Medicare Glossary

The Must-Read Medicare Glossary

*Repost* http://www.aarp.org/health/medicare-insurance/info-2017/medicare-glossary-reference.html

A reference tool for some of the most commonly used Medicare terms

by Dena Bunis, AARP Bulletin, October 2017|Comments: 0

There are key terms you should know when researching Medicare options.

Medicare: The federal program that helps people over 65 and some people with disabilities pay for their health care. It is structured as an insurance program with several “parts.” Each covers a different type of cost.

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Part A: Covers hospital stays, selected costs of continuing care after a hospital stay, some home health services and hospice.

Part B: Covers doctor visits and services, preventive care, lab tests and screenings, medical equipment and supplies, and some home health care.

Part C: Allows private health insurance companies to provide Medicare benefits. Known as Medicare Advantage plans, they are often HMOs or PPOs offering comprehensive health coverage that includes the services covered by parts A and B and sometimes more. Most also cover prescription drugs (Part D).

Part D: Covers outpatient prescription drug costs.

Supplemental Insurance, also known as Medigap: This is optional private insurance that Medicare recipients can buy to pay for out-of-pocket expenses (such as coinsurance costs) that traditional Medicare doesn’t cover. 

Coinsurance: The percentage of the cost that you pay for a medical service or equipment. For example, for many Part B services, Medicare pays 80 percent of the cost; your coinsurance in those cases is 20 percent.

Copay: A specific dollar amount that you pay as your share of the cost of a medical service or equipment. For example, in a Medicare Advantage plan, you might have a $25 copay for a doctor visit; under Part D, you might have $10 copay for a particular prescription each time you get a refill.

Coverage gap: Also called the doughnut hole, this kicks in when you and your prescription drug plan costs reach a coverage limit that the government sets each year — $3,750 for 2018. After that, you pay a larger share of your prescription drug costs until your out-of-pocket costs reach a government-set threshold — $5,000 in 2018. After that, the government picks up most of the tab for your drugs. Under the Affordable Care Act, this coverage gap will be eliminated in 2020.

Deductible: The amount you must pay before insurance pays anything. For example, the Part B deductible in 2017 was $183; that means you must pay for the first $183 in expenses that fall under Part B before it will begin covering costs. 

Also of Interest

• READ: Medicare Resource Center
• WHERE AARP STANDS: AARP CEO: We'll fight for Medicare
• READ: Navigating the Medicare maze
• TELL US: What are your concerns about Medicare?

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New Medicare Cards - Coming Soon

Your Medicare card

*Repost* https://www.medicare.gov/forms-help-and-resources/your-medicare-card.html

When you’re enrolled in Medicare, you’ll get your red, white, and blue Medicare card in the mail. If you're automatically enrolled, you'll get your red, white, and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of getting disability benefits. Your Medicare card shows that you have Medicare health insurance. It shows whether you have Part A (Hospital Insurance), Part B (Medical Insurance) or both, and it shows the date your coverage starts.

Be sure to carry your card with you when you’re away from home. Let your doctor, hospital, or other health care provider see your card when you need hospital, medical or other health services.

New Medicare Cards

Note

Medicare will mail new Medicare cards between April 2018 and April 2019. Your new card will have a new Medicare number that’s unique to you, instead of your Social Security number. This will help to protect your identity. The new card won’t change your coverage or benefits.

You don’t need to take any action to get your new Medicare card. Medicare will never contact you for your Medicare number or other personal information. Don’t share your Medicare number or other personal information with anyone who contacts you by phone, email, or by approaching you in person, unless you’ve given them permission in advance. Learn more about the limited situations in which Medicare can call you.

How can I replace my Medicare card?

If your Medicare card is lost, stolen or damaged, you can ask Social Security for a new one.

• Your Medicare card will arrive in the mail in about 30 days.
• Social Security will mail your card to the address they have on file for you.
• If you need proof that you have Medicare sooner than 30 days, you can request a letter from Social Security. The letter will arrive in the mail in about 10 days.
• If you need proof immediately for your doctor or for a prescription, visit your local Social Security office.

How do I change my name or address for my Medicare card?

Medicare uses the name and address you have on file with Social Security. To change your name and/or address, visit your online my Social Security account.

Note

Medicare is managed by the Centers for Medicare & Medicaid Services (CMS). Social Security works with CMS by enrolling people in Medicare.

Need Medical Equipment? See what Medicare Covers....

*Repost* https://www.medicare.gov/coverage/durable-medical-equipment-coverage.html?linkId=24566463&utm_source=facebook&utm_medium=social&utm_campaign=medicare&utm_content=071717_DME&linkId=39844787

Durable medical equipment (DME) coverage

How often is it covered?

