Medicare and Your Medicare Rights By Sylvia Gaddis Florida Medical Quality Assurance, Inc.

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)

MEDICARE HEALTH INSURANCE SOCIAL SECURITY ACT NAME OF BENEFICIARY JOHN D. DOE MEDICARE CLAIM NUMBER SEX A MALE IS ENTITLED TO EFFECTIVE DATE HOSPITAL INSURANCE (PART A) 1/1/95 MEDICAL INSURANCE (PART B) SIGN HERE John D. Doe

B A “Hospital Insurance” “Doctor Insurance”

  Part A is premium free for most people   Part A Hospital Deductible $812 per benefit period   Part A Hospital Co-insurance Days 1-59No Co-insurance Days 61-90$203 per day Days $406 per day

  Part A helps pay for things like: Hospital Stays Nursing Home Care (Very Limited) Home Health Care Hospice Care

 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

  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 You pay all costs after 100 days

  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

  Part B helps pay for things like: Doctors’ Visits Outpatient Surgery Preventive Health Care Outpatient Tests Medical Equipment Used at Home Ambulance Services

Medigap   Covers Payment ‘Gaps’ in Original Medicare   Standardized Plans ‘A’ through ‘J’   Sold by Private Insurance Companies   May Help Lower Out-of-Pocket Costs

Covered Services  Ambulance  Artificial eyes  Artificial limbs  Braces - arm, leg, back, and neck  Chiropractic services (limited)  Emergency care )  Eyeglasses (one pair after cataract surgery)

Covered Services  Immunosuppressive drug therapy  Kidney dialysis  Macular degeneration treatment  Medical nutrition therapy  Medical supplies  Prosthetic devices  Transplants

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.”

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

Preventive Healthcare  Diabetes Monitoring  Nutritional Therapy  For those with Diabetes/Kidney Disease  Glaucoma Screening  Flu (influenza) shot  Pneumonia Vaccination  Hepatitis B Vaccination

Preventive Healthcare  Colon Cancer Screening  Prostate Cancer Screening  Mammogram Screening  Bone Mass Measurements  Pap Tests/Pelvic Exams

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

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

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.

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

Medicare Rights   Appeals Billing, Payment, or Services   Grievances Quality of Care Issues

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.

Thank You! If you have questions, call MEDICARE