Category Archives: Medicare Coverage

How to Regain it if Medicare Coverage is Lost?

Posted by on February 24, 2012 No comments

Medicare is a beneficial health insurance program developed by the American federal government to provide essential medical coverage at inexpensive rates to its citizens who are over 65 years, along with individuals suffering from prolonged kidney disorders like kidney failure and disabled people. At times, certain events or circumstances might take place due to which Medicare coverage is lost, but owing to new legislations passed by the government of United States, the beneficiaries can regain their medical coverage. Mentioned below are some examples as a result of which Medicare coverage can be discontinued and the required steps for restoration:

1. An individual who is not entitled anymore for health benefits as per the Social Security Act usually termed as Medicaid, he or she can obtain a Medicare supplement plan with the help of an issuing company if an application is submitted by the person within a maximum duration of 63 days from loss of eligibility.
2. If the Medicare Advantage plan you have enrolled for gets over or stops offering services in your area or if due to some reason you relocate somewhere else outside of the Medicare Advantage network area, it brings Medicare coverage to an end but it surely makes you eligible to regain Original Medicare and select from Plan A, B, C, F, K, or L provided you inform the Medicare centre in 63 days.
3. If an individual has enrolled for a plan of Part D, i.e. coverage of prescription drugs and if that plan is not going to be included in Medicare anymore, it is crucial that he or she selects a new plan between 15th October-7th December in order to maintain the drug coverage, otherwise the coverage will be lost. Similarly, in case you lose this coverage concerning prescription medicines owing to certain circumstances, you are required to enrol for a Medicare drug plan within a span of 63 days of losing coverage.
4. In case if employees who have joined a group health plan for medical coverage and if this plan comes to an end owing to some situations, these individuals possess the right to acquire a Medicare supplement policy wherein they have to choose from Plan A, B, C, F, K or L. Furthermore, in the event of a health complication, the insurance company will issue the policy if the employee submits an application within 63 days of losing coverage.
5. If the insurance company providing Medicare coverage to the beneficiaries turns insolvent or runs into bankruptcy, the health benefits of these beneficiaries will be terminated. However, such individuals must apply for another Medicare supplement policy by selecting from Plan A, B, C, F, K or L within 63 days of losing their coverage in order to sustain their benefits. The same process is needed if there’s an involuntary end of medical coverage.

When you decide to sign up for Medicare, it is essential to be fully aware about your rights and benefits regarding various plans. If Medicare coverage is lost and you do not know how to go about regaining the same, it’s best to speak to a Medicare representative so as to know the correct procedure.

Medicare Alternatives that you can Consider

Posted by on February 2, 2012 1 comment
Medicare Alternatives

Medicare Alternatives

The information on Medicare alternatives is over flooded and often seniors get perplexed as to which option to turn to. The alternatives are usually presented in a confusing manner and are difficult to understand. We are going to read about the information on Medicare alternatives. I have tried to keep it as simple as I can and an effort has been taken to keep this write-up as brief as possible so that you don’t feel over loaded with information and can decide quickly which option you want to go for. Listed below are your choices.

• You can keep the original Medicare and combine it with a supplement (Medigap) policy so that you get covered for co-pays and deductibles.
• Alternatively, you can select part C (Medicare advantage plan) offered by a private insurance firm authorized by Medicare.
• Add original Medicare with or without Medigap to Part D (prescription drug plan). If you choose Medicare advantage plan, you get drug coverage. ‘Now you may say even a layman knows these 3 basic choices, what’s so great about it. However this blog is an attempt to assist you in selecting the best choice applicable to your situation. Unfortunately there is no ‘one cure fits all’ thing here, so let’s just glance through these 3 basic options.

Medigap Option
Medicare supplement plan or Medigap option purchased from a private insurance company can assist you with co-pays and deductibles. It’s not a government policy but is mandatorily managed by Medicare and the policies are standardized. The US government has laid 11 Medigap plans to offer such as A, B, C, D, E and F, which are high deductible and G, K, L, M and N. The coverage offered under these plans does not change yearly. Once you settle on any one of these 11, you are very much set for quite some time in the future.

