There are two medical programs run by the U.S. government. One, Medicare, is paid for contributions from workers' paychecks. The cost of the means-tested program for low-income folks, Medicaid, is split between the federal and state governments, though their general funds.
Medicare pays for most of the cost of hospitalization, rehabilitation, doctors' visits, labratory expenses, prescription drugs, and much other medical care for older and disabled Americans, but it still leaves almost half of all medical costs unpaid. Most people need a medigap insurance policy or Medicare managed care plan (Medicare Part C) to cover the gaps in Medicare.
For those with low income and assets, Medicaid can pay for medical expenses for who don't qualify for Medicare -- or can cover the gaps in Medicare for those who do.
Please follow this link for an excellent overview on these two programs. http://www.nolo.com/legal-encyclopedia/medicare-medicaid
The primary government program for persons over the age of 65. Replacement coverage for Medicare coverage is available through Medicare Advantage programs.
You can't sue the government until you've asked the government to pay your claim.
Until a claimant has exhausted her administrative remedies by going through the agency appeals process, a federal district court has no subject matter jurisdiction over her lawsuit seeking to 'recover on any claim arising out of' the Medicare Act."
These replacement products provide seniors with an alternative to standard Medicare coverage typically at a lower overall cost and typically with an expanded set of covered services.
1. Coordinated Care Plans (CCPs)
2. Private Fee-for-Service (PFFS) plans
3. Medical Savings Account (MSA) plans
4. Employer Group Waiver plans (EGWPs)
Medicare has several coinsurance and deductible provisions which are the financial responsibility of the beneficiary. Medicare supplement policies provide a standard set of insurance policies to cover various aspects of these coinsurance and deductible requiremnts.
All Medicare Supplement policies must conform to specific guidelines and cover one of ten specific groupings of benefits. Descriptive information on Medigap coverage can be found on the CMS websit on the Medigap page.
See the Social Security Administration requirements for these standardization requirements by clicking on the following to view the CERTIFICATION OF MEDICARE SUPPLEMENTAL HEALTH INSURANCE POLICIES.
TriCare is the primary insurance for the families of active duty military personnel as well as providing coverage for retired military members and their families.
Elder Law Essentials: What Every Lawyer Should Know About Representing The Elderly Client by This Practice Guide provides an excellent overview of Medicare, Medicare Replacement, and Medicare Supplement coverages as well as a good primar on Medicaid eligibility issues. Sometimes when settlng a dispute over a beneiciary's obligation, it is helpful to understand the distinction between the product imagined and the product purchased.
