H5: Medicare

Medicare

Generally, one must be fully insured (40) to be eligible for Medicare.

People eligible for Medicare

Public Assistance Recipients (Welfare) are NOT eligible for Medicare

Medicare Part A= Hospital Coverage

Medicare Part B= Medical Coverage

I went to A hospital to B seen by a doctor

Medicare Part A: deductibles, copayments and Coinsurance can apply

Part A Cover:

Medicare Part B covers

Medicare Part B:

$135 Annual Deductible
80/20 Coinsurance

Part A is FREE if fully insurable

Part B= monthly premium

You are enrolled in Medicare Part A and B @ 65 if receiving SS benefits.

Enrollment in Part B can be delayed by someone who is covered under a group health plan based on the active employment of...

Initial Enrollment Period (IEP)

General Enrollment Period (GEP)

Special Enrollment Period (SEP)

Part A Funding

Part B

Medicare Advantage Plans (Part C)

Private Fee For Service (PFFS)
Free to choose providers, No restrictive networks, No referrals needed

Demonstrations

Medicare Prescription Drug Coverage (Part D)

Part D can be added for an additional premium to:

Late penalty added to Part D premium if purchased AFTER initial enrollment period for coverage

penalty avoided if NO MORE THAN 63 DAYS pass without CREDITABLE COVERAGE following initial enrollment period.

Creditable Coverage

Con-Creditable Coverage

Annua Enrollment Period (AEP)

Open Enrollment Period (OEP)

Approved Amount

Medicare Assignment

Medicare Assignment

If provider accept ASSIGNMENT they agree to:

Medicare benefits CAN be assigned to an HMO OR PPO

Participating Physician

Non-Participating Physician

Medicare claim is started when medical provider contacts (bills) Medicare

Medical Summary Notice (MSN) AKA Explanation of Benefits

Medicare recipient can appeal ANY claims decision