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* Medicare Health Insurance is a single-payer, national social insurance program administered by the U.S. federal government since 1966. Currently using about 30–50 private Medicare Health insurance companies across the United States under contract for administration. Medicare is funded by a payroll tax, premiums and surtaxes from beneficiaries, and general revenue. It provides health insurance for Americans aged 65 and older who have worked and paid into the system through the payroll tax. It also provides health insurance to younger people with some disability status as determined by the Social Security Administration and people with end stage renal disease and amyotrophic lateral sclerosis.
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The Two Parts of Medicare Health Insurance
By [http://EzineArticles.com/expert/Julie_Wise/438795]Julie Wise
Medicare health insurance in the United States has been causing quite a stir in the political landscape. This is because of the changes and the recent addition of the prescription drug plan. Originally, Medicare was created as a means to afford health insurance for adults over the age of 65, provided that the person is eligible for Social Security. That means that the person was able to make contributions for a minimum of ten years wherein the deduction for Social security payments from their salary was made. The ten years minimum does not have to be ten consecutive years and can be non-consecutive.
After sometime, people with certain permanent disabilities and those with severe kidney disease or end stage renal disease (ESRD) are able to enjoy the Medicare benefits as well. To be able to take advantage of the Medicare coverage benefits for people with ESRD or with permanent disabilities, they should be able to fulfill the definition of ESRD and permanent or totally disabled individuals, as defined by the Social Security Administration. It is without a doubt that the Medicare health insurance became one of the vital means for many Americans to pay for their health care, and its main coverage actually has two parts.
Hospital insurance is the popular term for the first part of Medicare health insurance or Medicare Part A. US citizens who are qualified for Medicare benefits are often entitled with the Part A coverage, even without them paying for a monthly premium. This is because they were able to pay it already via their Social Security withholdings. This part of Medicare health insurance includes the coverage for hospital stays, rehabilitation as well as other skilled nursing services, home health care if needed, therapies for physical, occupational and speech, medical equipment and the hospice care for a terminally ill patient, which include the support services and the drugs for pain relief and symptom treatments.
The other part or Medicare Part B is often referred to as Medical Insurance. Here, there is a monthly premium where patients must be able to meet the annual deductible before they can take advantage of the benefits. This includes insurance coverage for doctor's appointment if found medically necessary. Other inclusions are the outpatient medical as well as surgical services, some medical equipments and diagnostic tests. It does not cover regular routine check-ups, except for the one-time routine check-up performed on the onset of the Medicare health insurance.
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Article Source: [http://EzineArticles.com/?The-Two-Parts-of-Medicare-Health-Insurance&id=5938760] The Two Parts of Medicare Health Insurance
By [http://EzineArticles.com/expert/Julie_Wise/438795]Julie Wise
Medicare health insurance in the United States has been causing quite a stir in the political landscape. This is because of the changes and the recent addition of the prescription drug plan. Originally, Medicare was created as a means to afford health insurance for adults over the age of 65, provided that the person is eligible for Social Security. That means that the person was able to make contributions for a minimum of ten years wherein the deduction for Social security payments from their salary was made. The ten years minimum does not have to be ten consecutive years and can be non-consecutive.
After sometime, people with certain permanent disabilities and those with severe kidney disease or end stage renal disease (ESRD) are able to enjoy the Medicare benefits as well. To be able to take advantage of the Medicare coverage benefits for people with ESRD or with permanent disabilities, they should be able to fulfill the definition of ESRD and permanent or totally disabled individuals, as defined by the Social Security Administration. It is without a doubt that the Medicare health insurance became one of the vital means for many Americans to pay for their health care, and its main coverage actually has two parts.
Hospital insurance is the popular term for the first part of Medicare health insurance or Medicare Part A. US citizens who are qualified for Medicare benefits are often entitled with the Part A coverage, even without them paying for a monthly premium. This is because they were able to pay it already via their Social Security withholdings. This part of Medicare health insurance includes the coverage for hospital stays, rehabilitation as well as other skilled nursing services, home health care if needed, therapies for physical, occupational and speech, medical equipment and the hospice care for a terminally ill patient, which include the support services and the drugs for pain relief and symptom treatments.
The other part or Medicare Part B is often referred to as Medical Insurance. Here, there is a monthly premium where patients must be able to meet the annual deductible before they can take advantage of the benefits. This includes insurance coverage for doctor's appointment if found medically necessary. Other inclusions are the outpatient medical as well as surgical services, some medical equipments and diagnostic tests. It does not cover regular routine check-ups, except for the one-time routine check-up performed on the onset of the Medicare health insurance.
Looking for a medicare health insurance [http://healthinsurancedeals.org/health-insurance/medicare-health-insurance/]?
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Article Source: [http://EzineArticles.com/?The-Two-Parts-of-Medicare-Health-Insurance&id=5938760] The Two Parts of Medicare Health Insurance
Understanding Medicare
By [http://EzineArticles.com/expert/David_Hecker/209240]David Hecker
What Is Medicare?
Medicare is a national, tax-supported health insurance program for people 65 and over and some persons with disabilities. If you or your spouse have worked full time for 10 or more years over a lifetime, you are probably eligible to receive Medicare Part A (Hospital Insurance) for free. Medicare Part B (Medical Insurance) is available at a monthly rate set annually by Congress ($121.80 in 2016 for incomes $85000.00 or less for an individual). Some seniors are eligible to receive the medical insurance portion (Part B) free as well, depending on their income and asset levels. For more information, inquire about the Qualified Medicare Beneficiary (QMB), Special Low Income Medicare Beneficiary (SLMB), and Qualifying Individual programs through your county social services office.
How Does Medicare Work?
Medicare is actually two separate types of insurance--hospital and medical. It is not intended to cover all your medical expenses. Hospital insurance (Part A of Medicare) covers medical treatment and surgical procedures performed in a hospital. It also covers hospice, home health, and limited skilled nursing care. Medical insurance (Part B of Medicare) covers part of the cost of doctor bills, outpatient care, medical equipment, and lab and diagnostic tests. With the Medicare modernization act of 2003, Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Coverage), also became available, through private insurance companies.
How Do I Get Medicare?
If you are receiving Social Security benefits prior to turning 65, you should automatically receive notification of your enrollment in Medicare shortly before your 65th birthday. Other individuals must apply by calling or visiting their Social Security office to receive Medicare. If you are not yet receiving Social Security or if you have not received a Medicare enrollment notice, you should contact the nearest Social Security office for information. Applications for Medicare can be made during a seven-month period beginning three months prior to the month of your 65th birthday. IT IS BEST TO APPLY DURING THE THREE MONTHS PRIOR TO THE MONTH OF YOUR 65TH BIRTHDAY. If an application is made during that time, coverage will begin on the first day of your birth month. Applying later will delay the start of your benefits. You can also apply for Medicare from January 1 through March 31 every year after your 65th birthday. Your coverage then starts July 1 of the year you signed up and you will pay a 10 percent surcharge on the Part B premium for each 12 months you were eligible but not enrolled.
