Newsletters

Part A - Eligibility, Enrollment, and Diagnostic Related Groups

Part A provides hospital coverage to individuals who are eligible and enrolled in Medicare, the federal government's health care insurance program. Medicare uses diagnostic related groups (DRGs) to determine payment levels for services provided for varying diagnoses.

Medicare - Supplemental Health Insurance - Need and Eligibility

There are many items that Original Medicare will not cover under either Part A hospitalization coverage or Part B medical insurance. These include routine care, such as annual medical checkups, eye examinations and corrective wear, dental work, and most immunizations. Items that are not medically reasonable or necessary are also excluded. Examples of these items include cosmetic surgery, private nurses, and personal conveniences. In addition to items that are not covered, Medicare beneficiaries must pay coinsurance, copayments, and deductibles, all of which increase their out-of-pocket costs and create a market for supplemental health insurance.

Third Party Liability

Medicaid, a federal and state funded program, pays for health insurance for needy individuals and families, particularly pregnant women, children, teenagers, the aged, the blind, and the disabled. Medicaid provides an important component of benefits to the elderly population of the United States: medical assistance.

Social Security - Survivors' Benefits

The Social Security Administration pays Survivors' Benefits to certain family members of a worker who died after becoming eligible for the benefit. For each three-month period of employment, a worker gains one credit.

Veterans Benefits - Health Care

The Department of Veterans Affairs (VA) provides health care benefits, including hospital care, outpatient care, and nursing home care, to eligible veterans. Generally speaking, services are provided on a priority basis.