Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Medicare and Your Medicare Rights

402 views

Published on

  • Be the first to comment

  • Be the first to like this

Medicare and Your Medicare Rights

  1. 1. MedicareMedicare and Your Medicare Rightsand Your Medicare Rights By Sylvia Gaddis Florida Medical Quality Assurance, Inc.
  2. 2. Medicare is a health insurance program for:  People age 65 or older  Some people under 65 with disabilities Usually required to be eligible for Social Security Disability for at least 2 years  People with End-Stage Renal Disease (ESRD) (permanent kidney failure)  People with Lou Gehrig’s Disease (ALS)
  3. 3. MEDICARE HEALTH INSURANCE SOCIAL SECURITY ACT NAME OF BENEFICIARY JOHN D. DOE MEDICARE CLAIM NUMBER SEX 123-45-6789A MALE IS ENTITLED TO EFFECTIVE DATE HOSPITAL INSURANCE (PART A) 1/1/95 MEDICAL INSURANCE (PART B) SIGN HERE John D. Doe
  4. 4. BA ““Hospital Insurance”Hospital Insurance” “Doctor Insurance”
  5. 5.  Part A is premium free for most people  Part A Hospital Deductible  $812 per benefit period  Part A Hospital Co-insurance  Days 1-59 No Co-insurance  Days 61-90 $203 per day  Days 91-150 $406 per day
  6. 6.  Part A helps pay for things like:  Hospital Stays  Nursing Home Care (Very Limited)  Home Health Care  Hospice Care
  7. 7. Part A “Benefit Period” You pay only one deductible for each benefit period Starts the day admitted Ends when no care received for 60 days No limit to the number of benefit periods
  8. 8.  Part A Nursing Home Care For Each Benefit Period: Covered in full for 20 days (after hospital admission only)  Co-insurance • You pay $99 per day for days 21-100 • You pay all costs after 100 days
  9. 9.  Part B Premium  $54 per month  Part B Deductible  $100 each year  Part B Coinsurance  20% of approved amount for most services  20% of outpatient charges
  10. 10.  Part B helps pay for things like:  Doctors’ Visits  Outpatient Surgery  Preventive Health Care  Outpatient Tests  Medical Equipment Used at Home  Ambulance Services
  11. 11. Medigap  Covers Payment ‘Gaps’ in Original Medicare  Standardized Plans ‘A’ through ‘J’  Sold by Private Insurance Companies  May Help Lower Out-of-Pocket Costs
  12. 12. Covered Services Ambulance Artificial eyes Artificial limbs Braces - arm, leg, back, and neck Chiropractic services (limited) Emergency care Eyeglasses (one pair after cataract surgery))
  13. 13. Covered Services Immunosuppressive drug therapy Kidney dialysis Macular degeneration treatment Medical nutrition therapy Medical supplies Prosthetic devices Transplants
  14. 14. Therapy Coverage of Alzheimer’s Disease Patients Statement of Tom Scully, Administrator Centers for Medicare & Medicaid Services “Advances in medical science are helping physicians diagnose Alzheimer’s Disease at its earliest stages. Depending on a beneficiary’s medical condition, the Centers for Medicare & Medicaid Services believes that certain specific therapies can be helpful in slowing a beneficiary’s decline due to this terrible illness.”
  15. 15. Therapy Coverage of Alzheimer’s Disease Patients Statement of Tom Scully, Administrator Centers for Medicare & Medicaid Services Medicare provides payment for the following: •specific speech therapy •occupational therapy •rehabilitation therapy •neuro-diagnostic testing •medication management •psychological therapy The memorandum from Mr. Scully is available at http://hcfa.gov/pubforms/transmit/AB01135.pdf.
  16. 16. Preventive Healthcare Diabetes Monitoring Nutritional Therapy For those with Diabetes/Kidney Disease Glaucoma Screening Flu (influenza) shot Pneumonia Vaccination Hepatitis B Vaccination
  17. 17. Preventive Healthcare Colon Cancer Screening Prostate Cancer Screening Mammogram Screening Bone Mass Measurements Pap Tests/Pelvic Exams
  18. 18. Non-covered Services Acupuncture Dental care and dentures Cosmetic Surgery Custodial Care at home or in Nursing Home Health care while traveling outside the USA Hearing aids and hearing exams Orthopedic shoes
  19. 19. Non-covered Services Outpatient prescription drugs (with a few exceptions) Routine foot care (with only a few exceptions) Routine eye care and most eyeglasses Routine or yearly physical exams Screening tests except those listed as covered preventive services Shots (vaccinations) except those listed as covered preventive services
  20. 20. Medicare Rights  If you have Medicare, you have certain guaranteed rights and protections.  You have these rights whether you have the Original Medicare Plan, a Medigap policy, a Medicare HMO.
  21. 21. Medicare Rights  Respect  Protection Against Discrimination  Easy to Understand Information  Emergency care  Treatment Choices  Privacy of Personal Information  Privacy of Health Information  Culturally Competent Services
  22. 22. Medicare Rights  Appeals Billing, Payment, or Services  Grievances Quality of Care Issues
  23. 23. Medicare Rights Appeal a Hospital Discharge if you feel you are too sick to leave  You do NOT have to leave the hospital  You do NOT have to pay for the extra days you are in the hospital while we look at your medical record.
  24. 24. Thank You! If you have questions, call 1-800-MEDICARE

×