What If I Am Still Working? If you continue to work after age 65 or your spouse is working and you are covered by an employer group health plan (EGHP), you may want to delay enrollment in Part B of Medicare. Enrolling in Medicare Part B will trigger your open enrollment for Medicare supplement insurance at a time when you do not need supplemental coverage. The penalty for late enrollment in Part B does not apply if you are covered by an EGHP because of your or your spouse's current employment. If you do work after age 65, you may apply for Medicare Part B at any time prior to retirement, but you must apply no later than eight months after your formal retirement in order to avoid paying a premium penalty. Even if your employer offers a retirement health plan, you will want to sign up for Medicare Part A and probably for Medicare Part B when you retire. Most retirement plans assume you are covered under Medicare and will not pay for services that Medicare would have covered. Veterans may be eligible for special medical programs. However, eligibility and benefits are very restrictive and are subject to change. The Department of Veterans Affairs advises veterans to apply for both Parts A and B of Medicare to ensure adequate medical coverage.
What About Costs Medicare Does Not Cover? Medicare pays for only a portion of hospital and medical bills. As with many private insurance plans, the government expects beneficiaries to pay a share of their bills. Medicare Parts A and B both have deductible and coinsurance requirements. The deductibles for 2016 are $1288.00 per Benefit Period, for Part A. The Part B deductible is $166.00 per year. Private insurance is available to cover all or some of these out-of-pocket costs. These insurance plans are called Medicare supplements (also called Med Sup or Medigap plans).
Medicare Supplement Insurance
Medicare Supplements are standardized by the Federal Government. They are lettered A, B, C, D, F, G, K, L, M & N. Each standardized Medigap policy must offer the same basic benefits no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies. Plan A pays the Medicare hospital and physician coinsurance, the first three pints of blood, and 365 days of hospitalization beyond Medicare. Plans B through N provide these benefits and add further benefits such as coverage for Medicare deductibles, excess charges and limited preventive care, and foreign travel. ONLY ONE MED SUP PLAN IS NECESSARY. You should only buy one Med Sup plan. No one should try to sell you an additional Med Sup plan unless you decide you need to switch policies.
Open Enrollment in Medicare Supplement Insurance At age 65, all consumers - including those already receiving Medicare due to disability - have a six-month "open enrollment" period. For six months beginning when you are both age 65 or older and enrolled in Medicare Part B, companies must sell you any Medicare supplement plan they offer. After this limited open enrollment period, companies can pick and choose whom they will cover. Other Options If you have an individual or "bank group" insurance policy, becoming Medicare eligible does not require you to cancel it and purchase a Medicare supplement. Doing so may save premium costs but it is important to compare benefits before deciding what will work best. If you are eligible for employer retirement insurance, review the plan carefully to understand what benefits are available and how it works with Medicare. Be aware that employer plans are not standardized and are not subject to the requirements governing standardized Medicare supplement policies. Some Texas residents are eligible to enroll in approved Medicare Advantage plans. These plans are offered by private insurance companies. Each year Medicare Advantage companies decide where they will offer their plans, what benefits will be offered, and what the premiums will be. There are several Medicare Advantage plans available in several counties in East Texas. Depending on plan choice, a member may be responsible for paying co-payments for certain covered services.
Should I Purchase Long-Term Care Insurance?
In the past, families often stepped in to help when older family members were no longer able to care for themselves. Today, with older people living longer, families often living long distances apart and more women working outside the home, fewer families are able to provide this care. A wide range of long-term care services is now available--day care, respite care, home care, and nursing care. These services are expensive and often exceed a person's ability to pay. People often mistakenly assume that Medicare will cover their long-term care costs. MEDICARE ONLY COVERS LONG-TERM CARE UNDER VERY, VERY LIMITED CIRCUMSTANCES.
Many Texas residents are eligible for Medicaid payment of their long-term care bills. Medicaid is a medical assistance program for people with limited income and assets. Eligibility is determined by the local county social services office. Private long-term care insurance is an option for people to consider, particularly if they have assets they wish to protect. You should not buy this type of insurance unless you can afford to pay the premiums every year. Remember, long-term care insurance premiums can and often do go up. Long-term care plans are not standardized like Med Sup plans. Therefore, it is very important to shop around and compare benefit options and cost.
David Hecker is a Licensed Insurance Agent based in Longview TX. He specializes in Medicare Products. He is licensed in Texas, Louisiana and Arkansas. He can be reached at (903) 918-9091. E-mail: [mailto:[email protected]][email protected] or on the web at: [http://www.tx-medicaresupplement.com/]http://www.tx-medicaresupplement.com To receive your Free e-mail newsletter about Medicare Supplements, send an e-mail request to: [mailto:[email protected]][email protected] Not connected with or endorsed by the United States government or the federal Medicare program.
Article Source: [http://EzineArticles.com/?Understanding-Medicare&id=1889202] Understanding Medicare
By [http://EzineArticles.com/expert/David_Hecker/209240]David Hecker
What Is Medicare?
Medicare is a national, tax-supported health insurance program for people 65 and over and some persons with disabilities. If you or your spouse have worked full time for 10 or more years over a lifetime, you are probably eligible to receive Medicare Part A (Hospital Insurance) for free. Medicare Part B (Medical Insurance) is available at a monthly rate set annually by Congress ($121.80 in 2016 for incomes $85000.00 or less for an individual). Some seniors are eligible to receive the medical insurance portion (Part B) free as well, depending on their income and asset levels. For more information, inquire about the Qualified Medicare Beneficiary (QMB), Special Low Income Medicare Beneficiary (SLMB), and Qualifying Individual programs through your county social services office.
How Does Medicare Work?
Medicare is actually two separate types of insurance--hospital and medical. It is not intended to cover all your medical expenses. Hospital insurance (Part A of Medicare) covers medical treatment and surgical procedures performed in a hospital. It also covers hospice, home health, and limited skilled nursing care. Medical insurance (Part B of Medicare) covers part of the cost of doctor bills, outpatient care, medical equipment, and lab and diagnostic tests. With the Medicare modernization act of 2003, Medicare Part C (Medicare Advantage) and Medicare Part D (Prescription Coverage), also became available, through private insurance companies.
How Do I Get Medicare?
If you are receiving Social Security benefits prior to turning 65, you should automatically receive notification of your enrollment in Medicare shortly before your 65th birthday. Other individuals must apply by calling or visiting their Social Security office to receive Medicare. If you are not yet receiving Social Security or if you have not received a Medicare enrollment notice, you should contact the nearest Social Security office for information. Applications for Medicare can be made during a seven-month period beginning three months prior to the month of your 65th birthday. IT IS BEST TO APPLY DURING THE THREE MONTHS PRIOR TO THE MONTH OF YOUR 65TH BIRTHDAY. If an application is made during that time, coverage will begin on the first day of your birth month. Applying later will delay the start of your benefits. You can also apply for Medicare from January 1 through March 31 every year after your 65th birthday. Your coverage then starts July 1 of the year you signed up and you will pay a 10 percent surcharge on the Part B premium for each 12 months you were eligible but not enrolled.
