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 Medicare Insurances

General Overview
There are now 4 parts to the Medicare Insurance Coverage.  The first part is Medicare Part A or the Hospital portion of Medicare which is FREE to all those who qualify for the Medicare insurance benefits.  Medicare Part B or the Doctors office portion and Medicare Part D is the allowance for pharmacy coverage both of which the patient must pay a monthly fee for out of their social security benefits.

The last one is Medicare Part C which is where the Medicare HMOs, PPOs, and PFFS come into play.  Medicare Advantage Plans are a combination of the Medicare Part A and Medicare Part B allowed benefits with some offering addition services such as for Medicare Part D.   Private insurance companies that are approved by Medicare offer Health Maintenance Organization, Preferred Provider Organization and Private Fee For Services plans.  Most of these will accept the Medicare Part B payment for the coverage and, now, if there is a pharmacy component to the coverage then the Medicare Part D payment as well as payment in full for the Medicare Advantage Plan.  The HMO and PPO rules then apply as to restricted provider networks and the patient owing copays and coinsurance for service.

With regular Medicare the patient will owe a yearly outpatient deductible, a per admission Inpatient deductible every 60 days, 20% coinsurance on most outpatient services and for long-term care you get into coinsurance days on inpatient and finally life-time reserve days copays.
 

 
Specific Information
The Medicare Program is medical coverage for those individuals who have Retirement Social Security Benefits.  To qualify they have paid into the program through some kind of employment throughout their lifetime or qualified through a spouse and reached the age of 65.  Your patients may also qualify for Medicare Insurance Coverage through Disability Social Security benefits as well.   Some patients will qualify for coverage through a medical disability, physically disability or psychiatric disability.   Medicare is often considered a primary insurance unless there is an another reason for the medical treatment.  For instance, if the patient is involved in an automobile accident or are injured at a job.    For more information on Medicare visit the Medicare website.

The patients have a choice each year to sign-up for a Medicare Advantage Program that may have additional benefits are no extra cost.  These programs are approved by Medicare, administered by a private insurance company and may help those individuals who do not have a secondary insurance coverage through an employment retirement plan or cannot afford a Medicare supplement.  Medicare has a comparison chart on their website for you to get more information on the plans.

Quite a few of the Medicare patients who elect not to participate in a Medicare Advantage program have a secondary insurance either through a retirement program at work or a supplement.  Otherwise they must pay all of their deductibles and coinsurance amount out-of-pocket.  Quite a few of the Medicare supplement also called Medigap policies will cross-over to their system once Medicare pays thus reducing the paperwork for both the medical facility and the patient.  For more information on all the medigap policies go to the Medicare website.