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Medical Insurance Coverage and Attorney Representation

The United States federal government has sponsored several social insurance programs that give benefits to qualified citizens. These programs are designed all for giving benefits and protection to well-qualified sectors of society. The classic example of these programs includes the Social Security, Medicare, the Pension Benefit Guaranty Corporation (PBGC) program, the railroad retirement program and the state-sponsored unemployment insurance programs.

This article will mean to explain in a comprehensible manner all about medical insurance (Medicare). Specifically the article will tackle basic points regarding the coverage of this social insurance program of the federal government including the value of attorney representation and guidance in matters of claims, coverage and complaints.

All about Medical Insurance Program (Medicare)


Medicare is a social insurance program administered by the United States government that insures indigent recipients. The Medicare as well as its companion program Medicaid is signed into law by President Lyndon Johnson as amendments to Social Security legislations. Later on, up until now, this program had undergone series of changes and overhauling. The changes relates to the features, coverage and exact definition of covered citizens who may come to avail of this social benefit.

Originally, Medicare program has two parts, that is: Part A (Hospital Insurance), and Part B (Medical Insurance). Later on, with the changes, Medicare Part C and Part D were introduced extending more benefits and comprehensive health insurance protection to the aged, disabled, and those with end-stage kidney disease.


Medicare is a Health Insurance Program for:

  • People age 65 or older

  • People under age 65 with certain disabilities

  • People of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant)

Parts of the Medicare program

As laid above, the original Medicare program is composed of Parts A and B. However, with the passing of time, the coverage was broadened having introduced Parts C and D.

In brief, the Medicare Plans are composed of the following:

  • Medicare hospital insurance (Part A) helps pay for inpatient hospital care, inpatient care in a skilled nursing facility, home health care, and hospice care.

  • Medicare medical insurance (Part B) helps pay for physician services, outpatient hospital services, outpatient physical therapy, other medical services that are medically necessary, and supplies and equipment that are covered by Part A.

  • Medicare Advantage Plans (Part C) are plans offered by private companies that contract with Medicare to provide all Medicare Part A and Part B benefits. This has been constituted with the passage of the Balance Budget Act of 1997. Medicare Advantage Plans gives beneficiaries the option to receive their Medicare benefits through private health insurance plans instead of through the original Medicare plan (Parts A and B). Medicare Advantage Plans are HMOs, PPOs, or Private Fee-for-Service Plans. Some plans also offer prescription drug coverage.

  • The Medicare Prescription Drug Benefit (Part D) provides outpatient prescription drug coverage for the aged and disabled. This went into effect on January 1, 2006. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). Unlike Original Medicare (Part A and B), Part D coverage is not standardized.

Medicare situations and facts

The issue of disentitlement of Medicare has been the constant problems of most claimants, since the inception of this social insurance program. On several occasions, contentions respecting claims disentitlement beset administrative agencies tasked to implement the program.

It is accounted for disentitlement happened because of lack of proper guidance and representation in claiming this federal benefit. Most claimants have no real inkling on the mechanics of proper claims including its substantiation. To say, the lack of proper guidance of a Medical Insurance Attorney is wanting.

Attorney representation

Everybody wants to get the most of social security benefits including the Medical insurance and Medicare coverage. However, this can hardly be attained when proper guidance and representation of a Medical Insurance Attorney is lacking.

Just like any other claims for benefits, medical insurance claim needs to undergo considerations of a good lawyer. In order to harness a substantial claim that is both viable and workable, an adeptly qualified lawyer is required all for leading to a successful benefit claims.

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