According to the Official U.S. Government Site for Medicare, the Medicare program guarantees health insurance for people ages 65 or older and people under 65 with certain disabilities as well as people of any age with End – Stage Renal Disease (ESRD) (permanent kidney failure that requires a regular course of dialysis or a kidney transplant).
The whole Medicare social insurance program is divided into different parts where each of the part covers specific services:
Medicare Part A applies to Hospital Insurance and covers inpatient care in hospitals and skilled nursing facility, hospice, and home health care.
Medicare Part B applies to Medical Insurance and covers not only doctors’ and other health care providers’ services, outpatient care, durable medical equipment, and home health care, but also some preventive services to help maintain your health and to keep certain illnesses from getting worse (for example, preventive services include Pap tests, flu shots, and screening mammograms).
Medicare Part C, or Medicare Advantage, offers health plan options run by Medicare-approved private insurance companies, helps to get the benefits and services covered under Part A and Part B, and may include extra benefits for an extra cost. Most Medicare Advantage Plans cover Medicare prescription drug coverage (Part D).
Medicare Part C, or Medicare Prescription Drug Coverage, covers the cost of prescription drugs or may help lower your prescription drug costs and help protect against higher costs in the future.
What are your Medicare coverage choices?
There are 2 main ways to get your Medicare coverage —
Original Medicare or a Medicare Advantage Plan.
Use these steps to help you decide which way to get your coverage.
In addition to Original Medicare or a Medicare Advantage Plan, you may be able to join other types of Medicare health plans (Medicare Cost Plans, Demonstration/Pilot Programs, and Programs of All-inclusive Care for the Elderly (PACE)).
You may be able to save money or have other choices if you have limited income and resource.
- You may also have other coverage, like employer or union, military, or Veterans’ benefits.
You may be eligible to save money on medical and drug costs with the following programs:
Medicaid – A joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid programs vary from state to state, but most health care costs are covered if you qualify for both Medicare and Medicaid.
Medicare Savings Programs – A Medicaid program that helps people with limited income and resources pay some or all of their Medicare premiums, deductibles, coinsurance, and co-payments if you meet certain conditions. There are four types Medicare Savings Programs:
- Qualified Medicare Beneficiary (QMB)
- Specified Low-Income Medicare Beneficiary (SLMB)
- Qualified Individual (QI) Program
- Qualified Disabled and Working Individuals (QDWI) Program
Extra Help/Low-Income Subsidy – If you meet certain income and resource limits, you may qualify for Extra Help from Medicare to pay the costs of Medicare prescription drug coverage. Drug costs in 2011 for most people who quality will be no more than $2.50 for each generic/$6.30 for each brand-name for covered drugs. Other people pay only a portion of their Medicare drug plan premiums and deductibles based on their income level.
State Pharmacy Assistance Programs (SPAPs) – A state program that provides help paying for drug coverage based on financial need, age, or medical condition.
Pharmaceutical Assistance Programs (PAPs) - Some drug companies have Pharmaceutical Assistance Programs (PAPs) that help people pay for the drugs they make.
Programs of All-inclusive Care for the Elderly (PACE) – PACE is a Medicare and Medicaid program that helps people meet their health care needs in the community instead of going to a nursing home or other care facility. PACE covers prescription drugs, doctor visits, transportation, home care, check-ups, hospital visits, and even nursing home stays whenever necessary.
To qualify for PACE, you must meet all of the following conditions:
- Be 55 or older,
- Live in the service area of a PACE organization,
- Need a nursing home-level of care (as certified by your state), and
- Be able to live safely in the community with help from PACE.
What are your Medicare rights?
No matter how you get your Medicare, you have certain rights and protections. All people with Medicare have the right to:
■ Be treated with dignity and respect at all times,
■ Be protected from discrimination,
■ Have your personal and health information kept private,
■ Get information in a way you understand from Medicare, health care providers, and Medicare contractors,
■ Have questions about Medicare answered,
■ Have access to doctors, other health care providers, specialists, and hospitals,
■ Learn about your treatment choices in clear language that you can understand, and participate in treatment decisions,
■ Get emergency care when and where you need it,
■ Get a decision about health care payment, coverage of services, or prescription drug coverage,
■ Request a review (appeal) of certain decisions about health care payment, coverage of services, or prescription drug coverage
■ File complaints (sometimes called grievances), including complaints about the quality of your care,
An appeal is the action you can take if you disagree with a coverage or payment decision by Medicare or your Medicare plan. For example, you can appeal if Medicare or your plan denies:
■ A request for a health care service, supply, item, or prescription drug that you think you should be able to get ;
■ A request for payment of a health care service, supply, item, or prescription drug you already got ;
■ A request to change the amount you must pay for a health care service, supply, item, or prescription drug .
You can also appeal if Medicare or your plan stops providing or paying for all or part of an item or service you think you still need.
If you decide to file an appeal, you can ask your doctor or other health care provider or supplier for any information that may help your case.
Keep a copy of everything you send to Medicare as part of your appeal.
What’s New in 2013?
More covered preventive services: Medicare now covers depression screenings, screenings and counseling for alcohol misuse and obesity, behavioral therapy for cardiovascular disease, and more.
More help in the prescription drug coverage gap: If you reach the coverage gap (donut hole) in your Medicare prescription drug coverage (Part D), you’ll pay only 47.5% for covered brand-name drugs and 79% for generic drugs.
Medicare health & prescription drug plans: See
If you want to know more information about Medicare programs and plans, please, visit the link below: