Medicare is broad in scale and complex in nature. It comprises an alphabet soup of parts and plans.
Then there are the many policy combinations, eligibility guidelines, and enrollment periods.
We understand Medicare.
Here, we take on common questions and answer them in detail. Our goal is to remove any confusion or doubts you have about Medicare, so you can move forward with making your decision.
Medicare In-Depth FAQ’s
There are times when you may be able to change your Medicare health or drug coverage. The length of the Special Enrollment Period (SEP) and the effective date of the new SEP vary depending on the circumstances that trigger your SEP. The plan and, in some...read more
Hospice is a program of end-of-life pain management and comfort care for those with a terminal illness. Medicare’s hospice benefit offers end-of-life palliative treatment, including support for your physical, emotional, and other needs. It is important to...read more
If you qualify for the hospice benefit, Medicare covers the following: Skilled nursing services, which are services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness. Services you may receive include...read more
Hospice care is always covered under Original Medicare, even if you have a Medicare Advantage Plan. After electing hospice, care related to your terminal illness will follow Original Medicare’s cost and coverage rules. While you cannot receive curative...read more
Medicare’s hospice benefit should cover any prescription drugs you need for pain and symptom management related to your terminal condition. You pay a $5 copayment for outpatient pain and symptom management drugs. You pay nothing for drugs you receive as an...read more
Medicare covers hospice at a skilled nursing facility (SNF) only if the SNF has a contract with a Medicare-certified hospice that can provide your care. The hospice benefit will not pay for room and board at the SNF, so you will be responsible for that...read more
Medicare covers hospice care for two initial 90-day benefit periods, or a total of six months. After this, it will cover an unlimited amount of 60-day (two-month) benefit periods. At the start of each benefit period, your hospice doctor or a related...read more
If you decide you want curative treatment (instead of just palliative treatment), you have the right to stop hospice at any time. Speak with your hospice doctor if you are interested in stopping. If you end your hospice care, you will be asked to sign a...read more
As a Medicare beneficiary, you should look out for suspicious behavior from health care providers that might indicate Medicare fraud or abuse. For example, providers should not be providing or billing for hospice services for patients who are not...read more
An appeal is a formal request for review of a decision made by your Original Medicare, Medicare Advantage, or Part D plan. If you were denied coverage for a health service or item, you may appeal the decision. Before you start any appeal, make sure you...read more
If you have Original Medicare and your health service or item was denied, you have the right to appeal. Check your Medicare Summary Notice (MSN) to see if Medicare has paid for your services and how much you may owe your provider.A Medicare Summary Notice is a summary...read more
If you have a Medicare Advantage Plan and you were denied coverage for a health service or item before you received the service or item, you can appeal to ask your plan to reconsider its decision. Follow the steps below if you feel that the denied health...read more
If you have a Medicare Advantage Plan and were denied coverage for a health service or item that you have already received, you may choose to appeal to ask your plan to reconsider its decision. Follow the steps below if you think the denied health service...read more
Below are some general rules to follow when appealing the denial of a health service or item:Try to understand the reason that your plan is denying coverage for your health service or item.Address any relevant coverage rules in your appeal letter, and...read more
When initially filing an appeal and for each subsequent level, you have a limited amount of time to file. That said, after the deadline has passed, if you can show good cause for not filing on time, your late appeal may be considered. You can request a...read more
If you are dissatisfied with your Medicare Advantage or Part D prescription drug plan for any reason, you can choose to file a grievance. A grievance is a formal complaint that you file with your plan. It is not an appeal. Times when you may wish to file a...read more
In many cases, you can still appeal if you signed an Advance Beneficiary Notice (ABN). An ABN, also known as a waiver of liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has...read more
Medicare Part A covers the following services: Inpatient hospital care (see Does Medicare Cover Inpatient Hospital Care?): This is care received after you are formally admitted into a hospital by a physician.You are covered for up to 90 days each benefit...read more
In Original Medicare, these are the costs related to Part A covered services: If you have a Medicare Advantage Plan, you should contact your plan to learn about their costs for these services. Read More: Does Medicare Cover...read more
Part A covers medically necessary inpatient hospital care, which is care that you receive as a formally admitted hospital inpatient. You must be formally admitted into the hospital by a physician in order for your care to be considered inpatient hospital...read more