Q1: What Is a Medicare Advantage Plan?
Answer: Medicare Part C, also known as the Medicare Advantage program, allows you to choose a health plan offered by a private insurance company that is approved by medicare. It”s Advantage plans include:
1.Managed Care Organizations
2.Private Fee-for-Service Plans
Medicare Advantage plans receive payments from Medicare to provide you with the benefits covered by Medicare, including Part A and Part B. Most Medicare Advantage plans include Part D drug coverage and many offer extra coverage, such as vision and hearing care, dental services, and wellness programs.
Q2: What Does “Medically Necessary” Mean?
Answer: Medicare will only pay for services that are considered to be medically necessary. According to Medicare, services or supplies are considered medically necessary if they:
Are proper and needed for diagnosis, or treatment of your medical condition.
Are provided for the diagnosis, direct care, and treatment of your medical condition.
Meet the standards of good medical practice in the medical community of your local area.
Are not mainly for the convenience of you or your doctor.
Q3: What Is the Medicare Part D Coverage Gap?
Answer: Most Medicare drug plans have a coverage gap, also known as the “doughnut hole.” This means that after you and your drug plan have spent a certain amount of money for covered medications, you have to pay all out-of-pocket costs for your drugs (up to a limit). Your yearly deductible, your co-insurance or copayments, and what you pay in the coverage gap all count toward this limit.
1. Medicare Part D Enrollment.
2. Understanding the Part D Donut Hole.
3. Lower Your Drug Costs in the Donut Hole.
Q4: Who Is Eligible for Medicare Benefits?
Answer: If you get benefits from Social Security or the Railroad Retirement Board, you are automatically eligible for Medicare starting the first day of the month you turn 65.
If you are under 65 you are eligible to receive Part A benefits under the following circumstances:
You have been receiving Social Security Disability Insurance for more than two years.
You have permanent kidney failure (end-stage renal disease requiring ongoing dialysis or a kidney transplant. You have been diagnosed with amyotrophic lateral
sclerosis (Lou Gehrig’s disease).
1. An Overview of Medicare Benefits
2. Medicare & You 2010
3. Medicare Benefits when Receiving Disability Benefits
4. Medicare Coverage of Kidney Dialysis and Kidney Transplant Services
Q5: What Does Medicare Part A Cover?
Answer: Medicare Part A, also known as the Hospital Insurance program, helps cover the costs of care in the following facilities:
Inpatient care in hospitals
Inpatient care in a skilled nursing facility
Inpatient rehabilitation facility
Hospice care services
Some home health care services
Inpatient mental health and psychiatric care
If you are eligible for Medicare you will not have to pay a monthly premium for Part A if you or your spouse paid Medicare payroll taxes while working.