Medicare is a federally-funded health insurance program in the United States. The program is designed to provide health coverage to people 65 years old and above, people with certain disabilities, and those with end-stage renal disease. The program is divided into different parts, including coverage and costs. This article will provide an overview of the different parts of Medicare and explain how they are regulated by ACA/OIG-Medicare regulations.
Medicare Part A:
- Medicare Part A, also known as hospital insurance, covers inpatient hospital care, skilled nursing facility care, hospice care, and some home health care services. This part of Medicare is funded by payroll taxes paid by employees and employers. To be eligible for Medicare Part A, you must have worked and paid into the system for a certain amount of time.
- Medicare Part B, also known as medical insurance, covers medically necessary services such as doctor visits, outpatient care, preventive services, and medical equipment. This part of Medicare is funded by monthly premiums paid by enrollees, as well as by the federal government. In order to be eligible for Medicare Part B, you must be enrolled in Medicare Part A.
- Medicare Part C, or Medicare Advantage, is an alternative to original Medicare. Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans cover all the services provided by original Medicare but may also include additional benefits such as prescription drug coverage, dental, vision, and hearing coverage. Medicare Advantage plans may also have different rules and costs than original Medicare.
Medicare Part D:
- Medicare Part D is a prescription drug coverage program that helps cover the cost of prescription drugs. This part of Medicare is also provided by private insurance companies approved by Medicare. Medicare Part D plans vary in terms of the drugs they cover and the cost of premiums and co-payments.
Regulations for Medicare Parts A, B, C, and D:
ACA/OIG-Medicare regulations apply to all parts of Medicare. Covered entities and business associates that provide services under Medicare must comply with these regulations to prevent waste, fraud, and abuse in the healthcare system. The regulations require covered entities to ensure that their workforce members receive appropriate training on specific compliance topics related to Medicare regulations.
Understanding the different parts of Medicare is essential for individuals who are eligible for Medicare and healthcare providers and entities that provide services under Medicare. Compliance with ACA/OIG-Medicare regulations is essential to prevent waste, fraud, and abuse in the healthcare system. Covered entities and business associates must ensure that their workforce members receive appropriate training on specific compliance topics related to Medicare regulations.
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