Medicare can be confusing and difficult to understand, particularly if you have recently become responsible for the care of a parent, grandparent, or loved one. At Maxim Healthcare Services, we understand that when the time comes for you or your loved one to seek professional care services, navigating the Medicare system can be overwhelming. We are here to help. Maxim specializes in healthcare for individuals in hospitals and medical facilities, long-term care facilities, assisted living facilities, and private residences. Our clients have peace of mind knowing that they are working with an industry expert dedicated to their comfort and satisfaction.
All of Maxim’s office locations are licensed, as required, and accredited by the Accreditation Commission for Healthcare (ACHC). In addition, many Maxim offices are also Medicare & Medicaid certified. Maxim’s Medicare certified offices* will work with patients and their families to help gain a better understanding of Medicare eligibility requirements, the different options available, as well as the services that should be covered by Medicare. Medicare does not cover all home health medical expenses. Please contact your local Maxim office to determine whether or not Medicare is an accepted coverage option for your healthcare needs in your area.
What is Medicare?
Medicare is health insurance offered to eligible individuals by the federal government through The Center for Medicare & Medicaid Services. It offers coverage for necessary inpatient and outpatient medical care, certain types of Physician-ordered durable medical equipment, and short-term rehabilitation or skilled nursing care following a qualifying hospital stay. While Medicare does help pay for healthcare, it does not cover all medical expenses.
Who is eligible for Medicare?
• Individuals 65 and older, receiving Social Security or Railroad Retirement Board benefits
• Individuals younger than 65 who are permanently disabled or who have been diagnosed with end-stage renal disease
What Medicare options are available?
Medicare has four parts:
Medicare Part A is the original Medicare insurance coverage that helps pay for hospital bills. It is the only part that is automatically covered when an individual signs up for Medicare. Most people will not have to pay a monthly premium for Part A because either they or their spouse paid Medicare taxes while they were employed. Part A covers costs when in the hospital, such as:
• Hospital rooms
• Nursing services
• Hospice care and home healthcare
Medicare Part B is a supplemental insurance option for people who qualify for Medicare. Its purpose is to provide coverage for healthcare not covered under Part A, such as Physician services outside the hospital setting and other medical services not covered under Part A. Individuals must sign up for Medicare Part B and pay a monthly premium and annual deductible, which are deducted from their Social Security check. Additional services covered by Part B include:
• Physician visits
• Laboratory tests and X-rays
• Physical therapy or rehabilitation services
• Ambulance service
• Some home healthcare
• Medical equipment and supplies when medically necessary
Medicare Part C or Medicare Advantage Plans are private health plans that are Medicare approved to offer healthcare to eligible people. They provide all of Medicare Part A and Part B coverage and must cover medically-necessary services. These plans generally offer additional benefits and many include Part D drug coverage. Similar to Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), Medicare Advantage Plans often have networks, meaning it may be necessary to see the plan's Physicians and go to certain hospitals to receive care. These plans can save money since the out-of-pocket costs in them are typically lower than with Medicare alone; however, costs will vary by the services used and the type of policy purchased.
Medicare Part D is prescription drug coverage. Your loved one must be enrolled in Medicare before he/she can apply for Part D coverage. There are many plans and pricing options to choose from under Part D, so it is important to carefully review your loved one’s prescription drug needs when selecting a Part D plan. Part D plans, similar to the Medicare Advantage Plans, are issued by private insurance companies authorized to sell their plans in specific areas.
Medigap Plans, also known as Medicare supplemental plans, work with the original Medicare program to help cover some of the out-of-pocket costs like annual deductibles, co-pays, and co-insurances. There are twelve standardized Medigap plans available (A through L), and the Medicare program determines the type of coverage for each plan. Each standardized Medigap policy must offer the same basic benefits, no matter which insurance company sells it. Despite this, there can be large differences in the charges of various plans, so it always pays to research all of the options before choosing a Medigap Plan.
The information above should not be used as a substitution for information about Medicare learned through The Center for Medicare & Medicaid Services or through consultation with your Physician. For more information about Medicare, please visit http://www.medicare.gov/.
* Medicare certification and service offerings vary by individual office location. Please contact your local Maxim office to determine whether or not Medicare is an accepted coverage option for your healthcare needs in your area.
Center for Medicaid and Medicare Services (CMS), Department of Health and Human Services
http://www.cms.hhs.gov/ or http://www.medicare.gov/