What is Medicare?



Medicare provision is a common inquiry to managed care specialists.

Medicare serves low-income, elderly and chronically sick patients; many of whom would not be able to pay for health care otherwise. The US Federal social healthcare insurance program covers most medical treatment and aftercare intervention. Medicare ensures that the most vulnerable citizens do not suffer financial risk associated with prolonged illness.

What is Medicare?: A National Healthcare Insurance Program

The US federal national social insurance program was established in 1965. The program is designed to take care of those who cannot pay for medical services out of pocket. Enrollees may be age sixty five plus, disabled, or patients with end stage renal disease. At present, about fifty million Americans participate in the plan in total.While most enrollees participate in the traditional Medicare at 76%; the Advantage program currently stands at about 24% enrollment.

What is Medicare?: Plans A-D

Medicare enrollees are provided defined benefits through four plans. Hospital care under Part A, with outpatient medical services met under Part B. Open-network, single payer health care plans and private practitioner network plans are available under Part C. Part D pays for prescription drugs in the private plan program. Supplemental health care costs such as dental, hearing and vision care may not be covered.

What is Medicare?: HIPAA 5010 Reporting and Medicare

The most recent New HIPAA 5010 requirements changed the content of Medicare record. Claims submitted via managed care systems now include data of patient record in response to electronic inquiries. The healthcare informatics addition to Medicare administration has required changes to managed care software, hospital systems and billing procedure used in accounting for services to Medicare patients.

New senior patients can find out “what is Medicare” at: www.seniorcorps.org For more information on Medicare benefit plans visit: www.medicare.gov



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