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Medicare Advocacy

MedicareEnrolling in and understanding your rights under the traditional Medicare insurance program and its various parts, Medicare Advantage programs and Medigap insurance policies can be confusing if you do not have a health law attorney advocate for you and advising you on your options. Donna J. Craig, RN, JD, a nurse attorney, advocates for your rights and provides clients with a clear understanding of the options whether a client goes with traditional Medicare insurance, or opts for a Medicare Advantage plan which is an alternative to tradtional Medicare offered by insurance companies. To understand who is eligible for Medicare and what Medicare covers, you need to know the various programs and requirements under Medicare. Individuals who are entitled to Social Security retirement insurance who are 65 years of age or older are entitled to Medicare coverage. Also, those individuals who are entitled to Social Security disability benefits for not less than 24 months are eligible to participate in Medicare. Finally individuals with end-stage renal disease and amyotrophic lateral sclerosis (“ALS” or Lou Gehrig’s Disease) are also entitled to participate in Medicare.

Part A Coverage – Medicare Part A covers inpatient hospital care, skilled nursing facility care under certain conditions, home health care services that are medically necessary and reasonable, and hospice care, subject to certain criteria being met. While there is no premium associated with Part A coverage, an annual deductible amount must be met. When being discharged from a hospital to a nursing facility or rehabilitation facility, let The Health Law Center advocate for you so that your rights under Medicare are not overlooked.

Part B Coverage – Medicare Part B coverage generally covers physician services, outpatient hospital services, emergency room services, home health care not covered under Part A, durable medical equipment (“DME”) services and supplies, laboratory tests and X-rays, and physical and occupational therapy and speech pathology services, again subject to certain criteria being met. Part B coverage is optional, but does carry with it an annual premium and deductible. After a beneficiary meets the deductible, Medicare Part B will pay 80 percent of the reasonable charges for covered services. The remaining 20 percent is the responsibility of the beneficiary. Should you have a billing dispute for Part B Coverage, Donna J. Craig, RN, JD can advocate for you and make sure the bill is appropriate.

insurancePart C Coverage or Medicare Advantage Plans – Medicare Advantage Plans, Medicare Part C, or Medicare + Choice all refer to private insurance plans which are alternatives to receiving traditional Medicare. It is important that individuals carefully examine the pros and cons of each Medicare Advantage Plan, as they differ between insurance companies. The Health Law Center can assist you in understanding what each Medicare Advantage plan has to offer.

Part D Coverage – The Medicare Part D coverage is a volunteer program that covers prescription drugs costs. The individual pays a monthly premium. The beneficiary pays an annual deductible set by Medicare. Once the deductible is met, the beneficiary pays 25% of the prescription drug costs until an initial coverage limit is met, known as the donut hole. While in the donut hole, the beneficiary will have a 52.5% discount until he/she reaches the other side of the donut hole. Under the Affordable Care Act, the donut hole will be eliminated over time and by 2020 the individual will pay a 25% co-pay. Due to changes to the Medicare Part D coverage as a part of Health Care Reform, it is important to have a knowledgable advocate on your side.

Medigap Policies – Medigap policies, also known as Medicare Supplement Insurance, are various insurance policies that cover co-pays and deductibles for services provided under the Medicare program. As the name implies, it covers the “gap” of co-pays and deductibles that are not otherwise covered by the Medicare program. In deciding on the appropriate Medigap policies, the individual should compare and contrast the various Medigap policy available for purchase. The Health Law Center can assist individuals in evaluating the pros and cons of various Medigap policies.

If you have any questions regarding Medicare and your rights under various options, contact The Health Law Center to get reliable information from an advocate who will advise you every step of the way, by contacting donna@healthlawcenterplc.com.