Medicare is a federal social insurance program that covers health insurance.
What Is Medicare?
According to Statista, Medicare is a, “federal social insurance program introduced in 1965.” It is offered to eligible individuals, partially covering their insurance. The availability of Medicare has resulted in a steady increase of 13% of Americans receiving coverage in 1990 to 18% of Americans receiving coverage in 2019. It has been reserved for individuals 65 and over and disabled persons.
Individuals who qualify for Medicare are able to access 2 types of Medicare support, which according to Medicare.gov are Medicare and Medicare Advantage. Furthermore, Medicare can be combined with other insurance for those who qualify. Medicare does not cover full healthcare costs but offers partial coverage available in varying parts. Examples of coverage range from medical visits, to alcohol withdrawal care and prescription medications, to mental health services.
Enrollment occurs automatically once an individual reaches 65 and they can access both Part A (which covers hospital visits) and Part B (which covers medical visits) and requires a payment of a monthly premium for all the months the individuals will be needing Part B coverage.
Who Is Eligible?
Medicare eligibility occurs in Parts A (hospital insurance) and B (medical insurance). It was traditionally reserved for people 65 and older and disabled persons. As of late, Medicare coverage has included older and disabled people, but has recently included individuals suffering with End-Stage Renal Disease. Those eligible must also be a U.S. citizen. According to HHS.gov, those eligible for Part A are those who are 65 and older and their spouse has been working and paying for Medicare taxes for at least 10 years.
Individuals over 65 years old can get Medicare without paying premiums. Furthermore, they can qualify for premium-free Medicare if they meet certain criteria:
You have received retirement benefits from the Railroad Retirement Board.
You or your spouse have received Medicare-covered governmental insurance.
You have received retirement benefits from Social Security.
Part D covers prescription drugs; Part D has individual premiums. Lastly, individuals over 65 can qualify for Medicare if they have received Social Security disability insurance and have waited 2 years. For more eligibility coverage, connect to HHS.gov or Medicare.gov.
For inpatient mental health coverage, for example, Part A does have a deductible of $1,484 per year that is required to be paid in order to activate the coverage Part A offers. Secondly, the patient pays $0 coinsurance from days 1 to 60; days 61-90, they pay $371 coinsurance each day benefit period; $742 coinsurance per every “lifetime reserve day” for anything exceeding 90 days for every benefit period.
Medicare Advantage: What Is It?
Medicare Advantage (or MA plans) is another option for those who want Medicare. This alternative plan covers insurance for services and conditions that are not covered in the Original Medicare plan. The Medicare Advantage plan is offered by private insurance companies and are often bundled with Medicare plans. According to Medicare.gov, patients can expect to have Part A which covers hospital insurance, Part B, which covers medical insurance, and Part D, which offers coverage for the medication (including alcohol withdrawal or treatment medications). Other coverage includes:
Over the counter medication.
Transportation to doctor’s offices for visits.
Fortunately, some Medicare Advantage plans have no premium, although some charge different costs out of pocket. Costs for the Medicare Advantage plans vary on factors, including but not limited to:
The type of treatment needed.
If your plan has a yearly deductible.
If you receive state funding or receive Medicare.
Individuals seeking more information about costs for Medicare Advantage can access Medicare.gov to see the breakdown for costs and plans.
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What Medicare Covers
Medicare covers health conditions. Parts A and B cover different elements of health care. Part A covers inpatient nursing home stays and hospital stays, and home healthcare. Furthermore, it covers surgeries and lab tests. If a patient with Medicare battles alcohol abuse and is hospitalized, he or she can receive coverage if the hospital accepts it.
For Part B, Medicare covers “medically necessary” and preventive services, home healthcare, inpatient and outpatient care for mental health services, medical equipment, some outpatient prescription drugs, and clinical research. Part D covers prescription medication and medication for substance abuse, including medication for alcohol withdrawal.
Medicare Coverage For Alcohol Addiction Treatment
Part B allows for individuals with Medicare to get alcohol screenings once a year free of charge. Such people must be an adult and does not have to struggle with alcohol abuse. Additionally, he or she can get counseling if there is a problem with alcohol abuse, with Medicare covering 4 brief one-on-one sessions for free. Fortunately, Medicare also covers inpatient and outpatient care for those facing substance abuse. For alcoholism, for instance, individuals can access Medicare for coverage under the following guidelines:
The provider sets up the plan of care.
Your provider believe the services are necessary in a medical context.
The services you get are Medicare-approved.
Additional alcohol-treatment related Medicare coverage includes:
Individual or group therapy.
Outpatient treatment medication.
Prescription drugs administered during a hospital visit or in a doctor’s office.
Some drugs may not be covered. To get more information, contact your local Medicare office to inquire.
Get The Treatment You Deserve
Individuals battling alcoholism who meet the requirements for Medicare have several options for coverage. Elderly alcoholism can be extremely devastating to the mind and body of those who endure it. Still there is hope. If you or a loved one faces alcoholism, contact a treatment provider to inquire how Medicare can cover you.
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