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Medicare Basics

The Health Care Financing Administration (HCFA) administers Medicare, the federal government’s health care insurance program for the disabled and the elderly. The HCFA contracts with private insurance companies to review and process the claims.

To be covered by Medicare, services must be reasonable and necessary; this is a standard administered by the Secretary of the United States Department of Health and Human Services (DHHS), the parent agency over the HCFA.

Patients may choose to receive Medicare benefits either through Original Medicare, which consists of Parts A and B, or through a Medicare Advantage Plan, which is also called Part C. Part A, Hospital Coverage, provides coverage for inpatient hospital care, skilled nursing care, home health care, and hospice care. Part B, Supplemental Medical Insurance, provides coverage for outpatient hospital care, physician’s services, ambulance services, and many other services not covered by Part A. Medicare Advantage Plans are provided through private insurance companies. Their benefits closely track Original Medicare Parts A and B, but they sometimes offer cost savings and broader benefits because they usually restrict a patient’s care to a network of medical providers.

There are many items that Original Medicare will not cover under either Part A or Part B. These include routine care, such as annual medical checkups, eye examinations and corrective wear, dental work, and most immunizations. Items that are not medically reasonable or necessary are also excluded. Examples of these items include cosmetic surgery, private nurses, and personal conveniences.

Medicare’s website provides a wealth of information about Medicare, including detailing coverage, eligibility, and the appeals process. It is located at Medicare’s toll-free telephone number is 1 (800) MEDICARE.

Copyright 2012 LexisNexis, a division of Reed Elsevier Inc.


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