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The Medicare Handbook
INCLUDING INFORMATION FOR BENEFICIARIES ON:
- MEDICARE BENEFITS
- PARTICIPATING PHYSICIANS AND SUPPLIERS
- HEALTH INSURANCE TO SUPPLEMENT MEDICARE
- LIMITS TO MEDICARE COVERAGE
ABOUT THIS HANDBOOK
Medicare pays for many of your health care expenses, but
it does not cover all of them. It is important for you to know
what Medicare does and does not pay for. This Handbook will
help you understand how the Medicare program works and what
your benefits are. You can use the alphabetical index at the
back of the book to find information on specific subjects. This
Handbook is also available in Spanish. (See inside back cover
for how to order.)
Don't Miss
- The Assignment Method of Payment
Many doctors and suppliers have agreed to be part of
Medicare's participating physician and supplier program. They
accept assignment on all Medicare claims. If you get your
medical services from one of these participating doctors or
suppliers, you can often save money. See page 28 for more
information about the assignment method of payment, and what
you can do to find a participating doctor or supplier.
- Your Appeal Rights
Pages 35 and 36 explain how to appeal when Medicare does
not pay your Part A or Part B claims.
- If You Need Financial Assistance to Pay for Health Care
Sometimes you can get help paying for Medicare. Look on
pages 2 and 3 for more information.
- New primary and preventive services
Medicare now has a Federally Qualified Health Center
benefit. Look on page 24.
- New Information About Insurance to Supplement Medicare
Some people want to have insurance to pay medical bills
Medicare doesn't cover. See pages 8 and 9 to find out about
Medicare supplement "Medigap" insurance, including a new open
enrollment period.
- New Benefits
Recently added Medicare Part B benefits for cancer
screening--mammograms and Pap smears--are described on page 25.
- Who Pays First?
Medicare is not always the insurer that pays first
on claims. For example, some people are employed, or their
spouse is employed, and the employer health insurance pays
first. For more about who pays first, see pages 10 and 11.
- Where to Call or Write
Look on the inside front cover to find where to call or
write to ask questions about Medicare.
This handbook is meant to explain the Medicare program,
but is not a legal document. The official Medicare program
provisions are contained in the relevant laws, regulations and
Rulings.
Save this handbook for reference. It is revised each year
and is available from Social Security, but you will not
automatically get a handbook in the mail unless there are major
changes in the Medicare program.
Contents
- What is Medicare?
- The Two Parts of Medicare
- Who Can Get Medicare Hospital Insurance
- Who Can Get Medicare Medical Insurance (Part B)?
- Buying Medicare Part A and Part B
- Enrollment in Medicare
- Your Medicare Card
- Assistance for Low-Income Beneficiaries
- Intermediaries and Carriers
- Peer Review Organizations
- Your Right to Decide About Your Medical Care
- Fraud and Abuse
- Your Rights Under the Privacy Act
- Medicare Coordinated Care Plans
- What Are Coordinated Care Plans
- Who Can Enroll in Coordinated Care Plans?
- Joining a Coordinated Care Plan
- Ending Enrollment in a Coordinated Care Plan
- If You Have Problems
- Medicare and Other Insurance
- Buying Health Insurance to Supplement Medicare
- When Other Insurance Pays Before Medicare
- What Medicare Does Not Pay For
- Custodial Care
- Care Not Reasonable and Necessary Under Medicare Program
- Standards
- Services Medicare Does Not Pay For
- Limitation of Liability
- Medicare Hospital Insurance (Part A)
- What Medicare Part A Includes
- How Medicare Pays for Part A Services
- When You Are a Hospital Inpatient
- Skilled Nursing Facility Care
- Home Health Care
- Hospice Care
- Medicare Medical Insurance (Part B)
- What Medicare Part B Includes
- Deductible and Coinsurance Amounts Under Part B
- Doctors' Services Covered by Medicare Part B
- Second Opinion Before Surgery
- Services of Special Practitioners
- Outpatient Hospital Services
- Other Services and Supplies Covered by Medicare
- Drugs and Biologicals
- Medicare Payments for Outpatient Treatment of Mental Illness
- Medicare Medical Insurance (Part B) Payments
- The Assignment Payment Method
- Participating Doctors and Suppliers
- When Your Doctor Does Not Accept Assignment
- Participating Providers
- Medicare Approved Amounts
- Submitting Part B Claims
- Getting the Part of Medicare You Do Not Have
- Getting Medicare Medical Insurance (Part B)
- Getting Medicare Hospital Insurance (Part A)
- Special Enrollment Period
- Events That Can Change Your Medicare Protection
- When Protection Ends for People 65 and Older
- When Protection Ends for the Disabled
- When Protection Ends for Those With Permanent Kidney
- Failure
- How to Appeal Medicare Decisions
- Appealing Decisions Made by Providers of Part A Services
- Appealing Decisions Made by Peer Review Organizations (PROs)
- Appealing Decisions of Intermediaries on Part A Claims
- Appealing Decisions Made by Carriers on Part B Claims
- Appealing Decisions Made by Health Maintenance
- Organizations (HMOs)
- For More Information
- Appendices
- Charts: Medicare Covered Services
- Medicare Carriers
- Medicare Peer Review Organizations (PROs)
- Index
To read chapters click on the links below...
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