Medicare Advantage Option
This option incurs you substantially reduced cost as compared to Medigap plan. Medicare advantage plans fall under part C. Statistics reveal that 1 in 4 people entitled for Medicare opt for 1 of these policies. In case you choose Medicare Advantage plan, it will offer you all of Hospital Insurance (Part A) and Medical Insurance (Part B). Medicare Advantage plans may also provide additional coverage such as dental, hearing, vision and other wellness programs. Most offer part D (Medicare Prescription Drug Coverage).

Prescription Drug Plan
Part D is referred to as prescription drug coverage plan. Medications offered in hospitals and some medicines recommended by a physician are covered by original Medicare, however there is no help with some other prescription drugs. This can be a major concern for most of the older people. Firstly, prescription drug plans are offered by private insurance companies, not government. You can buy these plans in one of two ways, either as a stand-alone policy that adds to the original Medicare or by joining a Medicare Advantage plan that covers prescription drugs. Both these choices are quite inexpensive. Out of approximately 45 million Medicare enrollees, about 27 million have registered for 1 of these prescription drug policies.

This was about Medicare alternatives that you can consider. You need to carefully analyze them and opt for an option that caters the best to your needs.

How is Medicare Coverage Lost?

Posted by on January 12, 2012 4 comments

There are many people who are largely dependant on Medicare coverage, for their health-related expenditure. They should know that certain circumstances can result in loss of Medicare coverage. They should be aware of the issue – how is Medicare coverage lost and how this can be prevented. Once Medicare coverage is lost, individuals get worried and confused about what they should do next for regaining their healthcare benefits. If the Medicare coverage is lost, the patient loses all the benefits provided under his or her selected plan. However, under some pre-specified circumstances, they can avail of the benefits by opting for the alternatives provided as Medicare supplement policies. This will help them in covering their healthcare expenses even after losing Medicare coverage.

The reasons for losing Medicare coverage are given below:

In many cases, the Medicare coverage is terminated due to non-payment of the premium. Hence, people should take care to pay the premium before the due date so that they continue to get the benefits of Medicare health insurance without any interruption.
People can also lose Medicare coverage if the Medicare Advantage Plan stops providing the services in the locality of the beneficiary. The American government has provided protection to individuals facing this problem by allowing them to opt for the Medicare supplement plan. They should choose any of these plans within 63 days of losing their original Medicare coverage to avail of this benefit.


If the beneficiary moves out of the service area of the Medicare provider, his or her Medicare coverage can be terminated. The beneficiary can opt for plan A, B, C, F, K or L, in this case, within 63 days of termination of the service to continue getting the benefits provided by their old Medicare plan.

The Medicare coverage may also be lost if the beneficiary voluntarily opts for withdrawing the plan due to any concerns related to the Medicare service provider. If the insurance company providing services to the beneficiary is not following the rules and regulations specified by Medicare or is not fulfilling the mandatory obligations, the beneficiary may choose to withdraw the policy. The beneficiary is entitled to get covered under the Medicare supplementary plan in this case.

In case the insurance company providing the Medicare plan to the beneficiary violates the policy provisions of Medicare, the beneficiary is given an option to opt out of the policy provided by that insurance company. The beneficiary will lose his Medicare coverage in this case.

If the insurance company is declared insolvent or runs into bankruptcy, the Medicare coverage of all its beneficiaries gets terminated. The beneficiaries should get covered under any of the Medicare supplement plans within 63 days of such an event to avoid any interruption in the benefits provided by their Medicare coverage.

There can be some cases of Medicare coverage lost when the beneficiaries are covered under a group health plan. If such a plan is terminated due to any reason, the Medicare coverage of each person covered under it is lost. These individuals will not be eligible for Medicare benefits.

People who are faced with such issues can contact the Medicare center to get information regarding how they can continue their policy. People should note that Medicare has several provisions under which senior citizens and disabled people can continue getting their health insurance benefits if their policy is terminated due to any pre-specified reason.

What Does Medicare Cover Involve?

Posted by on December 19, 2011 4 comments

For some patients receiving benefits from Medicare, it is very important to know exactly what their Medicare cover involves and what it does not. Medicare is divided into four parts which are, Part A, B, C and Part D. Before learning about the different parts and what each part covers, you need to know that Medicare cover does not provide coverage for everything. For instance, it does not cover the entire cost for most medical supplies or covered services. The premium is based on the kind of Medicare plan that you opt for. Mentioned below are the different Medicare Parts and what the cover involves.

