The Federal Medicare Insurance Benefits

The Medicare plan is one of the health insurance programs of the federal government for the seniors and disabled. It is administered by the Centers for Medicare Services (CMS).  The following will give you some important facts about the Medicare program. But still, it is good to seek the help of a Medicare insurance counsel for proper assistance. 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:

People eligible for social security benefits that have an 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:
  • People over age 65 who are not eligible for either social security or railroad retirement benefits that purchase monthly Medicare insurance coverage
  • Inpatient hospital care
  • Limited post-hospital skilled nursing facility
  • Home health care
  • Hospice care
  1. Medicare Part B – Also known as the Supplementary Medical Insurance Program, it centers 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 a different deductible and co-payment amounts.  The program also offers new plans for eligible members under the Medicare Plus 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 plans (“Medigap”) plans provide coverage for:

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

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
  • Routine dental services

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.

Information about Medicare assignment service and insurance plans

Most doctors, hospitals, skilled nursing facilities and home care groups accept Medicare insurance coverage. But, always make sure that you check with them prior to availing service. In case of assignments, the attending doctor or health care supplier is required by law to reimburse the Medicare approved amount for the entire services covered. Note that in such instances, both the participating bodies offering coverage must have had signed a prior agreement in advance to insure Medicare service for assignment.

Medicare assignment service

If your insurance service provider accepts the assignment, then you will not have to pay these extra charges. They will charge you only the deductible and copayment costs so that after their contribution to the amount you can place a claim directly with the health insurance provider. The attending service provider chosen by you cannot charge you for a claim submission if it has been already pre-agreed by Medicare and you in advance.

However, if your service provider isn’t a participating group that hasn’t signed up for any agreement with Medicare to process such a plan, they can still accept assignment for certain individual services. But, you have to bear some additional charges for amounts in excess of the upper Medicare approved limit also known as Excess Charges. There is also the limiting charge in which you will have to pay just 15 percent above the pre-defined amount to the service provider. This is the amount that non-participating services are paid by Medicare. They are also paid 95 percent of the fee allotted amount. The limiting charge is applicable only for Medicare approved service coverage. This does not extend to medical supplies.

The attending medical care specialist doctor or group has to file a claim to Medicare in order to supplement the services that they provide to you. Usually, the current service group has to request for your claim, but if they don’t then you should ask them to call up Medicare’s helpline number and the rest of the proceedings can be initiated thereafter. Using Form 1490S, you can also submit your own Medicare claim to obtain a reimbursement.

Supplement Insurance Plans

These are the Federal Government standardized insurance plans that come under the category of A-N. No matter which insurance company’s coverage policy you choose to avail, there are some basic Medigap policies that must be applicable for the insured to obtain. The same letter is provided to you by all insurance policy groups, but the only differentiating factor is the cost associated with each of the coverages. Using Plan A you can pay off the bills of the hospital under Medicare scheme and physician coinsurance. Beyond Medicare you will be able to avail the first three blood pints, and a whole year of hospitalization.

Plans B to N provide more benefits such as excess charges, Medicare deductibles, foreign travel and also limited preventive care. Make sure that you do not buy an additional Mutual of Omaha medicare supplement plan G as there will be only one supplement plan unless you want to change any of your earlier policies.

Is jumping from one Medicare Advantage Plan to Another Legal?

This is one of the crucial but disturbing question that has been lingering in the minds of many interested parties. At some point after taking an original Medicare and eventually enrolling in a Medicare plan of your choice, you will by chance realize that that could not be the right plan that would cover your needs to the later. The other thing that will drive you towards thinking of changing from one Medicare advantage plan to another is when you realize that your health condition has gradually changed. This are two instance when you will certainly realize the need to change from one plan to the other.  Get a quote for 2019 plans at

The first thing that one has to understand is the policies governing the overall Medicare original plan does allow one to shift from one plan to another. With that the answer as to whether it is legal to jump from one plan to the other. The only thing that you need to do is that you need to be careful to enroll within the Open Enrollment Period. The open enrollment period is within the Medicare advantage policy. As much as the legality of jumping from one plan to another is guaranteed, you need to be aware of the fact that switching from a plan to another will mean that you will forgo the other benefits you have been accruing from the previous plan.

advantage plans 2019

The new plan will take effect as soon as you switch from the previous plan to the current plan. The current plan will also take effect as soon and as possible meaning that you will get to enjoy health care benefits on immediate basis. In some case, there will be delays in those cases when there are critical concerns with your shift from one to another. The concerns might arise from mistakes or lack of proper application. This will bar you from being moved from one plan to the other. With that idea in mind, it is actually possible and legal to switch and start enjoying the benefits immediately after the shift from one plan to the other.

