How Insurance Medicare and Heatlthcare Providers Work Together



Four things you should know about Insurance Medicare

Medicare is a federal health insurance program created in 1965 to provide health benefits to people 65 or older, people under 65 with certain disabilities, and people with permanent kidney failure. There are several parts of Medicare that a person can apply for: Parts A through D and Medigap coverage. Part A is hospital insurance that covers emergency and inpatient care and doesn’t require a premium. Part B is medical insurance that covers outpatient care and requires a premium. Part C combines both Parts A and B. Part D is prescription drug coverage and Medigap is insurance to make up for the holes in Medicare.

What Insurance Medicare Doesn’t Cover

Medicare does not cover custodial care, dental care (including dentures), most immunization shots, foot care, eyeglasses or hearing aids, cosmetic surgery, or experimental procedures. Most prescriptions drugs (excluding Part D) are not covered.

When to Apply for Insurance Medicare

If you wish to enroll into Medicare it must be done within three months of your 65th birthday. Failure to enroll during this time period will result in a penalty fee for late enrollment.

The Difference Between Fee-for-Service and Medicare Provided by an HMO

Fee-for-service is when patients choose where to be treated and pay deductibles and coinsurance for Medicare (Medigap). HMOs require patients to use only approved medical providers. HMOs cost less and provide some benefits beyond Medicare but the quality of care is questionable.

Concerns over Medigap Coverage

Medigap policies may not cover certain conditions for the first six months of coverage. Also some Medigap policies have a maximum of the amount of aid a patient can receive within a certain time period. Recipients of Medigap should also check to make sure they have not been sold duplicate coverage. Also some Medigap policies may not be renewed.



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