costs are covered.

The people who control Medicare and decide what will be covered obviously have never had to deal with any of the situations frequently involved with its recipients. Medicare pays 80% of the cost they deem appropriate for the service rendered. For example if the doctor charges $100 for a visit Medicare may decide that the doctor should only charge $75 and thus pay the 80% of the $75 leaving the patient to pay the rest. The same rule applies to hospital costs; and with rooms running in excess of $1,000 per day the amount left for the patient to pay can be rather high. Needless to say bills can add up quickly. There are programs available to help cover the left over costs but they can be expensive and are only for seniors.

Among the rules Medicare applies to decide what a client may need is bizarre at best. Medicare will not cover any cost for equipment that is used outside of the home. For example if a client can get around the home with little or no difficulty but requires a mobility aid (cane, walker, scooter, etc.) to get around outside of the home Medicare will not pay for the mobility aid. However; they will pay for a man’s Viagra prescription. Medicare will also not cover bath aids (items to help a person in taking a bath in their own bath tub or shower) because Medicare considers this to be a luxary. It was proven that during the plague the people who took baths and kept clean did not get sick and survived; yet Medicare considers a bath to be a luxary item.

Medicare is designed for people who are older and/or have disabilities yet their policies do little to help these same people. When a client needs a new eyeglasses Medicare will only buy them once and that is only when the client has had cataract surgery with lens implants. Anyone else is out of luck and cannot get a new pair of glasses.

But even with the rules and restrictions Medicare has in place fraud is a problem. Companies charge more than the cost of the item or make clients pay the 20% charge before Medicare determines the cost. Clients have health service providers get them a new piece of equipment even when the one they have is still in very good order just because Medicare says they can get a new one. For example, Medicare will pay for a new wheelchair every five years. For some clients who are active this is needed, but for someone who goes out little and is not active a wheelchair can last much longer and will not need replacing but because they can get a new chair they want a new chair; and usually get it.

On the other hand if someone receives help from Social Services, receives Social Security Supplemental Income, or is an alien then they can receive Medicaid which will pay for all of these things and much more. Medicaid unlike Medicare will cover ALL medical costs. Medicaid is also a programs that is run by the federal government.