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.