Understanding Medicare

Understanding Medicare.

If you are ill, your health care coverage is the most important financial piece and keeping you on your treatment plan. I want to take a moment to give a high level overview of Medicare.

Surprisingly, few people really understand this program and what it covers and what options you have and don't have. Additionally, people don't really take the time to review their options after enrolling.

Medicare is a health plan system funded by the government on behalf of Americans that are 65 years old or older.

You can sign up for this benefit up to three months before you turn 65. If you want the coverage to be effective on your 65th birthday,

You will then have the month of your birthday and an additional three months after your birthday to sign up.

If you do not sign up during this time, you will have to wait until the next enrollment period, which lasts from October 15th to December 7th. There are different parts to Medicare because Medicare is a government funded insurance.

Seniors have few options when signing up. You can either sign up for traditional Medicare, which is Medicare Part A and B, or you can sign up for Medicare Advantage or Medicare Part C, The prescription drug program is Medicare Part D, that you have the option for enrolling in. Medicare Part A is your traditional hospital and home health care insurance.

It covers services related to doctor's visits, ambulance services and mental health services, among others.

Many also believe it's for nursing home care. We will talk more on this a little later on. If you sign up for Medicare Part A and B, you can go to any hospital in the country that accepts Medicare patients.

Keep in mind there is no monthly premium for Medicare Part A, but there is a monthly premium for Medicare Part B.

Medicare Part B covers two types of services.

First, it covers medically necessary services.

These are services or supplies that are needed to diagnose or treat your medical condition. Second, it covers preventive services, meaning health care to prevent illness or detect it at an early stage. You pay nothing for most preventive services if you get the help from a health care provider who accepts assignments.

Part B covers things like getting a second opinion before a surgery, limited outpatient prescription drugs., clinical research Analyst service., durable medical equipment, mental health, inpatient care, outpatient care, a partial hospitalization.

Medicare Part C or Medicare Advantage are private insurance programs administered by health insurance companies.

These plans must offer the same coverage as traditional Medicare plans, except for the hospital coverage, which is covered under their traditional Medicare Part A program.

However, Medicare Part C must also offer additional services and coverages that are not covered in traditional Medicare. Unfortunately, this coverage is restrictive in that it does not allow you to visit any doctor you want. Does Medicare pay for a nursing home costs or long term care needs? Medicare does provide limited nursing home calls. Medicare Part A covers institutional care in hospitals and skilled nursing facilities, as well as certain care given by home health agencies and care provided in hospice.

Medicare Part A will cover up to 100 days of skilled nursing care per incident of illness. However, guidelines must be met and they are quite stringent. The recipient must have entered the nursing home no more than 30 days after a hospital stay for which they receive treatment and must have been in the hospital for at least three days, not including the day of discharge.

The care they receive at the nursing facility must be for the condition that cause the hospitalization or for the condition related to the hospital stay. The patient must receive skilled level care in the nursing facility that cannot be provided at home or on an outpatient basis. Skilled means a nursing home must be ordered by a physician and delivered by or under the supervision of a professional such as a physical therapist, registered or a licensed practical nurse.

The care must also be delivered daily.

First, many nursing homes assume that if a patient has stopped making progress toward a recovery, the Medicare coverage should end.

They should understand instead that if the patient needs the skilled care in order to maintain his or her status, or to slow or prevent deterioration. Then care should be provided and is covered by Medicare. Second, many nursing homes falsely believe that the care in the facility must be given directly by a skilled nurse and are therefore excluded from Medicare, a skilled nursing facility benefit. In fact, care could be given while being supervised by a nurse and still be covered by Medicare, a skilled nursing facility benefit.

Additionally, a patient may need a wide variety of treatments that do not require a nurse to directly provide. However, supervision by the nurse may be required to monitor the patient's care and status to prevent adverse interactions among the treatments.

Medicare, in this instance, will continue to provide coverage when a patient leaves a hospital and enters a nursing facility, the nursing home will provide Medicare coverage.

The nursing home must give the patient a written notice of whether the nursing home believes that the patient requires nursing home, at which point the Medicare is merited. Unfortunately, even though the skilled nursing facility may initially treat the patient for several weeks, often the skilled nursing facility will determine the patient no longer require skilled care, and will issue a notice of non coverage terminating the medical coverage.

Even if the non coverage determination is made prior to or even after treatment at the skilled nursing facility, the patient is offered a notice asking if they would like the bill to be submitted to Medicare despite the nursing home assessment of the patient's care needs.

The patient or the legal representative should always ask for the bill to be submitted. This requires the facility to submit the patient's medical records for review to the fiscal intermediary and insurance company hired by Medicare, which reviews the facility's determination. This review is free of charge to the patient and may result in more Medicare coverage. Also, while the case is in review, the patient is not responsible for the bill.

This appeal can take a year as well as a need to hire an attorney. This appeal should only be pursued if after reviewing the patient's medical records, the lawyer believes that the patient was receiving a skilled level of care that should have been covered by Medicare.

If you get to this point and are still turned down, there are subsequent appeals to the appeals court in Washington and then to federal court.

In order to make sure you have chosen the best coverage for your unique situation.

It is best to talk to an expert that can go over your unique health situation and other credible coverage options you may have and the costs associated with this plan. There are late fees or exclusions that some of their choices are not made in a timely manner. You can get additional information from www.medicare.gov.

You can also get in touch with a local expert on Medicare.