What If I Am Still Working? If you continue to work after age 65 or your spouse is working and you are covered by an employer group health plan (EGHP), you may want to delay enrollment in Part B of Medicare. Enrolling in Medicare Part B will trigger your open enrollment for Medicare supplement insurance at a time when you do not need supplemental coverage. The penalty for late enrollment in Part B does not apply if you are covered by an EGHP because of your or your spouse's current employment. If you do work after age 65, you may apply for Medicare Part B at any time prior to retirement, but you must apply no later than eight months after your formal retirement in order to avoid paying a premium penalty. Even if your employer offers a retirement health plan, you will want to sign up for Medicare Part A and probably for Medicare Part B when you retire. Most retirement plans assume you are covered under Medicare and will not pay for services that Medicare would have covered. Veterans may be eligible for special medical programs. However, eligibility and benefits are very restrictive and are subject to change. The Department of Veterans Affairs advises veterans to apply for both Parts A and B of Medicare to ensure adequate medical coverage.
What About Costs Medicare Does Not Cover? Medicare pays for only a portion of hospital and medical bills. As with many private insurance plans, the government expects beneficiaries to pay a share of their bills. Medicare Parts A and B both have deductible and coinsurance requirements. The deductibles for 2016 are $1288.00 per Benefit Period, for Part A. The Part B deductible is $166.00 per year. Private insurance is available to cover all or some of these out-of-pocket costs. These insurance plans are called Medicare supplements (also called Med Sup or Medigap plans).
Medicare Supplement Insurance
Medicare Supplements are standardized by the Federal Government. They are lettered A, B, C, D, F, G, K, L, M & N. Each standardized Medigap policy must offer the same basic benefits no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies. Plan A pays the Medicare hospital and physician coinsurance, the first three pints of blood, and 365 days of hospitalization beyond Medicare. Plans B through N provide these benefits and add further benefits such as coverage for Medicare deductibles, excess charges and limited preventive care, and foreign travel. ONLY ONE MED SUP PLAN IS NECESSARY. You should only buy one Med Sup plan. No one should try to sell you an additional Med Sup plan unless you decide you need to switch policies.
Open Enrollment in Medicare Supplement Insurance At age 65, all consumers - including those already receiving Medicare due to disability - have a six-month "open enrollment" period. For six months beginning when you are both age 65 or older and enrolled in Medicare Part B, companies must sell you any Medicare supplement plan they offer. After this limited open enrollment period, companies can pick and choose whom they will cover. Other Options If you have an individual or "bank group" insurance policy, becoming Medicare eligible does not require you to cancel it and purchase a Medicare supplement. Doing so may save premium costs but it is important to compare benefits before deciding what will work best. If you are eligible for employer retirement insurance, review the plan carefully to understand what benefits are available and how it works with Medicare. Be aware that employer plans are not standardized and are not subject to the requirements governing standardized Medicare supplement policies. Some Texas residents are eligible to enroll in approved Medicare Advantage plans. These plans are offered by private insurance companies. Each year Medicare Advantage companies decide where they will offer their plans, what benefits will be offered, and what the premiums will be. There are several Medicare Advantage plans available in several counties in East Texas. Depending on plan choice, a member may be responsible for paying co-payments for certain covered services.
Should I Purchase Long-Term Care Insurance?
In the past, families often stepped in to help when older family members were no longer able to care for themselves. Today, with older people living longer, families often living long distances apart and more women working outside the home, fewer families are able to provide this care. A wide range of long-term care services is now available--day care, respite care, home care, and nursing care. These services are expensive and often exceed a person's ability to pay. People often mistakenly assume that Medicare will cover their long-term care costs. MEDICARE ONLY COVERS LONG-TERM CARE UNDER VERY, VERY LIMITED CIRCUMSTANCES.
Many Texas residents are eligible for Medicaid payment of their long-term care bills. Medicaid is a medical assistance program for people with limited income and assets. Eligibility is determined by the local county social services office. Private long-term care insurance is an option for people to consider, particularly if they have assets they wish to protect. You should not buy this type of insurance unless you can afford to pay the premiums every year. Remember, long-term care insurance premiums can and often do go up. Long-term care plans are not standardized like Med Sup plans. Therefore, it is very important to shop around and compare benefit options and cost.
David Hecker is a Licensed Insurance Agent based in Longview TX. He specializes in Medicare Products. He is licensed in Texas, Louisiana and Arkansas. He can be reached at (903) 918-9091. E-mail: [mailto:[email protected]][email protected] or on the web at: [http://www.tx-medicaresupplement.com/]http://www.tx-medicaresupplement.com To receive your Free e-mail newsletter about Medicare Supplements, send an e-mail request to: [mailto:[email protected]][email protected] Not connected with or endorsed by the United States government or the federal Medicare program.
Article Source: [http://EzineArticles.com/?Understanding-Medicare&id=1889202] Understanding Medicare
Medicare Explained
By [http://EzineArticles.com/expert/Sonia_Ashford/2307051]Sonia Ashford
The Basics
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). If you or your spouse have worked full time for 10 or more years over a lifetime, you are probably eligible to receive Medicare Part A for free.
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. What Medicare covers is based upon, Federal and state laws, National coverage decisions made by Medicare about whether something is covered, local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
Medicare Part B is available at a monthly rate set annually by Congress ($121.80 in 2016 for incomes $85000.00 or less for an individual). Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Some seniors are eligible to receive the medical insurance portion (Part B) free as well, depending on their income and asset levels. For more information, inquire about the Qualified Medicare Beneficiary (QMB), Special Low Income Medicare Beneficiary (SLMB), and Qualifying Individual programs through your county social services office. Remember, in most cases, if you don't sign up for Part B when you are first eligible, you will have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B, and coverage will start July 1 of that year. Usually, you don't pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.
Medicare Part C (Medicare Advantage Plans) are a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMO's), Preferred Provider Organizations (PPO's), Private Fee-for-Service Plans (PFFS's), Special Needs Plans (SNP's), and Medicare Medical Savings Account Plans (MSA's). If you're enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and are not paid for under Original Medicare. Most Medicare Advantage Plans have prescription drug coverage included.
Medicare Part D (prescription drug coverage) adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare.
Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans. Keep in mind, you may owe a late enrollment penalty if you go without a Medicare Prescription Drug Plan (Part D), or without a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, or without creditable prescription drug coverage for any continuous period of 63 days or more after your Initial Enrollment Period is over.
How Medicare Works
Original Medicare is coverage managed by the federal government. Generally, there is a cost for each service. In most cases, you can go to any doctor, other health care provider, hospital, or other facility that is enrolled in Medicare and is accepting new Medicare patients. With a few exceptions, most prescriptions are not covered in Original Medicare. However, you can add drug coverage by joining a Medicare Prescription Drug Plan (Part D). With Original Medicare you don not need to choose a primary care doctor. In most cases, with Original Medicare, you don't need a referral to see a specialist, but the specialist must be enrolled in Medicare. You may already have employer or union coverage that may pay costs that Original Medicare does not. If not, you may want to buy a Medicare Supplement Insurance (Medigap) policy.
How to sign up for Medicare
If you are receiving Social Security benefits before turning 65, you should automatically receive notification of your enrollment in Medicare shortly before your 65th birthday or your 25th month of disability. Other individuals must apply by calling or visiting their Social Security office to receive Medicare. If you are not yet receiving Social Security or if you have not received a Medicare enrollment notice, you should contact the nearest Social Security office for information. Applications for Medicare can be made during a seven-month period beginning three months prior to the month of your 65th birthday.
