Posts tagged 'part a'
There is a lot of confusion regarding the difference between “original” Medicare and Medicare Advantage. This article will discuss the basic differences to help you understand what coverage is available and which plans are appropriate for you.
Medicare is made up of two basic categories Medicare (Original Plan) and Medicare Advantage Plan. Both plans have supplemental categories including Part A, B, C, and D.
The original plan includes Part A. You an add part B and D if you choose to. You will automatically be enrolled in original Medicare when you turn 65, unless you decide to choose Medicare Advantage (Part C). The Original Medicare Plan is managed by the federal government as a fee-for service plan with various options and co-pays.
The Medicare Advantage plan combines Part A and Part B and is provided by and managed by private insurance companies. If Part D coverage, which covers prescription drugs, is not included with the plan you purchase, you can purchase it as a separate supplement.
If you choose to Medicare Advantage plans, there are several types of coverage, including HMO, PPO, plans that include private fee-for-service, and Medicare special needs plans.
Part A covers hospital expenses and does not charge a premium. It also covers inpatient care in skilled nursing facilities, critical care hospitals, regular hospitals, hospice services and hoe health care services.
Part B pays for medically necessary services and supplies covered by Medicare. There is a premium for this coverage for most people. Part B covers outpatient, doctors, physical and occupational therapists and additional home health care.
Part C I the Medicare Advantage Plan which covers Part A and B. Though it is provided by private insurance companies, it is still overseen and approved by Medicare. With this program you may have lower costs and usually receive extra services.
Part D is prescription coverage which is a stand-alone plan. Most people pay a premium for this coverage and all medically necessary drugs are covered. There are different plans that cover different drugs. It is important to compare plans to be sure what coverage is best for you.
To be certain that you have the correct coverage, it is best to contact Medicare at 1-800-MEDICARE r visit them on the web at www.medicare.gov.
No matter what Medicare Plan you are on, you have the right to appeal any decision about your Medicare coverage. If Medicare does not pay for an item or service that you feel you are entitled to, you can appeal that decision.
This is not necessarily an easy process; however, there are ways it can be done. For instance, there are various appeal forms depending upon what plan you are on. They are available by downloading from the internet or calling the Medicare program you are enrolled in. The information should be on your Medicare card and your monthly statement.
If you file an appeal, Medicare has a limited amount of time to respond to you and at least let you know that they are looking into the matter. Often, you will hear from them in 7 to 10 days.
If you are not satisfied with any decisions regarding your appeal, you will be advised as to the next level you can go to. It is similar to taking a matter to civil court, then superior court then district court then the Supreme Court. With Medicare, hopefully you won’t have to go all the way to court.
There are five levels to an appeal. First, redetermination by a Medicare carrier, intermediary, or Medicare Administrative Contractor. Second is review by a Qualified Independent Contractor. Third is hearing by an Administrative Law Judge in the Office of Medicare Hearings and Appeals. Fourth is review by Medicare Appeals Council, and Fifth is Judicial Review by Federal District Court. Most cases are settled long before they get to step number five.
No matter what your question, grievance or appeal is, try to start by getting information directly from your Medicare provider. This may take some work, research and time, but it can save a lot of time and effort in the long run if you do not have to go through the entire appeals process.
For questions or information, call Medicare at 1-800-MEDICARE.
Medicare is designed for individuals 65 years old or older, and individuals with disabilities or on renal dialysis. Medicare Part A covers hospital and inpatient services, while Part B covers doctor visits and other services received as an outpatient (outside of the hospital).
Many people worry about how to enroll in Medicare. They worry that it will be difficult or confusing, but it doesn’t have to be, and it usually isn’t.
If you are receiving Social Security benefits, you will automatically be enrolled in Medicare Part A & B on the first day of the month that you have your 65th birthday. In other words, if you turn 65 on February 10th you will be enrolled at the beginning of February.
Your Medicare card will come in the mail up to three months before your 65th birthday. If you do not receive it in a timely manner, you should call the Social Security Administration at 1-800-772-1213 or visit them on the internet at www.ssa.gov. Either way, you will get assistance and can have the Medicare card sent to you.
If you are not receiving Social Security, you will need to sign up for Medicare. This is an easy process and you can do this a couple of ways. You can call Social Security Administration at 1-800-772-1213. They will take the information over the phone to get the process underway and then they will send you some paperwork in the mail.
If you prefer, you can go to your local Social Security office and apply in person. The advantage to this is that there is an individual there who will walk you through the entire process. Either way, it is your choice. You cannot, however sign up on line for Medicare only.
To sign up for both Medicare and Social Security Retirement Benefits together you can apply online at www.ssa.gov, or by phone at 1-800-772-1213, or go in person to your local Social Security office. Either way, you should be able to easily get enrolled for Medicare benefits without extra effort or worry.
