Medicare Guide

Medicare is the largest health insurance program in the United States. The Centers for Medicare and Medicaid Services (CMS) administer Medicare programs to people who are at least 65 years old. The program also provides medical coverage for people younger than 65 with certain disabilities.

Health Coverage

• Medicare coverage has specific parts. Medicare Part A covers insurance related to hospital expenses. This portion pays for inpatient care as well as services provided in nursing facilities, home health care and hospice facilities. Medicare Part B pays for medical-related expenses such as doctors's services, outpatient care and some preventative services. Medicare Part C has plans offered through Medicare-approved providers such as HMO or PPO health plans. These plans include hospital and medical insurance from providers who belong to a specific network. Medicare Part D is the plan's prescription drug coverage. It helps reduce the cost of prescription drugs.

Eligibility

• Applicants must meet specific eligibility requirements to enroll in a Medicare insurance plan. General eligibility is based on age and number of years worked in Medicare-covered employment. Eligible applicants are at least 65 years of age, a U.S citizen or permanent resident and have at least 10 years of applicable employment. People younger than age 65 may qualify for coverage if they are being treated for permanent kidney failure. Applicants younger than age 65 who collect Social Security or Railroad Retirement Board disability benefits are also eligible for Medicare coverage. There is no cost to the plan participant for Part A coverage, but participants must pay for Medicare Part B if they want it.

Geography

• Medicare plans are based on geographic location. To determine which plans are available in a particular area, a Medicare administrator must first determine if an applicant is currently covered by Medicare and if the Medicare payments are supplemented by state programs such as SSI. This will determine available programs, health plan providers and their respective costs.

Claims

• Medicare plan participants do not need to file insurance claims themselves. Doctors and hospitals who provide medical services file insurance claims on the participant's behalf. Every three months, participants receive a Medicare Summary Notice (MSN), which details all services and supplies that were billed to Medicare, what Medicare paid and what the participant may owe a particular provider. If a Medicare claim is denied, participants have the right to appeal the decision by completing a re-determination request and sending it to the Medicare contractor listed on the most recent MSN.