It is best to apply during the three months prior to the month of your 65th birthday. If an application is made during that time, your coverage will begin on the first day of your birth month. Applying later will delay the start of your benefits. You may also apply for Medicare during the General Enrollment Period from January 1 through March 31 every year after your 65th birthday. Your coverage then starts July 1 of the year you signed up and you will pay a 10 percent surcharge on the Part B premium for each 12 months you were eligible but not enrolled. If you have limited income and resources, your state may help you pay for Part A, and/or Part B. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage.
If you continue to work after age 65 or your spouse is working and you are covered by an employer group health plan (EGHP), you may want to delay enrollment in Part B of Medicare. Enrolling in Medicare Part B will trigger your open enrollment for Medicare supplement insurance at a time when you do not need supplemental coverage. The penalty for late enrollment in Part B does not apply if you are covered by an EGHP because of your or your spouse's current employment. If you do work after age 65, you may apply for Medicare Part B at any time prior to retirement, but you must apply no later than eight months (the Special Enrollment Period) after your formal retirement in order to avoid paying a premium penalty. Even if your employer offers a retirement health plan, you will want to sign up for Medicare Part A and probably for Medicare Part B when you retire. Most retirement plans assume you are covered under Medicare and will not pay for services that Medicare would have covered. Veterans may be eligible for special medical programs. However, eligibility and benefits are very restrictive and are subject to change. The Department of Veterans Affairs advises veterans to apply for both Parts A and B of Medicare to ensure adequate medical coverage.
How Medicare Pays
The way Medicare pays is, you generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance / copayment) for covered services and supplies. There is no yearly limit for what you pay out-of-pocket. You usually pay a monthly premium for Part B. You generally don't need to file Medicare claims. The law requires providers (like doctors, hospitals, skilled nursing facilities, and home health agencies) and suppliers to file your claims for the covered services and supplies you get.
Medicare pays for only a portion of your hospital and medical bills. As with many private insurance plans, the government expects beneficiaries to pay a share of their bills. Medicare Parts A and B both have deductibles and coinsurance. The deductibles for 2016 are $1288.00 per Benefit Period, for Part A. A benefit period begins the day you are admitted as an inpatient in a hospital or skilled nursing facility (SNF). The benefit period ends when you have not received any inpatient hospital or SNF care for 60 days in a row. Therefore, it is possible to have multiple Part A hospital deductibles in the same year. The Part B deductible is $166.00 per year. Private insurance is available to cover all or part of these out-of-pocket costs. These insurance plans are called Medicare supplements (also called Medigap or Med Sup plans).
Accepting Assignment
Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.
If your doctor, provider, or supplier accepts assignment, your out-of-pocket costs may be less, they agree to charge you only the Medicare deductible and coinsurance amount and usually wait for Medicare to pay its share before asking you to pay your share, and they have to submit your claim directly to Medicare and cannot charge you for submitting the claim.
If your doctor, provider, or supplier does not accept assignment they are "Non-participating" providers and have not signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for individual services.
If your doctor, provider, or supplier does not accept assignment, you may have to pay the entire charge at the time of service. They can also charge you more than the Medicare-approved amount, called "Excess Charges." Excess Charges have a limit called "the limiting charge." The provider can only charge you up to 15% over the amount that non-participating providers are paid. Non-participating providers are paid 95% of the fee schedule amount. The limiting charge applies only to certain Medicare-covered services and doesn't apply to some supplies and durable medical equipment.
Your doctor, provider, or supplier is supposed to submit a claim to Medicare for any Medicare-covered services they provide to you. They cannot charge you for submitting a claim. If they do not submit the Medicare claim once you ask them to, call 1-800-MEDICARE.
In some cases, you might have to submit your own claim to Medicare using Form CMS-1490S to get reimbursed.
Medicare Supplement Insurance
Medicare Supplements are standardized by the Federal Government. They are labeled A, B, C, D, F, G, K, L, M and N. Each standardized Medigap policy must offer the same basic benefits no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies. Plan A pays the Medicare hospital and physician coinsurance, the first three pints of blood, and 365 days of hospitalization beyond Medicare. Plans B through N provide these benefits and add more benefits such as coverage for Medicare deductibles, excess charges and limited preventive care, and foreign travel. You can only have one Med Sup plan. No one should try to sell you an additional Med Sup plan unless you decide you need to switch policies.
Open Enrollment for Medicare Supplement Insurance is at age 65 for all consumers, including those already receiving Medicare due to disability. The Open Enrollment period is a six-month period. For six months beginning when you are both age 65 or older and enrolled in Medicare Part B, companies must sell you any Medicare supplement plan they offer. After this limited open enrollment period, companies can pick and choose whom they will cover and how much they will charge based on your health. If you have an individual or "bank group" insurance policy, becoming Medicare eligible does not require you to cancel it and purchase a Medicare supplement. Doing so may save premium costs but it is important to compare benefits before deciding which will work best.
If you are eligible for employer retirement insurance, review the plan carefully to understand what benefits are available and how it works with Medicare. Be aware that employer plans are not standardized and are not subject to the requirements governing standardized Medicare supplement policies. Also, it is important to remember, if you leave an employer plan you may not be able to go back on it.
Some Texas residents are eligible to enroll in approved Medicare Advantage plans. These plans are offered by private insurance companies. Each year Medicare Advantage companies decide where they will offer their plans, what benefits will be offered, and what the premiums will be. Several include vision, dental, hearing, and wellness programs not covered by original Medicare. As noted earlier many Medicare Advantage Plans also offer prescription drug coverage. There are several Medicare Advantage plans available in Dallas, Tarrant and surrounding counties. Depending on plan choice, a member may be responsible for paying co-payments for certain covered services. Most importantly, with a Medicare Supplements, Medicare Advantage and standalone Part D plans, you must continue to pay your Part A (if any) and part B Medicare premiums.
Sonia Ashford is a licensed independent insurance agent in the Texas Medicare field. Sonia has delivered hundreds of speeches to consumers in the Dallas / Fort Worth area about turning 65, Medicare Advantage and Medicare Supplements. A respected agent within the industry, she is the owner of Ashford Insurance Services, LLC located in Bedford Texas. Visit Sonia's agency website http://ashfordinsuranceservices.com to learn more about how she can help you with your financial saving decisions.
Article Source: [http://EzineArticles.com/?Medicare-Explained&id=9466184] Medicare Explained
By [http://EzineArticles.com/expert/Sonia_Ashford/2307051]Sonia Ashford
The Basics
Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD). If you or your spouse have worked full time for 10 or more years over a lifetime, you are probably eligible to receive Medicare Part A for free.
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. What Medicare covers is based upon, Federal and state laws, National coverage decisions made by Medicare about whether something is covered, local coverage decisions made by companies in each state that process claims for Medicare. These companies decide whether something is medically necessary and should be covered in their area.
Medicare Part B is available at a monthly rate set annually by Congress ($121.80 in 2016 for incomes $85000.00 or less for an individual). Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. Some seniors are eligible to receive the medical insurance portion (Part B) free as well, depending on their income and asset levels. For more information, inquire about the Qualified Medicare Beneficiary (QMB), Special Low Income Medicare Beneficiary (SLMB), and Qualifying Individual programs through your county social services office. Remember, in most cases, if you don't sign up for Part B when you are first eligible, you will have to pay a late enrollment penalty for as long as you have Part B. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn't sign up for it. Also, you may have to wait until the General Enrollment Period (from January 1 to March 31) to enroll in Part B, and coverage will start July 1 of that year. Usually, you don't pay a late enrollment penalty if you meet certain conditions that allow you to sign up for Part B during a Special Enrollment Period.
