THINGS TO KNOW IF YOU DON'T HAVE INSURANCE

Medicare was created in 1965, when Congress and President Lyndon B. Johnson expanded FDR’s social security program to include a social healthcare beneft for the elderly. Today, Medicare is the largest single health plan in the United States covering over 40 million people. By the year 2017, it is expected that over 70 million people will be enrolled in Medicare.

It is my opinion that Medicare is the best insurance plan in the United States. It offers a broad array of benefts at a very reasonable price to the enrollees. Commercial insurance companies copy everything Medicare does. All commercial insurance companies require medical providers to be Medicare certifed before they can be included in their commercial health plans. Most commercial insurers only cover services covered by Medicare. When Medicare lowers or increases payment rates, commercial insurance will do the same.

The federal government only “underwrites” or pays for services under the Medicare program. The actual administration of the program is outsourced to commercial insurance companies that serve as “fscal intermediaries” for Medicare. Fiscal intermediaries run the day-to-day logistics of beneft administration, while the federal government writes the checks. Fiscal intermediaries are middle men. Across the United States there are about a dozen insurance companies that serve as fscal intermediaries or carriers that run day-to-day operations of the Medicare program. Every few years, the federal government accepts new “bids” and the fscal intermediaries change.

Medicare has four major components lettered A-D.

1) Part A: Includes benefts for inpatient hospital care and post-acute care.

2) Part B: Includes benefts for outpatient services like physicians, imaging tests, minor surgery, etc.

3) Part C: Is called “Medicare Advantage” or “Medicare+Choice.” This is the option to enroll in special Medicare plans that are

14 // The Medical Bill Survival Guide