Did you know that chronic diseases in America are the leading cause of death and disability? Annually, the government and taxpayers collectively pay nearly $4 trillion to cover the costs of diagnosing, treating, and preventing chronic diseases.
Because 60 percent of adults suffer from a chronic illness such as Alzheimer’s or Diabetes, and 40 percent of adults have two or more, the federal government has to provide financial assistance to help citizens deal with the burdens of mounting healthcare costs. So, after decades of legislative pushes to get a federal insurance provision passed, President Lyndon B. Johnson signed a bill that led to Medicare and Medicaid in 1965.
Today Medicare is defined as the federal health insurance program that covers all Americans who are: age 65 or older, less than 65 years of age but suffer from chronic disabilities, or those with End-Stage Renal Disease. In 2021, nearly 1 out of every 3 Americans (well over 100 million people) are on the federal social entitlement program.
While the initial plan only included Hospital Insurance and Medical Insurance, seven years later, Medicare was expanded to cover anyone with chronic disabilities such as ESRD (End Stage Renal Disease) that requires dialysis or a transplant, and everyone over the age of 65. Today, Medicare covers 21 chronic conditions listed below.
● Alcohol Abuse
● Alzheimer’s Disease and Dementia
● Atrial Fibrillation
● Autism Spectrum Disorders
● Cancer (Breast Colorectal, Lung, and Prostate)
● Chronic Kidney Disease
● Chronic Obstructive Pulmonary Disease
● Substance Abuse
● Heart Failure
● Hepatitis (Chronic Viral B & C)
● Ischemic Heart Disease
● Schizophrenia and Other Psychotic Disorders
Today Medicare is broken down into two main buckets, each offering different coverage, and each has its own cost. The two main buckets are aptly called Part A (hospital insurance) and Part B (medical insurance). For those that qualify (age over 65, or if you have End Stage Renal Disease), there is no monthly premium for Part A coverage. However, Part B does have a monthly premium based on income, and a deductible one services are rendered.
But what exactly do federal entitlements like Medicare or Medicaid cover? The extent has changed over the years. For example, with those who had Chronic Kidney Diseases in Stages 1-4 may not receive coverage for treatment options. However, those who have ESRD receive coverage in full that includes inpatient and outpatient dialysis treatments, home dialysis equipment and training, and dialysis when you travel in the United States in certified facilities.
Another example is Diabetes, which affects more than 34 million Americans (roughly 11 percent of the population). While general Medicare insurance covers glucose lab screenings, doctors visits, and in many cases equipment to monitor appropriate levels.
However, Medicare does not cover the cost of insulin (unless an insulin pump is ‘medically necessary’), insulin pens, syringes, needles, or cleanup supplies like swabs and gauze.
Meanwhile, annual insulin costs for roughly 8 million Americans are nearly $6,000 per person, and climbing annually.
Medicare also has sweeping preventative and diagnostic coverage for both inpatient and outpatient mental health care. Part B covers one depression screening a year, individual and group psychotherapy, family counseling, life coaching, and more. Additionally, once the deductible has been met, Part A covers up to 60 days for inpatient mental health care treatment at no additional cost.
Unfortunately, the bureaucratic loopholes make it difficult to understand what is or is not covered by Medicare or Medicaid. Luckily, the Medicare.gov site has a tool that can help! The “Is my service covered?” knowledge base should help you gain a better understanding as to how extensive your coverage is based on your chronic condition. If that doesn’t help, you can also contact your doctor for more information.
Susan Baker is a guest author that writes about a wide array of topics but specializes in medical copywriting and covering topics on health insurance. When she’s not traveling or adventuring, she’s staying safe at home with her two dogs.
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