Medicare Part A:

Medicare Part A cover involves only the medically necessary services that are mentioned below:

Hospital Stays: Hospital stays that include meals, semi-private room, general nursing as well as miscellaneous supplies and hospital services, are usually covered. Inpatient care and mental health in critical access hospitals are covered as well. However, the hospital stay needs to be for at least 3 days.

Skilled Nursing Facility: While in the hospital, stays must be related to diagnosis. For instance, the stay in a hospital may be due to a stroke. In such cases, a nursing home or a skilled nursing facility stay is covered. The stay includes a semi-private room, and meals as well as skilled nursing services.

Home Health Services: This involves limited and medically required care and part-time services such as skilled nursing care, physical therapy, home health aide services, speech therapy and pathology as well as medical social services. It also includes equipment for home use such as oxygen tanks, walkers, wheelchair, and hospital bed, as well as other medical supplies.

Blood Transfusions: This covers the blood received during a covered stay in a skilled nursing facility, hospital or critical access hospital.

Hospice Care: This is for patients who are terminally ill and have around 6 months or less to live. The cover includes pain relief and symptom – controlling medications, medical services, grief counseling, support and other services.

Medicare Part B:

Part B Medicare cover includes tests, services as well as preventive treatments which are quite common in healthcare patients, but not covered in Medicare Part A. Even though many products and services are covered, Medicare Part B does not provide 100% coverage. It covers only the medically necessary services which have been mentioned below:

Labs, Screenings and Tests: Preventive treatments include lab tests, screening, and inoculations to diagnose, manage or prevent an illness.

Glaucoma tests  - only once a year, and only when performed by an authorized eye examiner.

The tests include flexible sigmoidoscopy once every 4 years, a fecal occult blood test once a year, screening colonoscopy after every ten years, and barium enema after every four years.

Bone mass measurement is covered as necessary or every 2 years.

Lab Services including blood tests or urinalysis.

Diabetic supplies consisting of monitors, therapeutic shoes, lancet devices and test strips.

Colorectal cancer screenings in order to diagnose any pre cancerous growths

Diabetic screenings in case a patient is suffering from high blood pressure, high blood sugar, obesity or Dyslipidemia.

Cardiovascular screenings to avoid stroke or heart attack.

Medicare Part C:

Part C Medicare is a combination of both Part A and B. Part C is coverage provided by a private insurance company which is approved by Medicare. Here, the providers normally offer some extra benefits and also include prescription drug coverage.

Medicare Part D:

Part D Medicare is basically a prescription drug coverage which is provided by private insurance companies that have been approved by Medicare. It is designed to help patients get prescription medications at lower prices. Part D enables patients to have greater access to necessary medications.

What are Medicare Providers?

Posted by on November 21, 2011 2 comments

Medicare is a healthcare program developed by the United States to provide affordable health insurance. It was in the 1950s and 1960s that the need for a publicly funded program was felt as many senior citizens were unable to fund their medical insurance needs because of limited income post retirement and expensive insurance plans provided by private insurance companies. Medicare is aimed at:

Medicare-Health

Medicare Information for Providers

  • People who are 65 years and above
  • Those who are below 65 years of age that are permanently disabled or suffer from other particular disabilities making them incapable of earning a living
  • Individuals of any age bracket that have any long term kidney disease such as kidney failure

Administered by Centers for Medicare and Medicaid Services (CMS), Medicare coverage consists of 4 parts, which are as follows:

1. Medicare Part A offers coverage to individuals concerned with inpatient hospital stays, medical expert service and health care at home.
2. Medicare Part B assists in covering outpatient care, general medical services from doctors and other healthcare facilities like investigations, check-ups, etc.
3. Medicare Part D helps individuals to cover the expenses of prescription medications.
4. Medicare Part C, also called as Medicare Advantage covers all the benefits and services provided under all the 3 parts mentioned above i.e. A, B and D. This all in one plan is offered to individuals by means of private insurance firms approved by Medicare.

