Medicare Health Insurance Coverage

2014 Medicare and Medigap Updates

Medicare Health Insurance Coverage

Medicare health insurance coverage is medical coverage provided by the U.S. federal government for senior citizens above the age of 65 years. This health insurance coverage is also offered to certain qualifying individuals who are under the age of 65. These persons include people with disabilities (and are receiving disability benefits under the Social Security Disability Insurance) and people with certain medical conditions such as end stage renal disease (ESRD) and Lou Gehrig’s disease which is also known as amyotrophic lateral sclerosis (ALS).

Medicare health insurance coverage is divided into 4 parts. Part A which is Hospital Insurance coverage, Part B which is Medical Insurance coverage, Part C which is Medicare Advantage and Part D which is Prescription Drug coverage. Medicare part C is coverage offered by private insurance companies that have been allowed to offer this insurance coverage by Medicare. These private insurance companies are called MAOs (Medicare Advantage Organizations).

Medicare part C provides all the coverage offered by Medicare parts A and B as well as some extras such as dental care, vision care and hearing aids. Some plans under Part C will also offer prescription drug coverage (part D). Some Medicare advantage plans offer extra coverage at higher premiums.

Eligibility for Medicare health insurance coverage is determined by the Social Security Administration which is also responsible for processing premiums. The administration of the Medicare program is the responsibility of CMS (Center for Medicare and Medicaid Services). CMS is also responsible for appointing the MAOs and for making sure that they are doing the right thing.

Even though Medicare health insurance coverage is quite comprehensive, it does leave some gaps due to the number of medical costs it does not cover. There are a number of gaps in the different parts. For instance, part A, covers in-patient stays at a hospital, short stays at a skilled nursing home or facility and some hospice care. It does not cover long term care exceeding 100 days in a skilled nursing facility or more than 90 days in a hospital. Part B typically out-patient services such as doctor’s services, outpatient procedures, vaccinations for pneumonia and influenza, some ambulance services, chemotherapy and other treatments at the doctor’s office. It does not cover vision care including spectacles, contact lenses and eye examinations, dental care including fillings, extractions, dentures or dental cleaning.

Medicare health insurance coverage does not stretch to include coverage for health insurance premiums, co-payments and deductibles.

The gaps in Medicare health insurance coverage can be filled by Medicare supplemental insurance plans, also known as Medigap plans. These health insurance plans are offered by private insurance companies contracted by CMS. Medigap cost of premiums may be different with each company, however, according to law each plan must offer the same benefits regardless of price. This is why when trying to choose your Medicare health insurance coverage you should get at least three quotes.