It is also possible to remove your membership from any of the Medicare advantage plan and still enjoy the umbrella of the original Medicare. It is therefore, also, legal to for you to remove yourself from any of the Medicare plan as long as you will follow the right channels.


It is Important to know that which will be Covered and that which will not be Covered by Medicare Supplement Plan

There are conditions which have been tied to the Medicare supplement plan and with these conditions, we will end up discussing those services and benefits that may be covered or may not be covered by the Medicare Supplement plan. Those who are eyeing on becoming the beneficiaries under that Medicare supplement plan should be aware of the general elements that are covered and those that may not be covered by the Medicare supplement plan. What, therefore, do we stand from taking a Medicare supplement cover and what do we not stand benefiting from it.  Enroll at

In quest to avoid overlapping of functions, the Medicare supplement plan does not anything that has already been stated under the original Medicare policy. This is to mean that there are some of the basic benefits which can be accrued from being part of the original Medicare system. When this is said and done, it is crucial to be aware of those benefits that have been covered and can be accrued from the original Medicare plan. This is basically avoiding the overlap of benefits that have already been covered by or through the original plan.


You need also to be aware of the idea that there are some of the stand-alone Medicare prescriptions that have their own expenses and may not be entirely be covered by the Supplement plan. Such expenses may be covered only through taking a coinsurance plan. The original Medicare plan will therefore cover a section of such expenses and those that exceed will be covered through a supplementary plan. This is one of the tricky things to understand for some individuals but it is very important if you will have a thorough understanding.

Conclusively, the Medicare supplement plan will also cover all the medical expenses stated in the policy terms in respect to the location which you wish to stay in or is longing to enjoy your services. With that idea, if for instance you are stationed at New Jersey, Medicare supplement plan will cover based on the rates allocated to such a location. There are exception which the Medicare supplement plan will consider. Such exceptions include covering couples who are located in different states. However, the couples will be required to select facilities within the State that was stated in the initial policy terms.

Medicare Plans

Medicare Part A and Medicare Part B are health insurance plans that will take care of numerous medical issues someone may have. Only they do not cover everything. People will still have numerous copayments and deductibles that will be their responsibility. Medicare Part A and Medicare Part B do not cover all medical issues, such, as vision and dental checkups, prescription drugs and any foreign health care if you travel.

People with original Medicare Part A and Medicare Part B may get a Medicare supplement plan to cover all expenses or they may acquire a Medicare Advantage Plan. People have the option of making the choice of original Medicare or a Medicare Advantage Plan that incorporates original Medicare. Medicare supplement plans work with Medicare Part A and Medicare Part B and they are also known as Medigap plans. It is a consideration to really look at both plans to see what they have to offer and what medical expenses they will cover.

An Aetna Medicare supplement pays the gaps in Medicare Part A and Part B. and will help with the medical costs not covered by Medicare. You must continue to have Medicare Part A and Medicare Part B in order to have a Medicare supplement plan. You will also need to get Medicare Part D to help with your prescription drugs. That coverage is not included in a Medicare supplement plan.

Medicare pays 80% of your hospital costs and medical procedures while a Medicare supplement plan will cover the remaining 20% with copayments or deductibles. These plans may also cover medical expenses that Medicare does not take care of, like Medicare Part B excess charges or health care in a foreign country.

Medicare Advantage Plans are another option for a senior. You still have Medicare but its benefits are within the Medicare Advantage Plan. You must live in the state where you enlist the Medicare Advantage Plan you may be considering. With some exceptions, you may not have end stage renal disease. Some of the Medicare Advantage Plans will also cover your prescription drugs, vision, hearing exams and dental. The plans are all different and need to be looked at carefully to determine what will work best for your situation. Individual insurance agencies offer both Medigap plans, as well as, the Medicare Advantage Plans. Depending on where you live and what plan you want, each insurance agency will offer different costs for the premiums for the same plans.