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Medicare Rules

What is a Medicare Coverage Determination?

Medicare recipients often wonder if a specific prescription drug is covered or if a particular medical procedure will be paid...

How Does Medicare Decide if My Treatment is Medically Necessary?

For Medicare beneficiaries, you may have heard the term medically necessary a time or two. But what is it, and...

How Does Medicare Reimbursement Work?

To get reimbursed from Medicare, beneficiaries typically rely on their healthcare providers to file claims on their behalf, but there...

How Does Medicare Pay Hospitals?

Medicare insurance is one of the most popular options for those who qualify, and the number of people using this...

How Does a Secondary Payer Work with Medicare?

It’s possible for Medicare recipients to have health coverage through more than one insurance plan. When this happens, certain rules...

How Does the Medicare Program Impact Other Payers?

Ever since July 30, 1965, when the United States federal government established Medicare, millions of people have counted on their...

Is Medicare Primary or Secondary?

Medicare can be either the primary or secondary payer depending on your specific circumstances, such as other insurance coverage. However,...

How Does Medicare and Private Insurance Work?

Medicare works with private insurance carriers either by contracting with them to enhance or expand on existing Medicare benefits or...

How Does Medicare Affect Medical Billing?

Medicare is a federally funded health insurance option, and since Medicare is responsible for reimbursing all participating healthcare facilities, the...

How Does Medicare Reimburse Hospitals?

Medicare provides coverage for millions of Americans over the age of 65 or individuals under 65 who have certain permanent...

What Does Medicare Fund?

Medicare is run by the Centers for Medicare & Medicaid Services (CMS).  CMS is a federal agency and branch of...

How Does Medicare Determine Reimbursement Rates?

Medicare determines reimbursement rates for physicians primarily through the Physician Fee Schedule, which outlines payment for over 10,000 services. However,...

Does My Medicare Coverage Change if I Move Out of Assisted Living?

Medicare recipients who reside in assisted living facilities most commonly leave because they need a higher level of health and...

When Can I Change My Medicare Benefits?

If you signed up for a Medicare plan that’s no longer meeting your needs, there are times during the year...

How Do I Change My Address with Medicare?

To update your address with Medicare, contact the Social Security Administration (SSA) online, by phone, or in person. However, rules...