Larry’s View

Larry’s view on any and everything.

Medicare eligibility and green card status

When it comes to the eligibility of Medicare you will be able to find simple procedures to follow in order to determine if you are eligible to receive Medicare or not. Within this article you will find some information that will let you know if you are eligible for Medicare, you will also learn about green card status and see if you are eligible for Medicare if you are from a foreign country but live in the United States.

First off, you will find yourself eligible for Medicare if you are sixty five years of age or older or have a certain type of disease. If you are from a different country and have just moved to the United States you will find that you are eligible if you have worked for at least forty Quarters, besides these things, you can also be eligible for Medicare if you are a United States citizen and have worked for ten years of your life or forty quarters, if you have only worked for thirty to thirty nine quarters you will also qualify for Medicare, but you will find that you have to pay about $226.00 for the part A plan, as well as the part B premium which will be around $93.50.

You may also like to know that if you are sixty five years of age or older and you find that you do not qualify for Medicare under the categories that you have just read in the above paragraph, you may still be able to enroll for Medicare. The fact is, that if you are a United States citizen or a legal resident that has been in the United States for five years or more then you may be able to enroll in Medicare as a “voluntary enrollee.”

Once you are enrolled into Medicare as a voluntary enrollee you will have to pay some monthly premiums that will not apply to those individuals that have qualified under the categories that are listed in the above paragraph. If you meet the income assets you will find that there are actually limited income programs that will be able to help you when it comes to paying for these premiums.

Hopefully now you are able to see that the eligibility for Medicare and the green card status is fairly simple, by now you should have a basic understanding of the steps required to receive Medicare.

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February 4, 2008 Posted by | Blogroll, Medicare | 5 Comments

Medicare coverage

Within this article you will be reading about Medicare coverage and what it is. After you are done reading this article about Medicare coverage you should have a pretty good understanding of how Medicare coverage works.

If you are wondering how your retail pharmacy discount will work with your Medicare drug coverage then here is the answer for you. If you have enrolled in a Medicare drug plan you will be happy to know that you will gain access to a really long list of prescription drugs that will be offered to you at a discount price, but you may still be able to benefit from the retail pharmacy programs such as Wal-Mart, Target, K-Mart and any other retail programs that cover the selected generic drugs.

An example of the above paragraph would be if you have a drug plan such as Medicare that only charges twenty five percent coinsurance then you go to the wal-Mart pharmacy, you will only have to pay $1.00 for the generic drugs that are covered by the Wal-Mart program.

Are you wondering if your VA health benefits will work with Medicare prescription drug coverage? If this is the case your coverage is not going to change. If you actually find that the VA drug coverage meets your needs, you will be able to choose not to join a Medicare drug plan. If you do not want to lose your coverage then you also want to join a Medicare drug plan, you will have to wait for a valid enrollment period.

If you have been thinking about going to Medicare prescription drug coverage you should know that it depends on how you are paying for your drugs now and how you will be getting your Medicare coverage.
Once you have come to the decision that you would like to start receiving prescription drug coverage you will need to think about what matters the most to you. There are a variety of plans that are available to you so you will be able to focus on the type of coverage you prefer. There is two ways you will be able to get your Medicare drug coverage. You will be able to add the drug coverage to your normal Medicare plan through a plan called a “stand alone” prescription drug plan. If you do not want to do it this way then you can also get your drug coverage and the rest of your Medicare coverage through a plan known as a Medicare Advantage plan such as PPO or HMO.

