You might think Medicare health plans are strictly for your elder years. Since most people are eligible for Medicare at age 65, this is an understandable conclusion. But you might also be eligible earlier if you suffer from certain diseases or disabilities. In either case, choosing Medicare health plans can seem confusing. You could be covered under several plans, so it’s important to understand each before making a decision.
UNDERSTANDING MEDICARE HEALTH PLANS
If you’ve received Social Security Disability benefits for a total of two years, you’re eligible for a Medicare health plan. You should understand, though, that there are four types of Medicare plans: Parts A, B, C and D. Which plan is best for you depends on what you’re looking for in health insurance.
- Medicare Part A: Part A is one of the original Medicare plans, and it provides hospital insurance. This includes home health care, hospice, nursing home and hospital insurance when medically necessary.
- Medicare Part B: This is another of the original Medicare plans and provides medical insurance. These services include mental health care, laboratory tests, preventative health care and several other aspects not covered in Part A. There’s a monthly premium for Part B, and since Part A is free if you’ve paid taxes for 10 years, the two differ substantially here.
- Medicare Part C: Part C provides Medicare benefits through private health insurers. This is known as a Medicare Advantage Plan, and it provides both Part A and B benefits. The insurer must be approved by Medicare.
- Medicare Part D: This Medicare health plan provides prescription drug coverage, and like Part C, it is provided through Medicare-approved private insurance companies.
Choosing a Medicare health plan isn’t a one-time decision; you can change plans. Before considering that, however, you must select the one that’s right for you.
CHOOSING MEDICARE HEALTH PLANS
If your health insurance thus far has involved Social Security Disability medical expenses, you may be in a hurry to choose a Medicare health plan. There are many things to consider before choosing, but the most important is whether the services you need are covered. If you have expensive prescriptions, for instance, you’ll want to choose between Parts C and D to pay for your medicine.
You’ll also want to consider the services you usually receive. If you are typically treated as an outpatient, Part A covers none of your costs. Similarly, you could end up paying for everything except your physician’s bill if you’re an inpatient under Part B. Part C can provide both, but you’ll want to consider premiums and whether your SSD benefits can cover them.
MEDICARE CLAIM DENIED
Sometimes Medicare might refuse to pay for the healthcare services you expected. For cases like this, you have an appeals process. There are five levels of appeals, and you need to be at Level 3 before a judge hears your case. The mandated waiting period to have your case heard by an administrative judge is 90 days, but at least one recent lawsuit claims the wait has been over a year for some individuals.
This is why many people opt for a Social Security Disability attorney when appealing for either Medicare or SSD benefits. The biggest problem you may encounter in receiving Medicare benefits is being denied SSD benefits. You need strong Social Security Disability medical evidence proving you can’t work before you can successfully fight a Medicare denial.
At Levine Benjamin, our Social Security Disability attorneys fight hard to ensure you receive the SSD benefits and Medicare coverage you’ve earned. Having representation increases your likelihood of receiving benefits. Call us at Levine Benjamin so our experienced disability attorneys can make a difference in your claim.
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