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Medicare beneficiaries’ access to health care services is similar to that of privately insured people age 50–64.
Traditional fee-for-service Medicare covers items and services that are “reasonable and necessary for the diagnosis or treatment of illness or injury, or to improve the functioning of a malformed b
At least one in five older Americans has a mental health condition.
Beneficiaries in Traditional Medicare and enrollees in Medicare Advantage plans can protect their right to receive services and payment of claims through the grievance and appeals process.
Medicare pays for hospital inpatient services using a prospective payment system (PPS).
Medicare covers medical services under Part B, such as those provided by physicians and other clinicians (i.e., nurse practitioners and physician assistants).
Beneficiaries or their providers may ask a Medicare administrative contractor about the coverage and cost of certain services and items.
Beneficiaries enrolled in Traditional fee-for-service Medicare are exposed to significant out-of-pocket expenses.
Medicare hospital outpatient services are paid under Part B. Thus, they are subject to 20 percent coinsurance, as are most other Part B services.
There are two main types of prevention. In primary prevention, the goal is to promote good health. In secondary prevention, the goal is to detect disease at early stages when it is most treatable.