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The Medicare program, a health insurance program for the elderly and disabled, was established in 1965 under title XVIII of the Social Security Act. The Centers for Medicare and Medicaid Services (CMS-formerly the Health Care Financing Administration), an agency of the U.S. Department of Health and Human Services (DHHS), has responsibility for administering the program.
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A beneficiary, provider, or supplier dissatisfied
with a reimbursement amount or eligibility determination under Medicare
Part A, B, or C has certain appeal rights, depending upon the nature of
the service rendered, the entity which made the determination, and who
or what entity is seeking to appeal the determination. Following a reconsideration
or fair hearing decision by the contractor, an appellant may request a
hearing before an Administrative Law Judge of the Office of Hearings and
Appeals within the Social Security Administration.
More detailed information regarding the Medicare program is available on our web site: www.ssa.gov/mediinfo.htm.
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Part A -- Hospital Insurance (HI) is the basic plan that provides protection against the cost of inpatient hospital and related post-hospital nursing care. Part A is funded out of Social Security payroll taxes. Individuals meeting the eligibility requirements are automatically covered under the plan at no premium cost to them. |
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Part B -- Supplementary Medical Insurance (SMI) provides protection against
the cost of medical and other related services such as physician services,
durable medical equipment and other outpatient services which are not paid
for by Part A. It is a voluntary plan, eligible individuals are automatically
enrolled in the plan but have the right to refuse or terminate their coverage.
A premium fee is charged for Part B coverage. |
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Part C -- Medicare + Choice provides additional care options for Medicare
beneficiaries enrolled in both Medicare Part A and B. These choices include
Medicare managed care organizations and private fee for service plans. These
plans receive payment from the Medicare program to administer the program
to enrolled beneficiaries.
CMS contracts with private insurance organizations, known as intermediaries
or carriers, to process Medicare claims. These entities process Parts
A and B claims for hospitals, skilled nursing homes, home health agencies,
and hospices, as well as Part B claims for physicians and other outpatient
suppliers.
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| Last updated July 13, 2004 7:31 AM |
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www.socialsecurity.gov
