Medicare: Benefits for senior citizens

by tcope » Tue Dec 15, 2009 05:46 pm

Medicare is a national health insurance program that was implemented by the US government in the year 1965 as part of the Social Security Act. Since then Medicare has been serving elder Americans, who have reached the age of 65 and have certain disabilities, in getting proper medical care that they need and deserve.

Who qualifies for Medicare?

You will qualify for Medicare under certain conditions. You must be

65 years or older or
Under age 65 but with a specific disability or
Any age but with terminal-stage renal disease

Who is eligible for Medicare and how to enroll?

Medicare insurance is an entitlement program just like Social Security and anybody who meets the qualifying criteria for Medicare is eligible. The Medicare eligibility criteria are constant throughout America and coverage constant and independent of the state you get treated in.

What are the benefits of Medicare?

Medicare benefits have been divided in 4 main parts by "The Department of Health and Human Services":

Medicare Part A (Hospital Insurance):
Covers part of inpatient care in hospitals, skilled nursing facility, home health care (if you meet certain conditions) as well as hospice services. Benefit from Medicare Part A can be received beginning from the time you turn 65 if you already receive benefits from Social Security or the Railroad Retirement Board (RRB). If you are under 65 years and have some kind of disability, Part A benefits will be provided after you get disability benefits from Social Security or Railroad Retirement Board for 24 months. You will receive a Medicare card either in the mail 3 months in advance to your 65th birthday or on the 25th month of your disability.

When should you enroll for Medicare Part A?
Medicare Part A or Hospital Insurance can be bought during the period beginning 3 months prior to your 65th birthday and ending 3 months after your 65th birthday. You may also buy this insurance during January 1and March 31 every year. You may even opt for a special enrollment in case you are covered under the group health insurance plan of your spouse's employer or union.

Medicare Part B (Medical Insurance):
Covers services like doctor's service and outpatient care and also a part of the preventive services that helps maintain your health and check some health conditions from worsening.

When should you enroll for Medicare Part B?
If you already get Social Security Benefits or Railroad Retirement Board (RRB) benefits then you will automatically get Part B beginning the day you turn 65. If you are under 65 and disabled, you will be entitled to certain disability benefits from Social Security or RRB for 24 months.

Medicare Part C (Medicare Advantage Plans):
Private insurance companies approved by Medicare manage Part C. Medicare providers have combined hospital care, medical care and also sometimes prescription drug coverage in this plan. Such a plan can, however, charge different co-insurance premiums, co payments or deductibles compared to those charged by the government in Medicare parts A and B.

Part C or which is also popularly known as the Medicare + Choice or "Medicare Advantage" plan requires that you should pay a monthly premium in addition to the fixed premium. Whenever you see a doctor you need to pay a fixed amount but for seeing a specialist you need to pay extra. This plan may be more expensive than the original Medicare plan.

Medicare Part D (Prescription Drug Plan): Covers part of the cost for your prescription drugs. Individual plans vary in cost and the benefits received may also differ. Prescription Drug Plan can be added with the help of private insurance companies. However, if you have Medicare Hospital insurance and Medical Insurance, you will be automatically entitled to the Prescription Drug Plan.

With Medicare Part D you can pay less when buying prescription drugs. Use the Medicare ID card at any drug store and if you have limited income, you may get additional assistance with the costs.

Is there a supplementary plan for Medicare?

Yes there is a Medicare supplement plan for those who feel there are significant gaps or large expenses that is associated with medical cost sharing that can later add up to a Medicare plan. Solutions to cover these gaps have been developed by the collaborative efforts of the Federal and State Governments. You can choose from different levels of coverage.

Is there an alternative to Medicare?

Yes, you can go for a Medicaid plan if you think you can't pay for Medicare right now. Medicaid is available only to families that have a low income and that are eligible for medical aid as mentioned by the federal and state laws.

Medicaid is meant to directly send money to your health care provider. You might just have to pay a co-payment or some fixed amount for any medical service that you take and this amount will depend on the state that you live in. There are certain requirements for Medicaid like:

Your age
Whether you are pregnant
Your income and resources (bank accounts, real property or any other item that can be sold for cash)
Whether you are disabled (blindness included)
Whether you are a US citizen or a lawfully admitted immigrant

Although the Medicare program has faced several criticisms and has faced continuous financial challenges, it has been stably helping senior citizens of America in getting the health care that they deserve. So before you turn 65, think about Medicare. Do your research properly to avoid Medicare fraud.

Medicare has always had a "super lien"... meaning that Medicare could always seek recovery on a payment even if they had not informed the payer of their lien and even if the payer already paid some other party. Now there is Section 111, requiring pretty much everyone to notify Medicare of a payment is being made on an injury claim. That is, insurance companies now need to be pro-active and tell Medicare that they are making a payment beforehand so that Medicare can seek recovery. Medicare no longer needs to learn that a payment is being made... they need to be told.

I have a claim where I have $10,000 to pay toward medical bills. I know the bills were paid by Medicare so I called them to inform. They told me that I needed to report a "claim" and that someone would call me w/in 45 days. I have to file a "claim" when they already know about the claim? Needless to say no one called me so I called back to follow up. Now they tell me that I need to have the person's ID# or they cannot do anything for me. I explain that I simply want to issue then a $10,000 payment and need to have some lien paperwork. They tell me that they cannot discuss it with me due to privacy issues. Huh? If they need authorization to send me a lien then shouldn't _they_ get authorization? Why should I force the injured person to give them autho to send me a bill?

So even though Medicare had all the rights in the world.... and then added more, they _still_ can't figure out how to take money when it's handed to them.

BTW - I was on the phone for 45 minutes to learn this.

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