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World of Medicare

Summary

  • Medicare is a federal health insurance program for those:
    • Age 65 and older
    • Under age 65 with certain disabilities
    • With ESRD
  • The 4 Parts of Medicare are:
    • Medicare Part A
    • Medicare Part B
    • Medicare Part C
    • Medicare Part D
  • Medicare refers to people who qualify for both Medicare and Medicaid as dually eligible beneficiaries. Services covered by both Medicare and Medicaid are paid first by Medicare and then by Medicaid, up to a state’s payment limit.
  • To become a Medicare provider and get payment from Medicare, you must complete an enrollment application. In the enrollment process, CMS collects your information and makes sure you’re qualified and eligible to enroll in the Medicare Program.
  • The Centers for Medicare & Medicaid Services (CMS) is an agency of the U.S. Department of Health & Human Services (HHS), based in Baltimore, Maryland. CMS oversees the Medicare Program. CMS’s mission is to provide effective health care coverage and promote quality care for people with Medicare.
  • Several contractors work with CMS to process your Medicare claims, including:
    • Medicare Administrative Contractors (MACs)
    • MA Plan contractors
    • Medicare drug plan contractors