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What Is Medicare And What Doesn’t It Cover?!

By Jason Markum

Health insurance is mind numbingly confusing in the best of circumstances. Under the worst circumstances it’s impossible to understand and extremely frustrating, even downright impossible to deal with.

Many people believe that when they get older, that is to say, when they become senior citizens; they will no longer have to worry about health insurance problems because Medicare will take care of them… at least that’s what they think!

The problem is, most people know as much about Medicare as they do about their regular health insurance… which is to say, they don’t know much of anything! In this article today I’m going to discuss in a little detail what Medicare is and shed a light on some of the things that it does not cover that you need to know about as soon as possible.

First off what is Medicare? It’s different than Medicaid which is a federal program that gives medical coverage for poor people of all ages. Time and time again we see older people forced into Medicaid when they’ve used up all of their money and sold all their worldly possessions paying for the things that Medicare doesn’t provide. It’s truly a tragedy in this country, but I digress.

Medicare is an insurance program that was set up for people who are over 65 years old. The federal government pays for it through the Social Security Administration, which is something many people don’t know. What you do is pay insurance premiums every month to regular insurance companies like Blue Cross/Blue Shield. Those insurance companies act as a sort of intermediary between you and the government.

One of the main problems with this setup is that private insurance companies will always and have always acted on their own best interest. What this means is many times they will deny claims for Medicare. Now there is a watchdog agency that’s supposed to look out for things like that called the professional standards review organization.

The problem with that is that it’s a government agency and they don’t want to spend any more money than they have to either! So there’s a sort of wink and nod system some people might say between this agency and private insurance companies. Neither of them want to pay more than they have to!

So what does Medicare not cover… these things change from year to year but generally speaking it won’t cover custodial care. It also has hospital cutoffs which is a pretty big problem. Many times elderly people need longer care in hospitals and Medicare will not pay for it.

I’d like to end this article with a list of solutions for you to get around this problem; the problem is, I don’t have any solutions… and I don’t know anybody else who does either. I suppose the only solution is to become obscenely wealthy when you are young so that you can pay for the medical care that you need when you get older. Of course this is hardly feasible for 98% of the population who aren’t multimillionaires and for you guys, unfortunately, I don’t know what the solution is.

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