Medicare Part C (Medicare Advantage Plans) are a type of Medicare health plan offered by a private insurance company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMO's), Preferred Provider Organizations (PPO's), Private Fee-for-Service Plans (PFFS's), Special Needs Plans (SNP's), and Medicare Medical Savings Account Plans (MSA's). If you're enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan and are not paid for under Original Medicare. Most Medicare Advantage Plans have prescription drug coverage included.
Medicare Part D (prescription drug coverage) adds prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private-Fee-for-Service Plans, and Medicare Medical Savings Account Plans. These plans are offered by insurance companies and other private companies approved by Medicare.
Medicare Advantage Plans may also offer prescription drug coverage that follows the same rules as Medicare Prescription Drug Plans. Keep in mind, you may owe a late enrollment penalty if you go without a Medicare Prescription Drug Plan (Part D), or without a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, or without creditable prescription drug coverage for any continuous period of 63 days or more after your Initial Enrollment Period is over.
How Medicare Works
Original Medicare is coverage managed by the federal government. Generally, there is a cost for each service. In most cases, you can go to any doctor, other health care provider, hospital, or other facility that is enrolled in Medicare and is accepting new Medicare patients. With a few exceptions, most prescriptions are not covered in Original Medicare. However, you can add drug coverage by joining a Medicare Prescription Drug Plan (Part D). With Original Medicare you don not need to choose a primary care doctor. In most cases, with Original Medicare, you don't need a referral to see a specialist, but the specialist must be enrolled in Medicare. You may already have employer or union coverage that may pay costs that Original Medicare does not. If not, you may want to buy a Medicare Supplement Insurance (Medigap) policy.
How to sign up for Medicare
If you are receiving Social Security benefits before turning 65, you should automatically receive notification of your enrollment in Medicare shortly before your 65th birthday or your 25th month of disability. Other individuals must apply by calling or visiting their Social Security office to receive Medicare. If you are not yet receiving Social Security or if you have not received a Medicare enrollment notice, you should contact the nearest Social Security office for information. Applications for Medicare can be made during a seven-month period beginning three months prior to the month of your 65th birthday.
It is best to apply during the three months prior to the month of your 65th birthday. If an application is made during that time, your coverage will begin on the first day of your birth month. Applying later will delay the start of your benefits. You may also apply for Medicare during the General Enrollment Period from January 1 through March 31 every year after your 65th birthday. Your coverage then starts July 1 of the year you signed up and you will pay a 10 percent surcharge on the Part B premium for each 12 months you were eligible but not enrolled. If you have limited income and resources, your state may help you pay for Part A, and/or Part B. You may also qualify for Extra Help to pay for your Medicare prescription drug coverage.
If you continue to work after age 65 or your spouse is working and you are covered by an employer group health plan (EGHP), you may want to delay enrollment in Part B of Medicare. Enrolling in Medicare Part B will trigger your open enrollment for Medicare supplement insurance at a time when you do not need supplemental coverage. The penalty for late enrollment in Part B does not apply if you are covered by an EGHP because of your or your spouse's current employment. If you do work after age 65, you may apply for Medicare Part B at any time prior to retirement, but you must apply no later than eight months (the Special Enrollment Period) after your formal retirement in order to avoid paying a premium penalty. Even if your employer offers a retirement health plan, you will want to sign up for Medicare Part A and probably for Medicare Part B when you retire. Most retirement plans assume you are covered under Medicare and will not pay for services that Medicare would have covered. Veterans may be eligible for special medical programs. However, eligibility and benefits are very restrictive and are subject to change. The Department of Veterans Affairs advises veterans to apply for both Parts A and B of Medicare to ensure adequate medical coverage.
How Medicare Pays
The way Medicare pays is, you generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance / copayment) for covered services and supplies. There is no yearly limit for what you pay out-of-pocket. You usually pay a monthly premium for Part B. You generally don't need to file Medicare claims. The law requires providers (like doctors, hospitals, skilled nursing facilities, and home health agencies) and suppliers to file your claims for the covered services and supplies you get.
Medicare pays for only a portion of your hospital and medical bills. As with many private insurance plans, the government expects beneficiaries to pay a share of their bills. Medicare Parts A and B both have deductibles and coinsurance. The deductibles for 2016 are $1288.00 per Benefit Period, for Part A. A benefit period begins the day you are admitted as an inpatient in a hospital or skilled nursing facility (SNF). The benefit period ends when you have not received any inpatient hospital or SNF care for 60 days in a row. Therefore, it is possible to have multiple Part A hospital deductibles in the same year. The Part B deductible is $166.00 per year. Private insurance is available to cover all or part of these out-of-pocket costs. These insurance plans are called Medicare supplements (also called Medigap or Med Sup plans).
Accepting Assignment
Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.
If your doctor, provider, or supplier accepts assignment, your out-of-pocket costs may be less, they agree to charge you only the Medicare deductible and coinsurance amount and usually wait for Medicare to pay its share before asking you to pay your share, and they have to submit your claim directly to Medicare and cannot charge you for submitting the claim.
If your doctor, provider, or supplier does not accept assignment they are "Non-participating" providers and have not signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for individual services.
If your doctor, provider, or supplier does not accept assignment, you may have to pay the entire charge at the time of service. They can also charge you more than the Medicare-approved amount, called "Excess Charges." Excess Charges have a limit called "the limiting charge." The provider can only charge you up to 15% over the amount that non-participating providers are paid. Non-participating providers are paid 95% of the fee schedule amount. The limiting charge applies only to certain Medicare-covered services and doesn't apply to some supplies and durable medical equipment.
Your doctor, provider, or supplier is supposed to submit a claim to Medicare for any Medicare-covered services they provide to you. They cannot charge you for submitting a claim. If they do not submit the Medicare claim once you ask them to, call 1-800-MEDICARE.
In some cases, you might have to submit your own claim to Medicare using Form CMS-1490S to get reimbursed.
Medicare Supplement Insurance
Medicare Supplements are standardized by the Federal Government. They are labeled A, B, C, D, F, G, K, L, M and N. Each standardized Medigap policy must offer the same basic benefits no matter which insurance company sells it. Cost is usually the only difference between Medigap policies with the same letter sold by different insurance companies. Plan A pays the Medicare hospital and physician coinsurance, the first three pints of blood, and 365 days of hospitalization beyond Medicare. Plans B through N provide these benefits and add more benefits such as coverage for Medicare deductibles, excess charges and limited preventive care, and foreign travel. You can only have one Med Sup plan. No one should try to sell you an additional Med Sup plan unless you decide you need to switch policies.
