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The Federal MediCare Insurance Benefits

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Author: Manuel Salvacion

The Medicare program is one of the health insurance programs of the federal government for the elderly and disabled. It is administered by the Centers for Medicare and Medicaid Services (CMS).

The following will give you some important facts about the said program. Yet, it is still highly advisable to seek the aid of a medicare insurance attorney for proper assistance and representation.

Under the law, the program provides benefits for the following persons:

Those who have reached age 65 and are entitled to receive social security or railroad retirement benefits

Disabled individuals of any age who have received social security or railroad disability benefits for at least two years

Other people may be eligible and participate in the program. They include:

Persons eligible for social security benefits who have end-stage renal disease and require kidney dialysis treatment

Medicare pays or reimburses qualifying health care providers for specific medical services. There are two separate programs:

1. Medicare Part A - Also known as the Hospital Insurance Program, it provides beneficiaries with coverage for mostly hospital-related claims, such as:

Persons over age 65 who are not eligible for either social security or railroad retirement benefits who purchase monthly Medicare insurance coverage
Inpatient hospital care
Limited post-hospital skilled nursing facility
Home health care
Hospice care

2. Medicare Part B - Known as the Supplementary Medical Insurance Program, it focuses on medical costs other than hospitalization, such as:

Physician and surgical services
Diagnostic tests
Home health care
Physical, speech and occupational therapy
Medical supplies
Durable medical equipment
Ambulance services
Some preventive care services

Getting part B coverage is optional but each program requires different deductible and co-payment amounts.

The program also offers new plans for eligible members under the MedicarePlus Choice Program. Under this, any individual who is entitled to benefits under Part A and enrolled under Part B can choose from several types of health insurance plans. These include the following:

Coordinated Care Plans such as health maintenance organizations (HMOs), preferred provider organizations (PPO), and provider-sponsored organizations (PSO)
Private Fee-for-Service Plans
Medical Savings Accounts (MSAs)

Aside from that, there are other plans available for people under the federal program.

1. Medigap Plans

The Medicare supplemental insurance ("Medigap") plans provide coverage for:

Medicare deductible and co-payment amounts
Some health services not covered by Medicare

2. Qualified Medicare Beneficiary program (QMB)

3. Selected Low-Income Medicare Beneficiaries program ("SLMB")

The two latter plans may also provide payment for Medicare deductibles and co-payments to qualified individuals.

Medicare Exclusions

However, there are certain services not covered by the Medicare program. These include the following:

Custodial nursing home care
Most outpatient prescription drugs
Routine physical examinations
Routine eye examinations and eyeglasses
Hearing examinations and hearing aids
Routine dental services
Routine foot care and orthopedic shoes
Most immunizations
Personal convenience items
Cosmetic surgery

The social security administration allows individuals to have legal representation when pursuing their claims and benefits. In fact, getting the services of a medicare insurance attorney with a deep sense of professionalism can improve your chances of obtaining the claims that you deserved.

Further information about your medicare insurance benefits may be found at our Social Security Law attorneys' website at . We also provide free case evaluation services for our clients.

About the author: Manuel Salvacion

Before becoming an online writer, Manuel worked as a journalist, a newspaper columnist, a scriptwriter, a fiction writer, a magazine editor, and a tutor. He acquired his legal background as a Senate legislative officer and later on, as a researcher and paralegal staff in various law offices. Someday he hoped to go back and devote more time to writing fiction, which is his first passion.

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