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Medicare Insurance

Health Insurance Program

Medicare Insurance is a health insurance program for the following:

  • people age 65 or older
  • people under age 65 with certain disabilities and
  • people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)

Types of Medicare Insurance Programs

Medicare Insurance has the following programs:

Hospital Insurance Most people do not pay a premium for Hospital Insurance (Medicare Part A) because a spouse or a member of the family has already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.

Medical Insurance Most people pay a monthly premium for Medical Insurance. Medicare Part B (Medical Insurance) helps cover doctors' services and outpatient care. It also covers some other medical services that Hospital Insurance (Medicare Part A) does not cover, such as some of the services of physical and occupational therapists and some home health care. Medical Insurance (Medicare Part B) helps pay for these covered services and supplies when they are medically necessary.

Prescription Drug Coverage

Most people will pay a monthly premium for this coverage. Starting January 1, 2006, the new Medicare Prescription Drug Coverage will be available to anyone who has Medicare. Those with Medicare Insurance can get the coverage that will help in lowering prescription drug costs and protect beneficiaries against future price increase. Medicare Prescription Drug Coverage is also categorized as insurance. Private companies provide this coverage. Beneficiaries choose the drug plan and pay the monthly premiums. Like any other insurance, if a beneficiary decides not to enroll in a drug plan then this individual may just pay penalties if he or she wishes to join later.
Medicare Insurance Approved Facilities

In recent years, Medicare has issued several national coverage determinations providing coverage for complex services and procedures, with the stipulation that the facilities providing these services meet certain some criteria. These criteria usually require, in part, that the facilities meet the minimum standards to ensure the safety of beneficiaries when they receive these services in order to be considered as a provider with the ability and expertise to perform the procedure. Being a certified Medicare approved facility is required to performing the following procedures: lung volume reduction surgery, carotid artery stenting, VAD destination therapy, bariatric surgery, and certain oncologic PET scans in Medicare-specified studies.

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