Being a publicly sponsored initiative with the main objective of providing reliable medical coverage to American citizens across the country ranging from small rural areas to metropolitan cities such as New York, it was not feasible for the government to establish hospitals or medical centres throughout the nation for people to receive their benefits. Instead, Medicare providers were appointed that would arrange for health coverage for the concerned individuals and in return receive compensation from the Medicare organisation.

To become an approved Medicare provider, doctors, physicians, medical providers, healthcare practitioners and medical suppliers have to register with the CMS. The CMS has an online application form which can be filled and submitted online or downloaded and mailed to the Centers in order to obtain a National Provider Identifier. Once these providers are registered and appear on the National Provider Identifier network, it becomes extremely easy for Medicare beneficiaries to find providers located in their city or neighbourhood and acquire medical services from local health clinics.

Medicare has established a unique billing and coding system which ascertains the amount that the Medicare organisation will pay to any provider for a particular service. When a person covered under this program visits the doctor, the Medicare provider will bill Medicare for the services delivered according to the coding structure.

As Medicare is a nationwide healthcare program and Medicare providers can be found anywhere across United States, beneficiaries have a major advantage of consistent coverage irrespective of where they are located, owing to the National Provider Identifier list. Created in 1965, Medicare has been offering health insurance at affordable rates to senior citizens as well as to individuals of other age groups afflicted with a disease or suffering from a disability.

Medicare Coverage for Medications

Posted by on November 15, 2011 4 comments

The cost of healthcare is rising day by day. Getting good healthcare facilities can be very difficult due to this reason. It is true more specifically with reference to the

Medicare Coverage for Medications

PartD Medicare

prices of drugs. Although many newer medicines are available today, to treat all types of diseases effectively and safely, the prices of these medicines tend to be very high. These high prices can be attributed to the huge amount of money spent on research before producing these medicines. But, many patients cannot receive the benefits of these medicines due to the cost factor.

However, Medicare offers very effective and helpful health insurance plans to patients. Medicare insurance is divided into 4 distinct parts from which patients can make a choice. Patients who wish to buy medicines at lower prices can opt for part D of the Medicare health insurance plan. The medicines covered under this part depend on the plan selected by the patient. However, all the plans cover medicines belonging to all prescription categories. The Medicare coverage under Part D covers these drugs:- antidepressant, anticonvulsant, antiretroviral, antipsychotic, anticancer and immunosuppressant.

Although all plans do not cover each and every drug from these categories, patients have the freedom to select a plan that accommodates all the prescription medications needed by them. This ensures huge savings for the beneficiaries. Also, some plans cover generic medications while some plans also include branded drugs. This is one of the factors on which the premium of the plan depends.

The medicines covered in each plan are placed in different tiers. Drugs in different tiers have different costs. That means, if patients select drugs in lower tiers they need to pay a lower premium and vice versa. However, if you have selected a plan that covers medicines in a lower tier and your doctor feels that you need medicines in a higher tier that are similar to those in the tier you have selected, you can ask for an exception so that you get a lower co-payment.
Some medicines need prior authorization from the plan before filling the prescription. The doctor has to show that the medicine is essential for the patient in order to get the authorization. Also, there is a limit on the quantity of specific drugs that patients can order at a time. Patients need to try the medicines of a lower cost first. Only if those medicines do not produce satisfactory results, can they switch to medicines of a higher cost.

Part D of Medicare also covers all vaccines that are commercially viable and are necessary for preventing illnesses. However, some vaccines are also covered under part B of Medicare.

Some groups of medicines are specifically excluded from all the plans of Medicare part D. A few of these drugs are mentioned below:

  • Anti-convulsion and anti-anxiety medicines that contain barbiturates and benzodiazepines.
  • Vitamin and mineral prescriptions
  • Medicines used for anorexia, weight loss and weight gain
  • Medicines used for fertility and hair growth; and cosmetic medicines

How can patients change the Medicare coverage plan for drugs?

Patients can change the coverage of drugs under their selected plan by following a simple procedure. However, they can join another plan during a specific time period only. There is no need to cancel the old plan or to submit any documents for changing one’s plan. The old plan will be automatically cancelled once the new plan becomes effective. They should join the new plan at the earliest so that they receive their new membership card soon. Patients can also drop their plan if they wish to.
Patients should choose their plan carefully depending upon their medical condition and their need of meditations.