by Joseph Nicholson

Created on: February 05, 2009

U.S. citizens or permanent legal residents for at least five continuous years are eligible for Medicare if they are 65 years or older. Some individuals under 65 are eligible if they have been receiving Social Security benefits for at least two years. Others qualify because of their specific conditions, such as kidney failure or Lou Gehrig's disease.

Assuming one qualifies for Medicare coverage, because it is divided into four parts, signing up will vary. The first two, Parts A and B, were created by the original Medicare legislation in 1965. These provide insurance coverage to qualified individuals for care received in a hospital, or by physicians and nurses on an outpatient basis. Part C created Medicare Advantage plans, called (MAs), as part of the Balanced Budget Act, which encourage beneficiaries to seek private health insurance to which the Medicare provides premium assistance instead of reimbursement. Medicare Part D created comprehensive drug prescription plans, or PDPs.

Medicare operates according to regulations that govern private health insurance plans, who are reimbursed by the government. Thus, the details of any given plan offered under Medicare can vary widely within the regulaations. Signing up for Medicare, then, is a matter of shopping around for local offers. In many cases, the annual income of the beneficiary will also affect the premiums and copays, with very low-income beneficiaries having their costs waived or covered by Social Security, and those making above a certain threshold (about $80,000 per year for an individual) forced to pay somewhat higher premiums for their coverage.

Though there are many faults with the Medicare program, there is no doubt that it provides at least some support to the millions of seniors relying on it at least in part to meet the growing cost of their health care. Like most insurance policies, Medicare charges a regular premium and annual deductible in exchange for benefits. It doesn't provide full coverage, however, requiring a copayment of 20 percent or more in most cases. The 80 percent covered by the program is not based on the doctor's bill, but on a pre-determined "reasonable charge." If the doctor bills higher than this reasonable charge, the Medicare reimbursement will be less than 80 percent, and the copay for the patient will be higher. The law prohibits a doctor from billing more than 115 percent of the reasonable charge, though, which at least caps the potential cost for particular services.

Learn more about this author, Joseph Nicholson.
Click here to send this author comments or questions.