Eldercare refers to programs designed specifically to meet the needs of older individuals and includes Medicare, Social Security, private health insurance and other programs (housing, law, pensions, etc.).
End-stage renal disease refers to the point when a person’s kidneys fail and the patient must either have a kidney transplant, or undergo dialysis treatments. Individuals with ESRD are automatically eligible for enrollment in Medicare.
The enrollment period is a window of time set by Medicare during which you can enroll in a Medicare health insurance plan. Each type of health plan has its own enrollment period.
If a prescription drug that you need is not on the approved list of prescription drugs, you can file a formal written exception request to Medicare, asking that the drug be approved or that the cost of the drug be lowered.
For an Original Medicare enrollee, the excess charge is the difference between a doctor’s fee for service and what Medicare has approved as payment for that service.
Medicare enrollee denied coverage for a claim may challenge that denial in an expedited appeal if the patient’s life or health is in serious jeopardy. Typically, an expedited appeal is resolved within 72 hours.