The Medicare Health Insurance program is funded by the United States Government to help US residents who are 65 years or older and/or are disabled and are unable to afford private insurance. The Individuals who are satisfying the eligibility criteria for Social Security will automatically qualify for the Medicare health insurance program.
Like many other plans, Medicare health insurance does not pay the complete cost of your medical bills. The coverage is broken down into four parts identified as Part A, B, C and D. To get the Original Medicare benefits you would be provided with Part A which is the basic coverage for hospital expenses. You would also be covered under Part B that includes visits to physicians and hospital services on an outpatient basis. The medical services that you receive may be to you by any doctor and/or hospital that is willing to accept Medicare and who belong to a medicare provider system.
Medicare Advantage Plans – This plan is available in practically all the states. If you have a medicare advantage plan, you do not need a Medigap policy. These plans include:
- Health Maintenance Organizations (HMO) or Medicare HMO
- Preferred Provider Organizations (PPO) served by a medicare provider network
- Private Fee-for-Service Plans
- Medicare Special Needs Plans
- Medicare Medical Savings Account Plans (MSA)
These plans typically cover more services and they have lower out-of-pocket costs compared to the Original Medicare Plan. Some of the plans provide prescription drugs coverage. In HMO plans you may only be able to see only specified doctors or be able to visit only specified hospitals to get covered services.
Medicare Drug Plans
On January 1, 2006, Medicare prescription drug coverage was made available to everyone with Medicare. The beneficiaries of Medicare can get this coverage, which can help lower the prescription drug costs. Medicare Drug plans are insurance. You choose from a number of medicare drug plans and pay a monthly premium. There are two types of Medicare drug plans that provide insurance coverage for prescription drugs. Medicare prescription drug coverage is an integral part of Medicare Advantage Plans and other Medicare Health Plans. The entire Medicare health care can be availed through these plans. Insurance companies that are approved by Medicare generally offer these plans.
Medicare Medicaid
Medicaid is available to certain low-income individuals and families who belong to an eligibility group recognized by federal and state law. Medicare Medicaid does not pay cash to you directly; instead, it sends payments to your health care provider. In some states, you may be asked to pay a small part of the cost as co-payment for some of the medical services. Medicare Medicaid is a state administered program subject to guidelines set by each state regarding eligibility and services.
Medicare Costs
The following is a list of the various medicare costs in terms of Medicare premium, deductible, and coinsurance rates that are in effect in 2010:
Medicare Premiums for 2010:
Medicare Part A: Hospital Insurance Premium
- If a person or the his/her spouse has 40 or more quarters of medicare covered employment, there is no need to pay monthly Part A premium.
- The Part A premium of $254 per month is payable by people having 30-39 quarters of Medicare-covered employment.
- The Part A premium of $461 per month is payable by people who are not otherwise eligible for premium-free hospital insurance and who have less than 30 quarters of Medicare-covered employment.
Medicare Part B: Medical Insurance Premium
Most beneficiaries will be continuing to pay $96.40 premium in 2010. Beneficiaries currently having the Social Security Administration (SSA) withhold their Part B premium and who have incomes of $85,000 or less (or $170,000 or less for joint filers) will not be having an increase in their Part B premium in 2010.
Medicare Deductible and Coinsurance Amounts for 2010:
Medicare Part A: This pays for inpatient hospital care, skilled nursing facility care, and some home health care services. For each benefit period, Medicare pays all the covered costs except the Medicare Part A deductible of $1,100 in 2010 during the first 60 days. It also pays the coinsurance amounts for hospital stays that last more than 60 days and but not more than 150 days.
For each benefit period you are expected to pay:
- A total of $1,100 for hospital stay services of 1 to 60 days.
- $275 per day for days for hospital stay services of 61 to 90 days
- $550 per day for days for hospital stay services of 91-150
- All costs for each of the days beyond 150 days
Skilled Nursing Facility Coinsurance
- $137.50 per day for days 21 to 100 in each benefit period.
Medicare Part B: This covers Medicare eligible physician services and outpatient hospital services. Certain home health services and durable medical equipment expenses are also included in this.
- $155.00 per year. You pay 20% of the Medicare-approved amount for the services after meeting the $155.00 deductible.
Medicare Billing Guidelines:
- The service (s) used must be medically considered necessary. This is by Medicare’s definition, not yours.
- The service (s) must have been performed: If you bill for a service and did not have the service performed or some other service different from the one billed for was utilized, you will be ineligible for the benefits.
- The service (s) performed must be sufficiently well documented to demonstrate medical necessity.
The last one is the most important for billing for the services rendered. Medicare billing is all about right documentation.
Indemnity plans
