Читать книгу Making The Right Move - Gillian Eades Telford - Страница 20

Because health care in the United States is not government subsidized, many people carry private health insurance (usually through their employers or unions). If you do not have private health insurance and you have no assets, you are covered under Medicaid. Medicaid is a federally supported, state-operated public assistance program that pays for health services for people with low incomes, including elderly or disabled persons who qualify. Medicaid pays for long-term nursing facility care; some limited home health services and may pay for some assisted living services depending on the state. Medicaid pays for the care of half of the clients in us skilled nursing facilities.

Medicare is the largest insurer in the United States and insures more than 40 million people. It is a federal health insurance program for people —

• age 65 and older,

• of any age with permanent kidney failure, and

• under 65 with certain disabilities.

Medicare provides primarily skilled medical care and medical insurance under the following schemes:

• Medicare Part A is hospital insurance that helps pay for inpatient hospital care, limited skilled nursing care, hospice care, and some home health care. Most people get Medicare Part A automatically when they retire as part of their social security benefits.

• Medicare Part B is medical insurance that helps pay for doctor’s services, outpatient hospital care, and some other medical services that Part A does not cover (like home health care). You must pay a monthly premium to receive benefits under Part B. The cost in 2003 was $58.70 per month.

Medicare Supplemental Insurance (often called Medigap) is private health insurance that pays Medicare deductibles and coinsurances and may cover services not covered by Medicare. Most Medigap plans will help pay for skilled nursing care, but only when that care is not covered by Medicare.

Health maintenance organizations (HMOS), pre-provider organizations, provider sponsored organizations, and private fee-for-service organizations all contribute to Medicare-managed care plans. A professional or group of professionals from any of these organizations paid by Medicare oversees and provides medical services for the people they insure, including hospital care, home care, and long-term care. Since Medicare is a co-payment plan and rates differ depending on the services, the people they insure need to partially pay for these services. Bear in mind though, that the physicians in these organizations are the gatekeepers. To save the organization money, they can control the number of tests ordered and the type of treatment recommended. (Note: Medicare is for people 65 and older.)

Social health maintenance organizations (S/HMO) provide the full range of Medicare benefits offered by standard hmos, plus additional services. These may include care coordination, prescription drug benefits, chronic care benefits covering short-term nursing home care, a full range of home and community based services such as a homemaker, personal care services, adult day care, respite care, and medical transportation. Other services may include eyeglasses, hearing aids, and dental benefits. Membership offers other health benefits that are not provided through Medicare alone or most other health plans for elders. There are currently four s/hmos participating in Medicare: Portland, Oregon; Long Beach, California; Brooklyn, New York; and Las Vegas, Nevada.