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Medicare is a federal government health insurance program targeted primarily at senior citizens. There are 4 parts in this program associated with different situations and correspondingly offering different benefits: Hospital Insurance (Part A), Medical Insurance (Part B), Medicare Advantage (Part C) and Prescription Drug Coverage (Part D). These parts incorporate a wide range of health care plans providing a number of options that influence the benefits you receive, the costs you have to pay, and even the doctors you apply to.
Choosing a Medicare health insurance plan correctly is very important as it predetermines what benefits you get and how much you pay for them. Your medical needs, your convenience and your financial abilities are the three great concerns to keep in mind when deciding on a suitable health insurance plan. Let's have a closer look at the types of Medicare plans so that you could determine which of them suits your own particular circumstances best.
The Original Medicare Plan, often called a Fee-for-Service system, falls into two parts: Part A is a hospital insurance and Part B is a medical insurance covering outpatient treatment (doctor and related services including lab tests and medical equipment).
Original Medicare covers many health care services and supplies from a strictly fixed set of benefits, but it does not reimburse you for all health care expenses. There are some costs which are initially not covered by Medicare. You have to pay coinsurance, co-payments and deductibles out-of-pocket. Therefore, the Original Medicare Plan is just a useful tool to help you decrease your health care costs.
If you apply for the Original Medicare Plan, each service you receive is covered separately. Payment for the services is usually split. Medicare pays its share within a set limit and you pay your share known as cost-sharing. There is a special Medicare-approved amount for each service. For most doctoral services Medicare policy covers 80% of the cost and you are charged with the rest.
The Original Medicare Plan may not give you all the benefits you need. That is why if you opt for this plan, it is worth considering additional health insurance plans which will help you recuperate without having to incur excess expenses and thus taking the worry about payment off your mind. Some of the options deserve your particular attention, for example, Medicare Advantage Plans and Medigap Plans which will help you cover doctor and hospital costs and a stand-alone Medicare Prescription Drug Plan which will cover prescription drug costs.
Now let's turn to the constituent parts of the Original Medicare program and examine offered benefits and inherent limitations.
The first part of the Original Medicare Plan is Hospital Insurance (Medicare Part A). It ensures the protection you might need to bridge the gap between hospitalization and recovery, allowing you to concentrate on getting better. Hospital Insurance covers medical treatment on an inpatient basis (including nursing care and related services furnished by Medicare-certified hospitals), skilled nursing facility, critical access hospitals (facilities that provide limited inpatient and outpatient services to people in rural areas), home health care and hospice care. If you are hospitalized for a covered condition, with Hospital Insurance you will receive daily benefits for the stipulated term of your inpatient treatment.
The basic benefits covered by Medicare Hospital Insurance are usually referred to as "reasonable and necessary". Your physician will help you determine the "reasonable and necessary" benefits for your diagnosis. To bring your Hospital Insurance into force, you are to meet the following requirements.
You are to have a physician's prescription for inpatient hospital care to provide the treatment of an illness or an injury. You cannot apply to any hospital to receive the services you need. The hospital you are applying to ought to be participating in Medicare. And the Utilization Review Committee of the hospital is to approve of your physician's prescription.
Hospital Insurance also covers home health care expenses. The underlying condition in this case is that the recipient is homebound and cannot leave the house without assistance even for a short trip to hospital. In such a situation a Hospital Insurance recipient can qualify for skilled nursing care, physical therapy, speech therapy or occupational therapy. The agency providing health care services at home is to belong to the comprehensive network of providers working under the contract with Medicare.
The Hospital Insurance Plan covers a limited set of services. Many important services remain uninsured and may require substantial expenses. For example, Hospital Insurance does not cover custodial or long-term care. The number of days for inpatient treatment or skilled nursing facility care in a benefit period can be limited. At the same time if something bad were to happen, the out-of-pocket expenses would be noticeably mitigated provided you are entitled for the Hospital Insurance Plan.
An individual is charged with deductibles and specified co-payments for Part A benefits. Your Hospital Insurance plan usually covers the greater part of the customary fees. On average, you are expected to cover 20% of the cost. If your doctor charges more than your insurance company finds appropriate you may end up paying more than 20% of the cost. You should also be aware of the hidden costs associated with a hospital stay, such as the cost of private hospital rooms, private duty nursing, transportation and housekeeping expenses which you may have to cover out-of-pocket.
Medicare Part A is available to most Americans. No monthly premium is required for this coverage. Given the range of benefits it offers, it is advisable to accept Hospital Insurance when you are eligible for it and then, if necessary, you can extend this policy through other types of health insurance plans which provide the services not covered by Medicare Part A.