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Medicare 101: Intro To Medicare

Medicare is an essential government program that provides medical resources to retired individuals and others who qualify. It is a complex program that greatly impacts your level of care as you age.

At Sikov and Love, P.A., our experience with elder law concerns includes Medicare difficulties for people across Pennsylvania. We understand the law because we work with it so much on behalf of our clients in Pittsburgh. You can count on a highly respected level of service when you turn to us for answers about Medicare.

Understanding Medicare’s Parts

While most people understand “Medicare” as being some kind of medical care provider run by the federal government, most don’t know that it’s split up into several parts. Each of these parts governs a different type of coverage:

  • Part A: Hospital insurance covers stays at the hospital or nursing home.
  • Part B: Medical insurance covers doctor’s visits, drugs and care administered in the hospital says, counseling and care.
  • Part C: Managed care offers most of the benefits of Parts A and B, with prescription drug costs as well. Private insurers manage this program, and you may have to pay out of pocket more.
  • Part D: Prescription drug coverage covers prescriptions if you do not enroll in a managed care program.

With each part of Medicare, there are significant benefits and drawbacks to enrolling. We can walk you through each of them.

Answering Frequently Asked Questions Our Pittsburgh Medicare Attorneys Receive

Medicare eligibility can be confusing. Here are answers to some of the most common questions our Pittsburgh Medicare attorneys are asked.

What are some eligibility requirements for Medicare?

Medicare is largely aimed at individuals aged 65 or over. However, there are certain other instances when a person may be eligible. These include if a person has a disability, end-stage renal disease or Lou Gehrig’s disease (ALS).

Eligibility for Medicare can also depend on a person’s work history and residency. Those with an extensive work history may be entitled to reduced fees or even completely free treatment.

What options do you have if your Medicare application is rejected?

A Medicare rejection can leave you wondering how your health needs will be met. It’s important to remember that you can appeal unfavorable decisions. Firstly, you can ask for an unfavorable decision to be reconsidered. Generally, the form to lodge this type of appeal is included in your Medicare summary notice.

If the decision is still unfavorable, then you have the option to appeal with an administrative law judge (ALJ). To do this, you will need to formally request a hearing. Following an unsuccessful ALJ appeal, you can then request a review from the Medicare Appeals Council. The highest level of appeal you can make on an unfavorable Medicare decision is to take your case to a federal district court.

Working with a Pittsburgh Medicare attorney from the start can help you avoid unnecessary denials, unwarranted delays and a lengthy litigation process.

What are some benefits and drawbacks of Medicare?

One of the key benefits of Medicare is that it provides access to health care for millions of aging Americans and disabled individuals. The out-of-pocket expenses for Medicare enrollees are relatively low, with standard premiums costing $148.50 per month. Nonetheless, Medicare also has some drawbacks in that it can be difficult to get all services approved, and you still need more than one type of coverage for managed care costs and prescription drug coverage.

Have More Questions? Reach Out For Answers.

Your eligibility or possible eligibility for Medicare is a major piece of your estate planning and elder care service. You will have many questions about this process, and contact our firm to reach Pittsburgh Medicare attorneys who are ready with answers.

Set up a meeting today by calling 412-567-1236 or sending an email using this form.