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For instance, did you know:
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- There are two distinct ways for individuals to receive their Medicare benefits: the Original Medicare program and Medicare Advantage Plans (including HMOs, PPOs, and more), which must cover at least the same benefits as Original Medicare but may offer additional services and have different rules and costs.
- Medicare’s drug benefit (Part D) offers outpatient prescription drug coverage for people with Medicare and is only available through private companies. Medicare Part B also covers drugs under certain circumstances, including a limited number of vaccines.
- Medicare covers dozens of preventive services, some at all times and some under special circumstances.
- There are a number of eligibility requirements and coverage rules for individuals in need of Medicare-covered outpatient physical, occupational, and speech therapies, as well as durable medical equipment (DME).
- People with Medicare have the right to appeal if they are denied coverage for a health service or item. Having a health care provider’s letter of support stating why the service or item—such as a medicine—is needed is often essential to a successful appeal.
- Medicare has complex rules regarding its coverage of hospital stays and related care, as well as regarding hospital discharge requirements and recommendations.
- There are a number of programs that can help reduce health care and prescription drug costs for people who meet income eligibility and other requirements.
MI Pro is a product of the Medicare Rights Center, a national nonprofit consumer service organization and the largest and most reliable independent source of Medicare information and assistance in the United States.
Author: Amelia Lochner Malavé
NASW-NYS