Overview of Health Care Coverage for Older People
Dealing with the costs of a serious or chronic disorder can be as distressing as dealing with the disorder itself. The costs are often beyond the personal resources of most people. For older people, most health care expenses are paid for by the following:
Medicare: It helps people who are age 65 or older, who are disabled, or who need kidney dialysis.
Medicaid: It helps certain people who are poor or disabled.
Other government programs such as the Department of Veterans Affairs (VA): The VA provides health care for honorably discharged veterans who meet certain eligibility requirements.
These programs are supplemented by private insurance or personal funds, including those of family members.
Understanding how Medicare, Medicaid, or other government programs work is complicated. What is completely paid for, what is partly paid for, who pays for how much of what, and how the payments are arranged can be difficult to understand. The programs change frequently, and for Medicaid, the regulations vary from state to state. The government and health care foundations provide current information about these programs on the Internet and in booklets available by mail. But part of the problem is the complexity and fragmented nature of the health care system and of the payment system for health care.
Health care can be paid for in two ways (see Financial Issues in Health Care):
Fee-for-service: Health care practitioners and institutions are paid for each hospital stay, each visit to a practitioner, each test, and each treatment.
Capitation: Practitioners and institutions are paid a fixed amount to provide health care for a specific group of people regardless of how many visits, tests, or procedures those people have or how much they cost.
Some health care plans are managed. Managed care simply means that a health care plan gives directions to health care practitioners and institutions about what care should be provided and when. These directions are intended to help ensure better, more consistent care and to control costs. Managed care can include HMOs, preferred provider organizations (PPOs), point-of-service (POS) plans, or a combination.