Health Care Article


Medicare

Medicare is a federal health insurance program that primarily covers Social Security recipients who are at least 65 years old. It also covers those who are younger but have certain disabilities, need kidney dialysis or a kidney transplant. Note that Income level and assets have no bearing on an individual’s eligibility for coverage.

 

Generally, Medicare participants may choose between the Original Medicare Plan, a Medicare Advantage Plan (HMO, PPO, special needs and private fee-for-service plans) and, in some instances, other Medicare health plans that are only available in certain parts of the country. The participant pays the deductibles, co-payments and, in some cases, a monthly premium. Medicare then pays the rest of the tab for covered services.

 

The program has three parts:

  • Part A, referred to as hospital insurance, covers inpatient hospital care, some skilled nursing and home health care and hospice care.
  • Part B, which has an $115.40 monthly premium (in 2011), helps pay for additional medical services. (It may cover physical and occupational therapy, for example, and some medically necessary home health care). This premium can change depending on your income.
  • Part D was launched in 2006 to provide prescription drug coverage. If you have very little income or currently receive certain other government benefits, you may qualify for greater help with your prescription drug bills.

More about Part D

All Medicare beneficiaries now qualify for prescription drug coverage. As a beneficiary, you can choose from a variety of Medicare-approved prescription drug plans. Keep in mind that these private insurance plans may have different premiums, deductibles, co-payments and lists of covered prescription drugs. There is also the Medicare Advantage Plan that covers physician and hospital care as well as prescription drugs. Before enrolling in any plan, make sure it meets your particular needs.

In addition, you may not need to enroll at all. You may already have a Medicare-approved prescription drug plan through Veteran Affairs, for example, or your employer, former employer, union or existing Medicare Advantage Plan. (If you are uncertain, contact your benefits advisor for guidance.)

Personalized Assistance

You have choices once enrolled in Medicare. For help in understanding Medicare and other health care options, eligibility, benefits, cost sharing programs, long term care insurance and claim filing, contact the State Health Insurance Assistance Program (SHIP) toll free at (800)432-4040.

SHIP is a free health benefits counseling service for Medicare beneficiaries and their families or caregivers. SHIP counselors are specialists trained in health insurance counseling, Medicare laws and regulations. Ship counselors are not connected with any insurance company.

You might also want to check out Medicare’s Official Web site for more indepth information about Medicare programs.


Comments:

QUESTIONS

  • What is Medicare?
  • What are rules for Medicaid recipients with regard to the other spouses rights? I'm planning for if I would have to go to a Nursing Home.
  • are clinics allowed to charge interest on medical bills? are they required to file claims with my secondary insurance after medicare? can they refuse treatment for a balance on an account after medicare has paid?
  • My mother is 85 and being treated by a naturopathic doctor. My sister and I are concerned that the care she is getting is harming her overall health. We have contacted the Naturopathic Physician Medical Board to file a complaint. They are willing to move forward and subpoena her medical records for review. The problem is that they say there is no way to keep this physician from mentioning it to our mother. We feel that our mother puts an abnormal amount of "faith" in this physician and that she has been, for lack of a better word, "brainwashed" into believing that he can do no harm. We want to proceed without fear that he will convince my mother that we are "the bad guys." What do we need to do to proceed without fear that he will discuss this with our mother? Any suggestions or guidance would be greatly appreciated.
  • How do I get a list of doctors that participate in the AHCCCS Medical Program in Chandler AZ?
  • My wife is permanatly disabled under social security disablity. Part of her disablitiy is problems with comprehension. Between her learning disablity and hearing impairment, she has a really hard time comunicating with doctors and insurance companies. She just can't comprehend these things. She wants me to be her Medical Power of Attorney so that she doesn't have to deal with insurance companies customer service. The only information I can find is related to seniors. Can you help us? Where to go.. who to see?
  • I CANT FIND A LAWYER WHO WILL TAKE MY CASE. I AM SUFFERING FROM A HYPOXIC BRAIN INJURY AFTER BOWEL OBSTRUCTION SURGERY. IM RUNNING OUT OF TIME TO FILE. WHATEVER HAPPENED TO JUSTICE FOR ALL?
  • What age can you start getting senior help with the des programs?
  • My Mom is an 80-year old senior with legal status, diable, no income, arrived in the US November 2007. She was just recently approved for AHCCCS Federal Emergency Services. I made an appeal to AHCCCS that she be granted a regular full coverage because of her current medical condition. What are the rights of the seniors in Arizona with the same case of my Mom in terms of health care. She has heart disease, severe arthritis, acute glaucoma that needs to be followed-up by specialists. She has been due for medical check up and needs continuous medication for the above illnesses. Your thoughts would be greatly appreciated.
  • My mother had quad bypass surgery 10/07. Upon coming home from the hospital we needed a caregiver to help my mom take her meds go to the bathroom , feed herself , bathe herself etc. After 90 days my mothers LTC kicked in. We filed a claim with Humana , which is the provider that administers her medicare , on 04/20/07. We called a couple of weeks later and were told it takes 30 days to process. We then called the end of May and were told they have it but to wait another 30 days. We called at the end of June and were now told it was in the wrong dept but it would now be expedited. I called mid July spoke to a "manager " Joe Clark who said it was still in the worng dept but he wopuld expedite it and call me back in 1-2 days. NO CALL 10 days later I call and speak to Stephanie, and she tells me her sup. will call me back NO CALL. i call 5 days later speak to Woodley , he tells me he has no idea about the delay but will rush it. I call at the end of July speak to yet another manager who tells me they "changed" vendors and need me to refax the entire claim. She asks me what the claim is about I tell her and she tells me that what I described to her is really more "housekeeping" work and not covered. KEEP IN MIND she hasn't even reviewed the claim. I am now approaching 4 months since we first submitted this and I am at wits end. What are my options to get this expedited one way or another

STORIES

  • He told me that I could actually get all the money I needed by using my home as collateral. . .
  • Age discrimination in the workplace. . .
  • I just helped my mother, age 89, deal with her Medicare HMO. . .

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