Open Enrollment for Medicare Supplement Insurance is at age 65 for all consumers, including those already receiving Medicare due to disability. The Open Enrollment period is a six-month period. For six months beginning when you are both age 65 or older and enrolled in Medicare Part B, companies must sell you any Medicare supplement plan they offer. After this limited open enrollment period, companies can pick and choose whom they will cover and how much they will charge based on your health. If you have an individual or "bank group" insurance policy, becoming Medicare eligible does not require you to cancel it and purchase a Medicare supplement. Doing so may save premium costs but it is important to compare benefits before deciding which will work best.
If you are eligible for employer retirement insurance, review the plan carefully to understand what benefits are available and how it works with Medicare. Be aware that employer plans are not standardized and are not subject to the requirements governing standardized Medicare supplement policies. Also, it is important to remember, if you leave an employer plan you may not be able to go back on it.
Some Texas residents are eligible to enroll in approved Medicare Advantage plans. These plans are offered by private insurance companies. Each year Medicare Advantage companies decide where they will offer their plans, what benefits will be offered, and what the premiums will be. Several include vision, dental, hearing, and wellness programs not covered by original Medicare. As noted earlier many Medicare Advantage Plans also offer prescription drug coverage. There are several Medicare Advantage plans available in Dallas, Tarrant and surrounding counties. Depending on plan choice, a member may be responsible for paying co-payments for certain covered services. Most importantly, with a Medicare Supplements, Medicare Advantage and standalone Part D plans, you must continue to pay your Part A (if any) and part B Medicare premiums.
Sonia Ashford is a licensed independent insurance agent in the Texas Medicare field. Sonia has delivered hundreds of speeches to consumers in the Dallas / Fort Worth area about turning 65, Medicare Advantage and Medicare Supplements. A respected agent within the industry, she is the owner of Ashford Insurance Services, LLC located in Bedford Texas. Visit Sonia's agency website http://ashfordinsuranceservices.com to learn more about how she can help you with your financial saving decisions.
Article Source: [http://EzineArticles.com/?Medicare-Explained&id=9466184] Medicare Explained
5 Things To Consider When Integrating Your Home Health Care With Medicare
By [http://EzineArticles.com/expert/Elais_Ponton/1316355]Elais Ponton
Medicare can be perplexing, all the more so when you combine complex health issues and the need for medical aids such as oxygen or hospital beds. While the insurance maze can be difficult to traverse, an estimated 47.5 million people received this program in 2010, which is more than a sixth of the nation's population.
Here is a brief overview and some answers to some commonly asked questions regarding Medicare and home health care.
1. Who qualifies?
Medicare is a national health insurance program provided by the U.S. government for those who are:
- 65 and older
- Under 65 with certain disabilities
- Diagnosed with End Stage Renal Disease (ESRD), a form of permanent kidney failure requiring dialysis or a kidney transplant
2. What types of services does Medicare cover?
Medicare has four different coverage sections: Part A, B, C, and D. "Original Medicare" consists of Part A & B, while Part C is known as "Medicare Advantage Plan". These four parts are summarized briefly:
- Medicare Part A: Hospital Insurance
* Part A covers care while in hospital as well as health care in skilled nursing facilities, home health care, and hospice.
- Medicare Part B: Medical Insurance
* Part B covers doctor's visits as well as visits to other health care providers. Additionally, Part B covers hospital outpatient care, durable medical equipment (like intravenous infusion devices), and home health care services. Part B also covers specific types of preventative services, such as getting certain vaccinations.
- Medicare Part C: Medicare Advantage
* Part C combines health plan options you purchase from other private insurance companies approved by Medicare. Part C also integrates Medicare Prescription drug coverage (Part D) and can be tailored to include extra benefits at an extra cost.
- Medicare Part D: Medicare Prescription Drug Coverage
* Part D covers the prescription of Medicare-approved prescription drugs and can lower the cost of other medications. Similar to Part C, Medicare-approved private insurance companies also run Part D.
3. Why do I need to choose between Medicare plans?
The choice of "Original Medicare" (Parts A & B) entails payment of monthly premiums for part B and may necessitate additional coverage to pay deductibles and coinsurance to see physicians, hospitals, and other providers who accept Medicare. If you require Prescription drug coverage, you must pay a monthly premium to join the Medicare Prescription Drug Plan (Part D).
The "Medicare Advantage Plan" (Part C, which covers Part A & B), also requires the payment of monthly premiums in addition to the Part B premium & a copayment for in-plan doctors, hospitals. If prescription medications are not covered by your supplemental coverage, you have the option of joining the Medicare Prescription Drug Plan (Part D).
As with prescription medications, you can purchase supplemental coverage to cover services not covered by Medicare. The "Original Medicare" plan allows for the option of buying Medicare Supplement Insurance (Medigap), while the "Medicare Advantage Plan" does not.
It is prudent to always check if you can take advantage of other additional coverage through your employer or union, military, or Veteran's benefits.
4. Is home health care covered by Medicare?
The Medicare website states, "Medicare only covers home health care on a limited basis as ordered by your doctor". As reviewed earlier, Parts A & B are the Medicare options which cover the home health care services specified by Medicare.
Coverage of home health care by Medicare in New Mexico stipulates you must meet the following criteria:
- You are currently receiving regular services from a physician. This physician must also maintain a care plan unique to you, which is reviewed regularly.
- Your physician must certify a "need" for specific medical services such as requirements for intravenous medication therapy, physical therapy, occupational therapy, respiratory therapy, or speech-language pathology services.
- The home health care agency providing you services must be Medicare-certified (for more details see below).
- Your physician must certify your health status as homebound, which is indicated by the following:
* Your health condition limits you from leaving the house.
* You are unable travel from home without help (i.e. transportation assistance such as aids or individuals).
* Leaving your home takes considerable effort and may be detrimental to your health condition.
5. My home health company does not take Medicare, why is this?
The Medicare-approval process is lengthy and costly, so while it may appear that many companies may not take Medicare, they may actually be in the process of becoming Medicare certified.
Furthermore, the Medicare criteria for individual qualifying to receive home health care are very strict; the reality is that many people who may apply for coverage by Medicare for their approved home health company services will not actually receive coverage. Currently, Medicare pays only about half of all health care costs to seniors. Medicare very often denies payment due to not meeting criteria, so it is essential to be aware if you meet these criteria prior to restricting yourself exclusively to Medicare-approved home health care companies.
It is crucial not to become overwhelmed by the complexities of Medicare, as there is a vast wealth of information on the Internet.
For a great chart and further information about your Medicare options, see http://www.medicare.gov/navigation/medicare-basics/coverage-choices.aspx
To look up if Medicare covers your medical services or tests, look at http://www.medicare.gov/Coverage/Home.asp
In conclusion, be mindful that while Medicare solely covers home health for the homebound, home health care is NOT exclusively for the homebound. Home health care agencies offer a variety of service which not only benefits those are not covered by Medicare but also those who are homebound or otherwise.
Article Source: [http://EzineArticles.com/?5-Things-To-Consider-When-Integrating-Your-Home-Health-Care-With-Medicare&id=7211834] 5 Things To Consider When Integrating Your Home Health Care With Medicare
By [http://EzineArticles.com/expert/Elais_Ponton/1316355]Elais Ponton
Medicare can be perplexing, all the more so when you combine complex health issues and the need for medical aids such as oxygen or hospital beds. While the insurance maze can be difficult to traverse, an estimated 47.5 million people received this program in 2010, which is more than a sixth of the nation's population.