February 4, 2008 Posted by | Blogroll, Medicare | Leave a comment

Medicare part b

Medicare health insurance program is designed for people who are 65 years of age or older, or who qualify under specific predetermined circumstances. When Medicare was originally established, it was broken into 2 parts. Part A is intended for hospital and skill nursing facilities. Part B covers prevention and outpatient services, including home medical equipment. Prescription drug benefits are not covered under the original plan, however under the newly established Medicare part D that has been covered.
Part B: Medical Insurance Overview
Part B medical insurance assists in payment services and products not covered by Part A. These are typically covered on an outpatient basis. Part B is optional, thus it may be delayed, if the Medicare recipient or spouse is actively working. There is a penalty of 10% every year for not participating in Part B should one not be actively working.
With part B, physician and nursing services are covered along with x-rays, laboratory and diagnostic tests. Part B also covers pneumonia and influenza vaccinations as preventative care. Out patient services provided by a hospital would also be covered under Part B. Organ transplant recipients, cancer fighters, and drug or hormonal treatments associated there with, are covered under Part B, while with these any hospital stay would be covered under Part A. The only time that medication is covered in part B is that during an office visit, a doctor administers the dosage.
Additionally when medical equipment (DME to Medicare) is needed, part B is the portion that covers it. This would include canes, walkers, wheelchairs, and various mobility scooters as the need arises. Prosthetic devices such as a breast prosthesis following a full mastectomy, or an artificial limb are covered here as well. One pair of eyeglasses will also be provided following a cataract surgery, as well as any home oxygen use.
Any services covered by Medicare Part B, is subject to need. There are many rules and guidelines that are utilized in the management of the Medicare Benefits. Additionally, once an annual deductible is met, the Medicare recipient is required to pay a 20% co-payment, based on the Medicare approved services and costs. Should a provider out of the qualified network of Medicare approval be used, an additional 15% will be charged to the customer.
Use of Medicare Part B is universally available. The cost of the services is the same regardless of income level, and pension status. Should the cost be more than affordable, then Medigap insurance or payment assistance should be sought out and purchased.

February 4, 2008 Posted by | Blogroll, Medicare | Leave a comment

Medicare fraud

There are so many different types of fraud, we have bank fraud, credit card fraud, social security number fraud, check fraud, we even have I.D fraud, we have all this and then some, hard to believe isn’t it? No. But can you believe that in this world today we even have Medicare fraud? Years ago it would have been hard to believe that one would actually pursue Medicare fraud.

Yes, there are those Medicare payments that have errors and are simple mistakes that are not the result of physicians, providers, or even suppliers that are trying to take advantage of the Medicare system. However, you will find some individuals in this world today that actually have intentions on abusing or defrauding the Medicare system. These individuals believe that they are able to cheat the Medicare system and get away with it. Each year individuals cheat the Medicare fraud out of millions of dollars.

Each year the premiums on Medicare are going up, do you know why? This is because they are paying for the amount of money that Medicare has loss do to those individuals that have scammed the Medicare program. The Medicare system is out and taking tough action in order to fight fraud and abuse in key areas. The main goal is to be sure that Medicare is only doing business with physicians, providers, and the suppliers that will provide individuals with Medicare by giving high quality services.

Medicare fraud is when someone purposely bills Medicare for the services that actually were never provider or received. Another form of Medicare fraud is when another individual uses someone else’s Medicare card in order to get medical care, equipment, or supplies. One more type of Medicare fraud that we are going to tell you about is when one bills Medicare for some home medical equipment that they do not have in their possession because they have returned it.

There are some things that you will need to be suspicious about such as, if the provider tells you that a test is free and he or she will only be needing your Medicare number for their records, keep in mind that for the clinical laboratory testes there will be no co-payments and the provider may actually tell you that the test is free but they will not need your Medicare number.

When it comes to Medicare fraud there is a lot of things that you need to be suspicious about, remember you should always go with the gut instinct you have and there should never be a charge for co-payments on clinical laboratory tests.

February 4, 2008 Posted by | Blogroll, Medicare | Leave a comment

Medicare dme

Although Medicare does cover wheelchairs, breathing machines and hospital beds, as well as additional durable medical equipment, it generates a significant amount of confusion among people with Medicare, as well as their families and those who work along side them. The significant gap in understanding can be attributed, in part to the fact that printed materials, and other resources for Medicare recipients rarely touch on the topic. Following is a very brief overview of the Durable Medical Equipment (DME) Coverage issues, and payment guidelines.

