Should you have taken the big decision to move across the pond, to the Land of Hope and Dreams in search of a better life, then you’re probably already well aware of the question of healthcare.
Due to its complexity, however, it’s unlikely you’re well aware of the answers to that question. Today, we’re exploring just one facet of healthcare in the US; medicare.
In short, medicare is a form of social welfare that was introduced in 1962. The idea was to offer healthcare protection for seniors and receives (retirees) over age 65 who could not afford it on their terms. The program is funded by the U.S. government and has a long history of major changes over time to keep itself relevant and to keep up with the current standards in healthcare for all ages.
For non-citizens, medicare is available in some instances. If you are eligible for or presently receive Railroad Retirement Benefits (RRB), Social Security Disability Insurance, or Social Security Retirement benefits, you will be eligible for Medicare even if you are not a citizen of the United States (SSDI). You are eligible for Part A with no premiums in any of these scenarios.
But just what is Part A, and the other categories? Let’s explore a little further…
Terminology: Medicare Parts A & B
Medicare is divided into several parts, with each providing a different set of services. Part A, also known as hospital insurance, covers inpatient hospital stays, skilled nursing facility care, hospice care, and home health care services. Most individuals who have paid Medicare taxes for at least ten years are eligible. As we previously mentioned, if you qualify for Social Security or Railroad Retirement benefits, you will automatically be registered in Medicare Part A.
Part B, also known as medical insurance, covers outpatient care, such as doctor visits, preventive services, and medical equipment. It also covers some services that Part A doesn’t cover, such as physical therapy and prescription drugs. You are eligible for Part B if you are 65 or older or have certain disabilities. This applies to both US citizens and non-citizens.
Medicare Advantages
In addition to Parts A and B, there is also Medicare Advantage (Part C), an alternative to Original Medicare. Private insurance firms offer Medicare Advantage plans that include all of the benefits of Parts A and B and extra benefits such as dental, eye, and hearing coverage. Some plans also include prescription drug coverage.
As illuminated by the team at medicarenationwide.com, one advantage of Medicare Advantage is that it usually has lower out-of-pocket costs than Original Medicare. However, your choice of healthcare professionals and hospitals may be limited, and you may require referrals from your general care doctor to see specialists.
Prescription Drug Coverage
Medicare Part D provides prescription drug coverage. It is offered by private insurance companies and is available to individuals with Medicare Part A or Part B. Part D covers most prescription drugs, including those used to treat chronic conditions such as diabetes, heart disease, and cancer. However, not all drugs are covered, and there may be restrictions on the amount of medication you can get at one time.
Medicare Supplement Insurance
Medicare Supplement Insurance, or Medigap, is private insurance that can help pay for some out-of-pocket costs associated with Medicare. Medigap coverage aims to fill in the gaps left by Medicare Parts A and B, such as deductibles, copayments, and coinsurance. They can also provide coverage for services that Medicare doesn’t cover, such as medical care received outside of the United States.
Private insurance firms sell Medigap policies, which are standardized statewide. This means the benefits you receive under a Medigap policy will be the same, regardless of which company you purchase it from.
What Medicare Doesn’t Cover
While Medicare provides comprehensive coverage for many healthcare services, there are some things that it doesn’t cover. These include long-term care, dental care, eye exams for eyeglasses, cosmetic surgery, and acupuncture. You must pay out of pocket or through private insurance if you require these services.
Medicare also has certain coverage limits. For example, it may only cover a certain number of inpatient hospital care days or physical therapy sessions. If you need more care than what Medicare covers, you must pay for it yourself.
Eligibility
To qualify for Medicare, you must be a U.S. citizen or a permanent legal resident living in the U.S. for under five years – the latter of which you may fall under as a UK citizen. Your Initial Enrollment Period (IEP) begins three months before your 65th birthday and concludes three months afterward. You may pay the penalty for the length of your Medicare coverage if you fail to enroll during your IEP.
If you did not enroll during the Initial Enrollment Period, you could enroll between January 1 and March 31 each year during the General Enrollment Period. If you sign up during the General Enrollment Period, your coverage will begin on July 1 of the following year.
Challenges Facing Medicare
One challenge is the sustainability of the program’s funding. Policymakers have proposed various solutions to address this issue, such as increasing payroll taxes or reducing benefits.
Another challenge is the rising cost of prescription drugs, particularly for enrollees in Part D coverage. The program’s structure can incentivize drug manufacturers to set high prices, and enrollees are often responsible for a significant portion of the cost. Legislators have proposed various solutions, such as allowing Medicare to negotiate drug prices or capping enrollee out-of-pocket costs.
In addition to these challenges, there are ongoing debates about how to improve the program overall. Some think that Medicare should be expanded to cover all Americans, while others argue that it should be modified to be more efficient and effective.
The Bottom Line
Despite these challenges and debates, Medicare remains a critical program for millions of Americans as well as those expats negotiating the country, from the UK and other countries. It provides access to necessary healthcare services and has helped to reduce poverty and improve health outcomes for older adults and those with disabilities.
*This article is not intended to replace medical advice, diagnosis or treatment given by a qualified health professional, either in the US or the UK. Neither does it constitute legal or financial advice. Instead, this article only provides information, not advice. For any medical or dietary enquiries, always consult your GP first*