Here is a brief overview and some answers to some commonly asked questions regarding Medicare and home health care.
1. Who qualifies?
Medicare is a national health insurance program provided by the U.S. government for those who are:
- 65 and older
- Under 65 with certain disabilities
- Diagnosed with End Stage Renal Disease (ESRD), a form of permanent kidney failure requiring dialysis or a kidney transplant
2. What types of services does Medicare cover?
Medicare has four different coverage sections: Part A, B, C, and D. "Original Medicare" consists of Part A & B, while Part C is known as "Medicare Advantage Plan". These four parts are summarized briefly:
- Medicare Part A: Hospital Insurance
* Part A covers care while in hospital as well as health care in skilled nursing facilities, home health care, and hospice.
- Medicare Part B: Medical Insurance
* Part B covers doctor's visits as well as visits to other health care providers. Additionally, Part B covers hospital outpatient care, durable medical equipment (like intravenous infusion devices), and home health care services. Part B also covers specific types of preventative services, such as getting certain vaccinations.
- Medicare Part C: Medicare Advantage
* Part C combines health plan options you purchase from other private insurance companies approved by Medicare. Part C also integrates Medicare Prescription drug coverage (Part D) and can be tailored to include extra benefits at an extra cost.
- Medicare Part D: Medicare Prescription Drug Coverage
* Part D covers the prescription of Medicare-approved prescription drugs and can lower the cost of other medications. Similar to Part C, Medicare-approved private insurance companies also run Part D.
3. Why do I need to choose between Medicare plans?
The choice of "Original Medicare" (Parts A & B) entails payment of monthly premiums for part B and may necessitate additional coverage to pay deductibles and coinsurance to see physicians, hospitals, and other providers who accept Medicare. If you require Prescription drug coverage, you must pay a monthly premium to join the Medicare Prescription Drug Plan (Part D).
The "Medicare Advantage Plan" (Part C, which covers Part A & B), also requires the payment of monthly premiums in addition to the Part B premium & a copayment for in-plan doctors, hospitals. If prescription medications are not covered by your supplemental coverage, you have the option of joining the Medicare Prescription Drug Plan (Part D).
As with prescription medications, you can purchase supplemental coverage to cover services not covered by Medicare. The "Original Medicare" plan allows for the option of buying Medicare Supplement Insurance (Medigap), while the "Medicare Advantage Plan" does not.
It is prudent to always check if you can take advantage of other additional coverage through your employer or union, military, or Veteran's benefits.
4. Is home health care covered by Medicare?
The Medicare website states, "Medicare only covers home health care on a limited basis as ordered by your doctor". As reviewed earlier, Parts A & B are the Medicare options which cover the home health care services specified by Medicare.
Coverage of home health care by Medicare in New Mexico stipulates you must meet the following criteria:
- You are currently receiving regular services from a physician. This physician must also maintain a care plan unique to you, which is reviewed regularly.
- Your physician must certify a "need" for specific medical services such as requirements for intravenous medication therapy, physical therapy, occupational therapy, respiratory therapy, or speech-language pathology services.
- The home health care agency providing you services must be Medicare-certified (for more details see below).
- Your physician must certify your health status as homebound, which is indicated by the following:
* Your health condition limits you from leaving the house.
* You are unable travel from home without help (i.e. transportation assistance such as aids or individuals).
* Leaving your home takes considerable effort and may be detrimental to your health condition.
5. My home health company does not take Medicare, why is this?
The Medicare-approval process is lengthy and costly, so while it may appear that many companies may not take Medicare, they may actually be in the process of becoming Medicare certified.
Furthermore, the Medicare criteria for individual qualifying to receive home health care are very strict; the reality is that many people who may apply for coverage by Medicare for their approved home health company services will not actually receive coverage. Currently, Medicare pays only about half of all health care costs to seniors. Medicare very often denies payment due to not meeting criteria, so it is essential to be aware if you meet these criteria prior to restricting yourself exclusively to Medicare-approved home health care companies.
It is crucial not to become overwhelmed by the complexities of Medicare, as there is a vast wealth of information on the Internet.
For a great chart and further information about your Medicare options, see http://www.medicare.gov/navigation/medicare-basics/coverage-choices.aspx
To look up if Medicare covers your medical services or tests, look at http://www.medicare.gov/Coverage/Home.asp
In conclusion, be mindful that while Medicare solely covers home health for the homebound, home health care is NOT exclusively for the homebound. Home health care agencies offer a variety of service which not only benefits those are not covered by Medicare but also those who are homebound or otherwise.
Article Source: [http://EzineArticles.com/?5-Things-To-Consider-When-Integrating-Your-Home-Health-Care-With-Medicare&id=7211834] 5 Things To Consider When Integrating Your Home Health Care With Medicare
What's Covered? How to Use Medicare's Website to Understand Original Medicare Coverage Better
By [http://EzineArticles.com/expert/Carolyn_E_Crooks/1750941]Carolyn E Crooks
Many people want to know how Original Medicare will cover a specific health condition, treatment, service, etc. Luckily for me, as an agent, and for you, as a Medicare beneficiary, the Medicare.gov website lets you easily search for this. For example, I am going to search how Original Medicare covers Kidney Dialysis. First, I go to medicare.gov. On the homepage, you will see a search field. This is where you can type the service you'd like more info on. Once I have typed Kidney dialysis, I hit "GO", and within a few seconds, a list of services pops up, dialysis services and supplies being the first. I click on the link, and am led to a detailed summary of coverage. It discusses inpatient coverage versus outpatient, training for home dialysis, support services, equipment and supplies, and certain drugs for home dialysis that are covered under Original Medicare. In addition to a list of what is covered is a brief mentioning of what is not. Medicare does not pay for aides to assist with home treatment, any lost pay during self-dialysis training, a place to stay during your treatment, and blood or packed red blood cells for home self-dialysis unless part of a doctors' service. The page then details how much Medicare will pay for the coverage offered, which in this case seems to be an 80/20 split for just about everything. This is where Medicare Supplements step in to help you with out-of-pocket costs. As you can see, with Original Medicare alongside a Supplement, your coverage will be quite comprehensive.
Medicare.gov also explains, in broader terms, what Parts A and B cover. There is a link to "What Part A Covers" as well as a link to "What Part B Covers." I truly love Medicare's website, I think it is so well done, and I urge you to explore it more!
Just as I discussed with Kidney Dialysis earlier, Medigap policies fill in the gaps of Original Medicare's coverage for different services and treatments. For example, Medicare pays for the first 60 days of a Hospital Inpatient Stay (there is a deductible that has to be met before they pay anything), but from days 61-90 you pay coinsurance every day, which is $304/day. All Medigap Plans cover this hospital donut hole, and this is good news, because the coverage gets even worse the longer you stay in the hospital. Days 91-150 include a $608 daily coinsurance. A Medigap plan will cover this, and you won't have to worry about these gaps in coverage with Medicare. In fact, Medicare Supplement hospital coverage will go up to an additional 365 days in coverage past what Original Medicare will help cover!
