Legally Easy

As healthcare reform continues to dominate the news, now is a good time to look at your legal rights under Medicare, the biggest government program that affects millions of Americans. Pictured here is Attorney Joseph S. Carp, whose practice includes Medicare legal issues.

Medicare is a health insurance program run by the U.S. government. It is a single payer health care system that covers people over the age of 65 and others who meet special status criteria. In our opinion, the websites run by the government, like medicare.gov, can be pretty confusing, so we're working on delivering the simple information and easy tools you need to exercise your healthcare legal rights.

Medicare consists of four parts - Part A through Part D.

Medicare Part A (hospital insurance) covers hospital care, limited post-hospital skilled nursing facility care, part-time home health services, and hospice care. If you are 65 years old or over, you can receive Medicare Part A insurance without having to pay a premium if you are currently receiving or eligible to receive but have not yet filed for either Social Security or Railroad Retirement benefits or if you or your spouse had Medicare-covered employment by the government. If you are under 65, you can receive Medicare Part A insurance without having to pay a premium if you have received either Social Security or Railroad Retirement benefits for twenty-four (24) months or if you are a kidney transplant or kidney dialysis patient. If you have been denied a Medicare Part A claim, click here for a Medicare Part A Appeal Denial Form.

Medicare Part B (Supplemental Medical Insurance) covers physician's services, certain outpatient hospital services (including emergency room visits), ambulances, diagnostic tests, laboratory services, certain preventive care services such as mammography and pap smear screening, outpatient therapy services, durable medical equipment and supplies, and home health care services not covered by Part A.

Medicare Part B pays 80% of approved charges for most covered services. The beneficiary is responsible for paying a deductible each calendar year as well as the remaining 20% of the Medicare approved charges. The beneficiary may have to pay additional charges if the doctor providing the care does not agree to Medicare's approved charges. If you have been denied a Medicare Part B claim, click here for a Medicare Part B Appeal Denial Form.

Medicare Part C (Medicare Advantage plans) gives Medicare beneficiaries the option of receiving their Medicare benefits from private health insurance plans.

Medicare Part D (Prescription Drug plans) makes those eligible for Medicare Parts A or B, eligible for certain access to funded prescription drug benefits.

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