The class of items covered by the DME includes prosthetics, orthodontics, and required supplies. (also abbreviated DMEPOS). Of these items, there are 3 primary categories applicable to DME.

1 – Durable Medical Equipment
2 – Prosthetics and Orthodontics
3 – Supplies.
For the purpose of this article, all 3 will be referred to as DME.
Medicare will pay for DME for patients that require the use of equipment to function on a daily basis, and it is ordered by their physician. To gain approval, the equipment must been particular requirements. The equipment must be able to withstand prolonged use. The primary use of the equipment must be for medical reasons. Needs to be generally useful in the presence of injury or illness. It must be non cumbersome in someone’s home, or thereby made specifically there for.
Without fail, Medicare requires that a doctor prescribe the required DME. From there, a certificate of medical necessity (CMN) that supports the prescription is also required. This special form authorizes the use of the prescribed equipment. The Medicare Certified supplier will know what items require the CMN and will make every effort to work with the doctor involved to assure the required documentation is submitted properly to Medicare.

Something to keep in mind is that anything that is disposable, such as bandages, surgical stockings, incontinence pad and tape are not covered under the DME benefit. There are some exceptions to this general rule that apply to Diabetic supplies such as lancets and test strips for checking blood sugar levels.

Medicare will only cover equipment that is customarily used for medical reasons and only when a patient has been injured or has a debilitating illness. Hospital beds, canes, respirators, walkers are all common examples of such equipment. Be aware, Medicare may chose not to cover certain devices that a patient may need to recover. One evident and classic example is the air conditioner. While it may benefit a patient with repertory issues, the primary use is not medically related. Medicare would there for not cover the requested air conditioner. Convenience items such as stair lifts and elevators are also not covered.

As can be clearly seen within this information, there is a lot to be aware of with regard to Medicare and Durable Medical Equipment. Becoming informed and asking many questions is the only way to be assured what is needed will be covered.

February 4, 2008 Posted by | Blogroll, Medicare | Leave a comment

Medicare enrollment

First we will start this article by telling you that Medicare is one of the many health insurance programs that are provided by the United States Government. The Medicare program will cover the citizens that are sixty five years of age or older, or those individuals that meet the other specific criteria.

The Medicare program is being administered by the Centers for Medicare and Medicaid Services department. If you are looking to join the Medicare Program and in order for your physician to accept your coverage, you will first have to complete a Medicare application.

Another thing you may need to be informed about is that your Medicare coverage and your information is actually subject to chance without notice at anytime. You should always check with your Social Security Agency in your area.

Most individuals will qualify for Medicare when hey reach the age of sixty five or if there is certain medical conditions that have came about. If you are already receiving Social Security benefits you may be happy to know that you will be automatically enrolled in Medicare Part A and also Part B. You must pay a Premium for Part B coverage so you will have the choice to not include Part B coverage on your Medicare application.

If you are automatically eligible for Medicare you can count on being notified a couple of months before your eligibility birth date and will be supplied with the proper information. Individuals that are not being automatically enrolled in Medicare must complete the Medicare application CMS 40B, which is known as, Application for Enrollment in Medicare. In order to obtain this application, you are going to have to either visit the Social Security Administration office in your local area or arrange for a Medicare application appointment by calling the Medicare office.

For your convenience, an application for monthly retirement, disability, or a spouse is normally submitted along with the Medicare application. If you like, you can apply for the monthly benefits online or at the Social Security office in your area, the Social Security office is always there to answer any questions that you may have pertaining to Medicare.

You should know that there are a lot more Medicare application forms that are out there that are not listed in this article. Whether you are a patient or a doctor, the enrollment process of Medicare simply begins with that Medicare application that you need to fill out if you are wanting to have Medicare as your health insurance.

February 4, 2008 Posted by | Blogroll, Medicare | Leave a comment