A quick note: there have been stories in the news lately concerning the labeling of hospital patients as outpatient instead of inpatient and making sure you know your classification. This is another important factor in whether Medicare will cover the costs; how they label you can determine whether Medicare will pay. Part A (which covers hospital stay) will pay if you are labeled an inpatient, and Part B (which does not cover hospital stay) will pay if you are an outpatient. I am going to write a blog about this soon; keep on the lookout for more detailed information!
The list below should help to give you a foundation in understanding what is covered and what is not covered by Original Medicare (and therefore Medicare Supplements):
1. Dental and Vision
2. Nothing cosmetic is covered.
3. If it is routine, preventative, and a yearly sort of deal-you will most like get help with it, although it is always good to check with Medicare.
4. If your doctor is a Medicare provider and accepts Medicare Assignment.
My fourth point in the ground rules list is important to understand. After making sure that your provider works with Medicare, your next question should be whether or not they accept Medicare Assignment. This is a term used to describe the price per service that Medicare is willing to pay. For example, if Medicare pays $1,200 for a certain surgery, if the doctor accepts Medicare Assignment, he is accepting this amount as payment for the surgery. Doctors who work with Medicare are allowed to charge an additional 15% above the Approved Amount (the $1,200), which means they are not accepting Medicare Assignment although they work with Medicare. Now you see why it is imperative that you ask both of these questions before receiving any service from a provider. Medicare Supplement Plans F and G covers this 15% "Excess Charge" for Part B services.
There are many nuances like the one above, but the ones in this article are the major players in the game. I hope this article gave you a better understanding of what is covered by Original Medicare and how Medicare Supplements work alongside Parts A and B.
I have also made a YouTube video that will give you a visual to this article, and also introduce you to my website, which has more information on how Medicare Supplements work with Parts A and B. The link for that video is below!
Here is the YouTube video that will assist in providing a visual for the article: [http://www.youtube.com/watch?v=DOMJvcn0g0o]http://www.youtube.com/watch?v=DOMJvcn0g0o.
If you have further questions please contact me by visiting my website at [http://www.bestmedigaprate.com]. Or emailing me at [mailto:[email protected]][email protected].
Be advised I am a TEXAS-only agent. I am not with Medicare and this information is to be used as additional help for those trying to understand how Original Medicare and Medigap coverage work. To get the best, most updated information, please visit Medicare.gov!
Article Source: [http://EzineArticles.com/?Whats-Covered?-How-to-Use-Medicares-Website-to-Understand-Original-Medicare-Coverage-Better&id=8271688] What's Covered? How to Use Medicare's Website to Understand Original Medicare Coverage Better
By [http://EzineArticles.com/expert/Carolyn_E_Crooks/1750941]Carolyn E Crooks
Many people want to know how Original Medicare will cover a specific health condition, treatment, service, etc. Luckily for me, as an agent, and for you, as a Medicare beneficiary, the Medicare.gov website lets you easily search for this. For example, I am going to search how Original Medicare covers Kidney Dialysis. First, I go to medicare.gov. On the homepage, you will see a search field. This is where you can type the service you'd like more info on. Once I have typed Kidney dialysis, I hit "GO", and within a few seconds, a list of services pops up, dialysis services and supplies being the first. I click on the link, and am led to a detailed summary of coverage. It discusses inpatient coverage versus outpatient, training for home dialysis, support services, equipment and supplies, and certain drugs for home dialysis that are covered under Original Medicare. In addition to a list of what is covered is a brief mentioning of what is not. Medicare does not pay for aides to assist with home treatment, any lost pay during self-dialysis training, a place to stay during your treatment, and blood or packed red blood cells for home self-dialysis unless part of a doctors' service. The page then details how much Medicare will pay for the coverage offered, which in this case seems to be an 80/20 split for just about everything. This is where Medicare Supplements step in to help you with out-of-pocket costs. As you can see, with Original Medicare alongside a Supplement, your coverage will be quite comprehensive.
Medicare.gov also explains, in broader terms, what Parts A and B cover. There is a link to "What Part A Covers" as well as a link to "What Part B Covers." I truly love Medicare's website, I think it is so well done, and I urge you to explore it more!
Just as I discussed with Kidney Dialysis earlier, Medigap policies fill in the gaps of Original Medicare's coverage for different services and treatments. For example, Medicare pays for the first 60 days of a Hospital Inpatient Stay (there is a deductible that has to be met before they pay anything), but from days 61-90 you pay coinsurance every day, which is $304/day. All Medigap Plans cover this hospital donut hole, and this is good news, because the coverage gets even worse the longer you stay in the hospital. Days 91-150 include a $608 daily coinsurance. A Medigap plan will cover this, and you won't have to worry about these gaps in coverage with Medicare. In fact, Medicare Supplement hospital coverage will go up to an additional 365 days in coverage past what Original Medicare will help cover!
A quick note: there have been stories in the news lately concerning the labeling of hospital patients as outpatient instead of inpatient and making sure you know your classification. This is another important factor in whether Medicare will cover the costs; how they label you can determine whether Medicare will pay. Part A (which covers hospital stay) will pay if you are labeled an inpatient, and Part B (which does not cover hospital stay) will pay if you are an outpatient. I am going to write a blog about this soon; keep on the lookout for more detailed information!
The list below should help to give you a foundation in understanding what is covered and what is not covered by Original Medicare (and therefore Medicare Supplements):
1. Dental and Vision
2. Nothing cosmetic is covered.
3. If it is routine, preventative, and a yearly sort of deal-you will most like get help with it, although it is always good to check with Medicare.
4. If your doctor is a Medicare provider and accepts Medicare Assignment.
My fourth point in the ground rules list is important to understand. After making sure that your provider works with Medicare, your next question should be whether or not they accept Medicare Assignment. This is a term used to describe the price per service that Medicare is willing to pay. For example, if Medicare pays $1,200 for a certain surgery, if the doctor accepts Medicare Assignment, he is accepting this amount as payment for the surgery. Doctors who work with Medicare are allowed to charge an additional 15% above the Approved Amount (the $1,200), which means they are not accepting Medicare Assignment although they work with Medicare. Now you see why it is imperative that you ask both of these questions before receiving any service from a provider. Medicare Supplement Plans F and G covers this 15% "Excess Charge" for Part B services.
There are many nuances like the one above, but the ones in this article are the major players in the game. I hope this article gave you a better understanding of what is covered by Original Medicare and how Medicare Supplements work alongside Parts A and B.
I have also made a YouTube video that will give you a visual to this article, and also introduce you to my website, which has more information on how Medicare Supplements work with Parts A and B. The link for that video is below!
Here is the YouTube video that will assist in providing a visual for the article: [http://www.youtube.com/watch?v=DOMJvcn0g0o]http://www.youtube.com/watch?v=DOMJvcn0g0o.
If you have further questions please contact me by visiting my website at [http://www.bestmedigaprate.com]. Or emailing me at [mailto:[email protected]][email protected].
Be advised I am a TEXAS-only agent. I am not with Medicare and this information is to be used as additional help for those trying to understand how Original Medicare and Medigap coverage work. To get the best, most updated information, please visit Medicare.gov!
Article Source: [http://EzineArticles.com/?Whats-Covered?-How-to-Use-Medicares-Website-to-Understand-Original-Medicare-Coverage-Better&id=8271688] What's Covered? How to Use Medicare's Website to Understand Original Medicare Coverage Better
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