When a person grows older, he or she is usually in more demand of healthcare services and the medical bills can be an important factor to take into consideration. In USA Medicare is a federal program taking care of seniors and some individuals who have disability through health insurance. Likewise, the European Union countries have different healthcare systems which provide multiple options to the seniors, but the details of those may differ depending on the country. It is always essential to understand the Medicare working principle, what it covers, and how to make a decision on health services available to seniors, in case you reach retirement age in the nearest future. The paper will discuss what older people should know about Medicare, compare it to those of the European Union and offer practical advice to the elderly so that they could receive the optimal care possible.
What is Medicare?
Medicare is a United States federal health insurance system that is mostly used by individuals at the age of 65 and above although some may qualify even at the ages of 37 and below due to their disabilities. Medicare is a program that supports the expenditure of the medical services, like hospitals, physicians, and medications. It is segmented into various sections that cover different types of coverage and it becomes imperative of a senior citizen to be aware of the sections so as to select the plan that best fits his or her healthcare requirements.
The Medicare Parts are Different
Medicare consists of four primary parts; Part A, Part B, Part C, and Part D. All the parts provide different forms of coverage and the seniors need to know the parts as this is what aids them in choosing their plan. Medicare Part A is hospital insurance, Part B covers medical care and visit to a doctor, Part C (Medicare Advantage) is alternative to Original Medicare and Part D aids in covering the cost of the drug.
Part A Medicare: Hospital Insurance
Medicare Part A is commonly known as a hospital insurance. It enrolls inpatient hospital care, skilled nursing facility (SNF) care, hospice care, and a limited provision of home health care services. The majority of the senior population will be eligible to receive premium-free Part A provided that they have paid Medicare taxes, or their spouse has paid tax on its behalf in the course of their life. Nevertheless, Part A still includes deductibles and co-pays of using services such as a stay in the hospital and skilled nursing services. Part A is important in meeting high expenditures in hospital and inpatient care.
Medicare- Part B: Medical Insurance
Medicare Part B covers visitations to the doctor, lab tests, preventative maintenance services, and medical equipment, and other outpatient services. Part B has a monthly premium unlike Part A which may change depending on income. Part B as well contains a deductible and costs are shared between the beneficiaries in percentage called co-insurance. Part B provides access to many services like preventive care such as vaccines and screening, hence an important component of Medicare among the members who need routine services as seniors.
Medicare part C: Medicare Advantage plans
Medicare Part C is also called Medicare Advantage. It is a private health insurance plan, an alternative to the Original Medicare or Parts A and B. Medicare Advantage plans are sanctioned by Medicare but are sold by the insurance companies. These plans may also offer other benefits (i.e. dental, vision, and hearing) non-offered by Original Medicare. Prescription drug coverage can also be in the Medicare Advantage plans and thus the beneficiaries do not necessarily have to have a special Part D plan. The Medicare Advantage plans might differ in their cost structure, however, it is also necessary to review the plans with much attention so that the seniors can ascertain which form fits them better.
Medicare Part D-Prescription Drug Coverage
Medicare Part D assists in paying up the prescription drugs. Part D can be obtained through the managed Care companies approved by Medicare. Elderly persons are allowed to enroll in a standalone Part D health plan or they can use Medicare Advantage plan to get access to the prescription drug coverage. Plans on part D are different in terms of costs, drugs covered and the formulary of covered drugs and seniors should read their list of prescription drug requirements and then comparing plans that they are offered when signing up.
The Interplay between the Other Health Insurance and Medicare
Very frequently, Medicare is not completely sufficient to pay all the costs related to treatment and some seniors might possess some health related insurance protection. As an example, others seniors may have their insurance that is sponsored by employers, union or they may have Medicaid, however, all these programs can complement Medicare. When a senior is already covered by Medicare and Medicaid, then Medicaid can be used to address extra expenses not covered by Medicare, including premiums, deductibles, and co-pays. Moreover, other seniors choose Medigap which is an extra insurance policy that aids in covering gaps in the Medicare insurance cover, i.e., the co-insurance and deductibles.
Medicare eligibility
In America, the average citizens get qualified to Medicare at the age of 65. Eligible citizens must include U.S citizens or legal residents who have resided in the country not less than five years. Others below age 65 years might also be eligible to Medicare benefits depending on any disability they might be having like end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS). Seniors should ensure that they enroll Medicare at their Initial Enrollment Period which commences three months before they reach their 65 th birthday and extends to seven months.
What is the Enrollment Period Supposed to be?
The enrollment in Medicare has a time frame and any delayed enrollments will attract late fees. The Medicare Initial Enrollment Period (IEP) begins 3 months prior to the month of a citizen turning age 65 and goes on to a period of seven months. This is when people get to enrol in Part A and Part B without penalty even though they are seniors. In case of the seniors who missed this period, they might undergo the General Enrollment Period (January 1 to March 31), and this will demand a late enrollment fee and might delay their cover. It is worth mentioning here that when you are still employed and on an employer health plan, you can decide not to enroll into the Part B without incurring a penalty.
Medicare Coverage Affinities and Restrictions
Although medicare is a very comprehensive coverage, it still fails to cover all services, especially the long-term care, dental care, and vision, and hearing services. Medicare does not cover regular visits to the dentists, dentures or glasses checkups and so seniors may require other insurance policies to cover these costs since Medicare does not cover costs. Also, Medicare lacks in covering the long-term custodial care that is normally required by the elderly who need somebody to help them perform their day to day activities like, bathing, changing and feeding them. Elderly persons in need of future care ought to take supplemental cover.
