Medicare

Medicare is insurance coverage for those 65 and older. Not to be confused with Medicaid which helps those in need to afford insurance. Medicare is currently funded primarily by the payroll tax and other sources. 

There are four parts to Medicare: A, B, C, and D. 

  1. Part A: Hospital Insurance
  2. Part B: Medical Insurance
  3. Part C: Medicare Advantage Plans
  4. Part D: Prescription of drug plans 
    1. You may have heard the famous term "donut hole" when articles talk about Medicaid Part D. Basically, the insurance will cover your drugs up to a certain amount X. Once you pass that limit, you are responsible for your drugs until you spend a total amount determined by Medicaid. For 2017, you begin paying for your own drugs when you pass the limit of $3,700 until you spend a total of $4,950 in 2017. 

If you are on Medicare, then you still have to pay for premiums, deductibles, and out-of-pocket costs. Don't be fooled; it's not free healthcare. 

The biggest problem with Medicare is that the system oh just I don't know go bankrupt. Why? Well, Medicare can only survive if it has enough money to pay for insurance for everybody eligible for the program (aka >65 years old). In the future, we are expected to have more seniors than younger people.  So what is going to happen is that we won't have enough people to pay for this program. A solution that has been floating around is to increase the age eligibility. Instead of being 65 to be eligible, you would have to be 80 or older. That way more people can pay for the program. People against this solution say that it's just another form of discrimination. It's like saying "oh we can't pay for your insurance because you have a preexisting condition" except the prexisting condition is not being old enouh. 

 

Medicaid

One of the main cuts in the Senate version of the AHCA is Medicaid. Senators want to cut Medicaid = stop the expansion of Medicaid. 

So what is Medicaid? 

Medicaid is a federal and state funded healthcare program that helps cover the costs of health services for low-income people in the U.S. States manage the program and have the power to control where that money goes toward and who is eligible. 

Now, just because you are a low-income person does not necessarily mean that you are qualified for Medicaid. There are other requirements, which is why sometimes you'll see people say that they don't make enough money but don't qualify for Medicaid. There are different categories of people who are eligible for Medicaid, such as low-income seniors and pregnant women. The details for each category varies from state to state.

Still confused? Worry not, I shall explain it another way below. 

Take a football player who is trying to get drafted onto an NFL team. Now the draft is created for those who want to pursue a professional career in football just how Medicaid is created to help those who are low-income. Continuing with the football analogy, let's say that all the teams in the NFL need a quarterback but each team in the NFL has their own requirements for what their quarterback needs to be. So the 49ers might have different specifications for their quarterback than the Redskins. Just how each state defines the categories to be eligible for Medicaid. And so some teams might reject this player because he doesn't fit their needs just how some people might not qualify for Medicaid in their state because they don't fit the requirements. 

Deductible

The other big word that's thrown around in insurance plans is deductible.

A deductible is an amount you pay yourself before the insurance company picks up the tab. For example, if your deductible is $2,000, then you pay for every health service until the total amount is $2,000. From then on every time you go to the doctor is paid for by your insurance.

Now, what is the issue with deductibles? People are saying that deductibles are too high. When people say that they're saying that they are paying for overpriced healthcare services and the insurance company doesn't help at all. Remember that people have to pay a monthly premium for their insurance. 

What if people just don't pay their premiums? Then they won't have health insurance and then healthcare providers might not be willing to take care of them. 

To sum it up, people have to pay a premium, which is usually $$$, and a deductible, which is also usually $$$. This is why people end up not having health insurance/uninsured. 

Premiums

Every week, I will try to post a new vocabulary word that is commonly used in the healthcare world. 

This week's term is premiums. 

A premium is a payment, usually paid monthly, to your insurance company so that you can keep the insurance. Don't pay the premium and your insurance will go bye-bye. 

So why are premiums such a big deal in the healthcare world? Well because insurance companies keep increasing premiums. Now one would think that the higher the premium you pay the more coverage you get right? Well that isn't exactly how the healthcare world works. The common complaint is "too high premiums and not enough coverage". In fact, rising premiums is one of the factors as to why people do not have health insurance. They simply cannot afford it.