Introduction to Medicare Health Insurance for Seniors

Part 3, Chapter 9: Medicare and Medicare Related Programs: Medicare Page 1

Medicare is one of the major components of the American system of health insurance. It provides health insurance coverage for senior citizens, for some people who are no longer able to work due to disability, and for some children and adults with End-Stage Renal Disease (ESRD) who require kidney dialysis treatments.

Certain aspects of the Medicare system are now standardized. For example, medical providers generally file claims directly with Medicare, and payments are usually sent directly to providers. After Medicare has processed a claim, the Medicare beneficiary generally receives an EOMBS (Explanation of Medicare Benefits Statement) from Medicare.

If a Medicare beneficiary has a Medigap policy or a secondary health insurance policy that acts as a Medicare supple ment -- for example, an employer-sponsored group health in surance plan that continues after an individual retires -- Medicare may automatically forward the claim to that insurer in certain cases, as long as the individual's identification number and insurance company information are listed on the Medicare claim form. (See Chapter 10 for a detailed discussion of Medigap policies and secondary health insurance policies.) The Medicare beneficiary will then receive an EOBS (Explanation of Benefits Statement) from the Medigap or secondary insurer, and a bill from the medical provider for any remaining balance.

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