Medicare in EU
As opposed to the United States where Medicare is the main health insurance coverage required among the elderly, several European Union nations offer universal or semi-universal health care systems where every citizen is entitled to the health insurance cover, even the seniors. Seniors in some countries such as United Kingdom, France and Germany are usually entitled to public medical care which covers most of their medical care needs including specialist aid, hospitalization and general doctor check ups. There is certain diversity among the EU countries regarding covered services and the level of coverage, yet, in general, EU countries take care of seniors in a comprehensive manner.
Public System of Health Insurance in the EU: Seniors
The EU countries have predominately publicly-funded healthcare systems, which covers the citizens (and the elderly ones as well). Such systems are tax-supported or paid through social insurance and the elderly who have no problems with paying insurance premiums or out-of-pocket expenses may enjoy a variety of healthcare services. As an illustration, senior citizens in the United Kingdom can access healthcare services using the National Health Service (NHS) that provides free healthcare services at the point of use. In such a manner, in such countries as France and Germany, older citizens have an opportunity to use different health services utilizing the state insurance programs. The EU has a considerable number of countries, which have public healthcare systems that cover a significant part of a medical care like the stay in the hospital, visits to the doctor, and prescriptions.
Senior EU Private Health Insurance
Although the EU has government-funded health programs that offer a wide scope of services, most of the elderly decide to buy privately sponsored health insurance to cover the gaps. The EU private health insurance can enable access to healthcare services more swiftly, offer greater selection of physicians and cover services other than those covered by the public health system: dental and vision. Private insurance can help increase access to treatments faster in the case of countries with prolonged waiting lists to elective procedures. But the price of the insurance provided by a direct insurance may be very different because of the country, the degree of coverage, and the insurance company.
EU Medicare By Expatriates
In the case of the expatriates in the United States, seniors residing in the European Union, the scenario may be different as far as health insurance is concerned. The residents of the EU may not have an automatic right to coverage as the U.S. expatriates living in the EU may need a different residency status. Some countries, like France or Germany, can have options by offering that expatriates could have access to the public healthcare system under certain conditions so they could receive healthcare on a state-funded basis, but this is not always a case in other countries where expatriates might require some means of covering their health insurance, either with a private company or through a national health insurance. Part B of Medicare is another option that some U.S. expats might like to buy, but covers care and services only in the United States and its territories, and such individuals might have to fill the gap with private insurance in the EU.
Public Health Insurance Eligibility to Seniors in the EU
In the majority of countries that form the European Union, at the moment when a person reaches his retirement age he/she becomes automatically entitled to the publicly supported state healthcare. Each country stipulates different eligibility criteria but in general, older people who have resided and worked within EU will gain first access to healthcare services within the national system. The seniors may be required to make some payments with regard to the social insurance to the public system in some countries, and some of those others may be employed without fees being charged. Also, there is a possibility of elderly getting benefits or discount in certain EU countries in healthcare services including being given co-pays or given free prescriptions.
Private and Public Health Insurance on the Elderly in the EU
European citizens also have the freedom to pick, whether they want a public or a private health insurance scheme and this is according to their wishes and health needs. Most health insurance systems in the form of public health insurance provide broad coverage of a majority of the healthcare services, but when the same is undertaken in the form of private health insurance, then it can be found that it may provide quicker access to care, a greater array of specialty care providers and also other services such as dental healthcare and eye healthcare. The people who are happy with the existing system funded by the government may not need the private one whereas others seeking faster service or more services can benefit with the help of the private insurance. A good decision should be made after weighing against the costs and benefits of the two alternatives.
Navigating the U. S Medicare System
The use of Medicare is rather confusing even to new enrollees. The U.S. government has various resources that assist the seniors in knowing about their Medicare plans which include the official Medicare site, toll-free helplines and local Medicare offices. Seniors are recommended to be conversant with the various components of Medicare (Part A, Part B, Part C, and Part D) and find out which plans are most appropriate to their medical conditions. Moreover, it is necessary to note that elderly people must know the significant dates, including the Initial Enrollment Period and the Annual Enrollment Period so that they are not late with enrolling (or switching) their plan.
Retirement Healthcare Planning
It is also important that seniors plan their healthcare costs in retirement since the medical expenses may turn into a major financial problem. Although Medicare can support numerous healthcare services, it does not cover all of them, and out-of-pocket expenses may be large. Seniors need to consider the expenses cooperated by premiums, deductibles, co-pay and prescription drugs when planning retirement. Depending on how willing they are to pay, some of the elderly people might take an insurance cover called Medigap, which covers Medicare gaps otherwise left by the Medicare cover, others may assist themselves with the help of their own medical covers called private health insurance and the long term care insurance.
The Future of Health Insurance and Medicare to the Seniors
The future of Medicare and senior health insurance in the U.S and EU remains uncertain since the governments still grapple with the aging population and the increasing costs of health care. The debate of reforming Medicare to make it more sustainable has gone on in the U.S with suggestions to reorganize eligibility, benefits and mechanisms of funding, have been proposed. These demographic changes are also putting pressure on healthcare systems in the EU and much research is going on in a variety of countries in order to find ways to make sure that getting high-quality healthcare remains a possibility even to the seniors. The elderly should take note of any possible changes to health insurance programs and adopt their plans accordingly.
Conclusion
Senior health insurance is a very important aspect of ensuring a healthy and secure life even at old age. In the U.S and in the EU, the key to getting through the complexities of healthcare at retirement is to know how the health insurance schemes such as Medicare operate as well as what the options are regarding possible supplementary plans. Seniors should remember to produce a balance between the cost of health insurance and their need and chose the one which suits them and the most, they should make use of all possible financial resources in order to acquire the insurance which they require. With diligence and awareness, elderly people can only be sure that they will get the healthcare services which will enable them to lead healthy and productive lives.