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Medicare coverages
For a layman, sometimes it is difficult to understand the health care benefits and plans. We'll see how Medicare coverage works in conjunction any healthcare provider. Medicare is a federal health insurance program for people age 65 or older, certain disabled people under age 65 and for people of any age who have End Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant). medicare coverages include Medicare has two primary parts - Part A is hospital insurance; Part B is medical insurance. Part A (hospital insurance) helps pay for medically necessary inpatient hospital care, inpatient care in a skilled nursing facility, home health care and hospice care. Part B (medical insurance) helps pay for medically necessary doctors' services, outpatient hospital services and a number of other medical services and supplies that are not covered by Part A. Part B can also help pay for home health care if you are not enrolled in Medicare Part A.
Medicare coverages in Part A include coverage that is available free of charge to people age 65 and older who meet the eligibility requirements necessary to qualify for Social Security benefits. You automatically qualify if you were a federal employee on January 1, 1983. People 65 or older who don't qualify for Medicare Part A free of charge can get Part A by paying a monthly premium. If you have any questions about Blue Cross and Blue Shield Service Benefit Plan coverage, call your local Blue Cross and Blue Shield Plan. All Medicare coverages in Part B is available for as less as $54 a month. Before you reach age 65, you need to decide whether to enroll in Medicare Part A and/or Part B. If you want Medicare protection to start the month you reach age 65, contact your local Social Security office three months before your 65th birthday. If you decide to sign up for Medicare after your 65th birthday, your Medicare Part B effective date will be delayed.
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Although Medicare pays for a significant portion of your health care costs, it does not pay the full cost of your expenses. There are still many expenses that you must pay. That's why many retired federal employees choose to supplement their Medicare coverages our coverage plan. In many cases, Medicare is your primary coverage (it pays your health care costs first), and your Service Benefit Plan coverage fills the gaps. However, the Service Benefit Plan may be primary and Medicare the secondary payer if you or your spouse or dependents are eligible for Medicare benefits because of end-stage renal disease or disability or if you have Medicare and are actively employed. We have a Plan that offers two types of coverage to federal employees and retirees - Standard Option and Basic Option. Both Options fill in most gaps in coverage that Medicare does not pay. When combined with Medicare coverage, your Service Benefit Plan generally covers 100 percent of your health care expenses.
Medicare covers each person separately, so remember that you may need coverage for your family members. Service Benefit Plan coverage allows you to sign up for family coverage when you have eligible dependents. If you have Basic Option coverage, a Preferred network provider must perform the care to be eligible for benefits except in certain situations such as emergency care.
- Inpatient hospital care
- Surgical care
- Physical exams and certain preventive screening tests
- Outpatient surgery
- Outpatient accidental injury care
- Outpatient physical, speech and occupational therapies
- Mental health/substance abuse care
- Home hospice care
- Retail Pharmacy Program
- Mail Service Prescription Drug Program (Standard Option only)
- Flu and pneumonia
immunizations
- Skilled nursing facility care (limited benefit for Standard Option members with Medicare Part A as primary coverage)
- Routine dental care
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