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What to Consider When Evaluating Medicare Benefit Options
Often, there is a lot of confusion with trying to understand exactly what Medicare offers as well as determining Medicare eligibility. By definition, this program is a social insurance program administered by the federal government. It is funded by the Social Security Administration and operates as a healthcare system in which single-payer health insurance collects all of an individual's medical fees and pays for all services through a single government source.
Types Of Benefits
The two most common types of Medicare benefit programs are Part A and Part B.
Medicare Part A: Hospital Insurance
Medicare Part A covers in-patient hospital stays, semi-private hospital rooms, food, tests and doctor fees. It also covers the gradual recovery or convalescence of someone in a nursing home or similar facility if the following criteria are met:
a. A preceding hospital stay must be at least three days and three midnights (not counting the discharge date).
b. Staying in a nursing home/facility must be related to something diagnosed during a previous hospital stay or be the main reason for the hospital stay.
c. The patient may not be receiving rehabilitation, but must have some other ailment that requires skilled nursing supervision.
d. The care received at the nursing home must be skilled. Part A does not cover non-skilled or long-term services, such as cooking or cleaning.
Some other things to keep in mind when receiving benefits under Part A include:
a. The maximum length of stay in a skilled nursing facility (per ailment) is 100 days.
b. The first 20 days of treatment are covered by your benefits, but the remaining 80 days require a co-payment.
c. Some insurance companies have a provision for skilled nursing care, so check your policy.
Medicare Part B: Medical Insurance
Medicare Part B covers a limited amount of healthcare services and products not covered under Part A of your benefits. Coverage includes:
a. Physician and nursing services
b. X-rays
c. Laboratory and diagnostic tests
d. Pneumonia and flu shots
e. Blood transfusions
f. Renal dialysis
g. Outpatient hospital procedures
Medicare Part C and Part D Benefits
Medicare beneficiaries also have the option for Part C (known as Medicare Advantage), which provides the same coverage as Parts A and B private health insurance plans. This plan combines benefits from Part A and Part B, and may also include additional benefits such as dental and vision.
Part D (known as the prescription drug plan) covers most prescription drugs. In order to qualify, a person must enroll in a standalone prescription drug plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). Depending on Medicare eligibility, some drugs may not be covered, so it's important to ensure that the drugs you need are covered under your plan.
Medicare Eligibility: Who Qualifies?
Today, benefits are available to approximately 45 million people nationwide. Medicare eligibility is available for the following groups of people:
a. Senior citizens (age 65 and older)
b. Anyone currently receiving Social Security Disability Insurance (SSDI)
c. People with end-stage renal disease (ESRD) or permanent kidney failure
Evaluating Your Benefits
The process of evaluating your Medicare options can be confusing, even if you have the information available. According to The New York Times, Medicare recipients may face an equally tough situation - too many options. They may need to sort through dozens, even hundreds, of choices during the annual enrollment period, which runs Nov. 15 through Dec. 31.
Things to Consider When Evaluating Your Benefits
a. Determine if your existing plan is still available and still appropriate for your situation.
b. If you belong to one of the Medicare Advantage plans that no longer exist, call your insurer if you haven't already received a notice from them.
c. If you do nothing, you will automatically be enrolled in Parts A and B plans, but you will have to enroll in a prescription drug plan separately during the Nov. 15 - Dec. 31 annual enrollment period.
d. If you've experienced any changes in your financial situation or health, re-examine your existing plan to see if it's still right for you.
e. Compare Part D (prescription drug) plans to make sure that the drugs you use will be covered by the plan that you choose.
Choosing a Medicare plan can be complicated. A Medicare plan selection service can be very valuable in helping you determine the right plan for your needs by researching and analyzing the options available to you.
Author Resource:-
Jim Allsup writes for Allsup, a nationwide provider of Medicare benefit representation that can work with you to determine your Medicare eligibility.
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