I don't mean to belabor a point with you Miami, but not everyone over 65 gets all parts of Medicare in the US. Everyone over 65 who is a citizen or has beeen a permanent resident for over 10 years gets Medicare Part A (& some younger who have certain disabilities - end stage renal disease for example) & this is at no charge for some depending on what their social security status is. Part A is hospitalization only.
Not everyone has Part B which is the medical benefit - doctor visits, immunizations among others. This part does cost the beneficiary & is dependent on their social security & other income (retirement, investment, etc...) For 2006, it started at about $89/mo & went up from there.
I've known many pts & some of my family members who do not have Part B. Some folks who have good retirement health benefits choose not to enroll in Part B.
There are always copays with Part A - the beneficiary pays the first $400 (last I checked) & must stay out of the hospital at least 60 days before they qualify for another hospitalization.
Part B benefits & copays vary - depending on the choice of plans.
Part D - the drug benefit - is endlessly variable with no uniformity of coverage, formulary or copays & can change without notice. Part D is not used by many over 65, however is used by the dually eligible. It is predicted that more of us who are under 65 will use this benefit, which will become a huge financial burden, because there are less of us who get retirement health benefits than those who are currently 65 or older.
There are also the dual insured - Medicare/Medicaid which changes the whole makeup of providers, benefits & coverage allowances & varies by state.
I have actually seen elderly folks who do not see physcians because there are areas near me where physicians don't take Medicare Part B assignments (as Kent said...you can opt out) & they don't have a secondary health insurance. So...they wait to get sick enough to go to the hospital...then their Part A kicks in...until they get discharged....cycle over & over...
These doctors choose to not be underpaid - they don't take Medicare Part B. As Kent said...they've made their choice to look at they payor mix & decided they don't want or need it. So...the elderly then have to make choices...to stay in the area or leave, which some do...
Its not as cut & dried or as uniform as you might think.