Medicare Part B (Medical Insurance) covers medically necessary durable medical equipment (DME) that your doctor prescribes for use in your home. Only your doctor can prescribe medical equipment for you. DME meets these criteria:

• Durable (can withstand repeated use)
• Used for a medical reason
• Not usually useful to someone who isn't sick or injured
• Used in your home
• Has an expected lifetime of at least 3 years

DME that Medicare covers includes, but isn't limited to:

• Air-fluidized beds and other support surfaces (these supplies are only rented)
• Blood sugar monitors
• Blood sugar (glucose) test strips
• Canes (however, white canes for the blind aren't covered)
• Commode chairs
• Continuous passive motion (CPM) machine
• Crutches
• Hospital beds
• Infusion pumps and supplies (when necessary to administer certain drugs)
• Manual wheelchairs and power mobility devices
• Nebulizers and nebulizer medications
• Oxygen equipment and accessories
• Patient lifts 
• Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
• Suction pumps
• Traction equipment
• Walkers

Who's eligible?

All people with Part B are covered.

Your costs in Original Medicare

If your supplier accepts assignment, you pay 20% of the Medicare-approved amount, and the Part B deductibleapplies. Medicare pays for different kinds of DME in different ways. Depending on the type of equipment:

• You may need to rent the equipment.
• You may need to buy the equipment.
• You may be able to choose whether to rent or buy the equipment.

Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them. 

It’s also important to ask your suppliers if they participate in Medicare before you get DME. If suppliers are participating suppliers, they must accept assignment. If suppliers are enrolled in Medicare but aren’t “participating,” they may choose not to accept assignment. If suppliers don't accept assignment, there’s no limit on the amount they can charge you.

Competitive Bidding Program

If you live in or visit certain areas, you may be affected by Medicare's Competitive Bidding Program. In most cases, Medicare will only help pay for these equipment and supplies if they're provided by contract suppliers when both of these apply:

• You have Original Medicare.
• You get competitively bid equipment and supplies in competitive bidding areas.

Contract suppliers can't charge you more than the 20% coinsurance and any unmet yearly deductible for any equipment or supplies included in the Competitive Bidding Program.

Note

To find out how much your specific test, item, or service will cost, talk to your doctor or other health care provider. The specific amount you’ll owe may depend on several things, like:

• Other insurance you may have
• How much your doctor charges
• Whether your doctor accepts assignment
• The type of facility
• The location where you get your test, item, or service

Note

If you live in an area that's been declared a disaster or emergency, the usual rules for your medical care may change for a short time. Learn more about how to replace lost or damaged equipment in a disaster or emergency.

Related Resources

• Where to get covered DME items  
• More information about DME
• Competitive Bidding Program

Attention! MORx Members with Medicare Only:

Missouri Rx Plan

Attention MORx Members with Medicare Only: *repost* http://www.morx.mo.gov/ 

Due to a law passed in 2014, your Missouri Rx (MORx) program coverage expires in 2017. The last day you can receive help with prescription drug co-payment costs from the MORx Program will be June 30, 2017. Prescriptions filled after this date will not be covered by MORx.

MORx member receiving MO HealthNet benefits will not be impacted by this change.

Questions?

Call MORx at 1-800-375-1406 with questions.

Helpful Resources

• To see if you qualify for MO HealthNet (Medicaid), call the Family Support Division at 1-855-373-4636.
• Partnership for Prescription Assistance 1-888-477-2669 or online at www.pparx.org
• Rx Outreach 1-800-769-3880
• Community Leaders Assisting the Insured of Missouri (CLAIM) 1-800-390-3330
• Area Agencies on Aging (AAA)

What Is Medicare Supplement Insurance?

                      *repost: https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html               What's Medicare Supplement Insurance (Medigap)?

A Medicare Supplement Insurance (Medigap) policy, sold by private companies, can help pay some of the health care costs that Original Medicare doesn't cover, like copayments, coinsurance, and deductibles.

Some Medigap policies also offer coverage for services that Original Medicare doesn't cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.

A Medigap policy is different from a Medicare Advantage Plan. Those plans are ways to get Medicare benefits, while a Medigap policy only supplements your Original Medicare benefits.

8 things to know about Medigap policies 

1. You must have Medicare Part A and Part B.
2. If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
3. You pay the private insurance company a monthly premium for your Medigap policy in addition to the monthly Part B premium that you pay to Medicare.
4. A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you'll each have to buy separate policies.
5. You can buy a Medigap policy from any insurance company that's licensed in your state to sell one.
6. Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can't cancel your Medigap policy as long as you pay the premium.
7. Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren't allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
8. It's illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.

Medigap policies don't cover everything

Medigap policies generally don't cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.

Insurance plans that aren't Medigap

Some types of insurance aren't Medigap plans, they include:

• Medicare Advantage Plans (like an HMO, PPO, or Private Fee-for-Service Plan)
• Medicare Prescription Drug Plans
• Medicaid
• Employer or union plans, including the Federal Employees Health Benefits Program (FEHBP)
• TRICARE
• Veterans' benefits
• Long-term care insurance policies
• Indian Health Service, Tribal, and Urban Indian Health plans

Dropping your entire Medigap policy (not just the drug coverage) 

If you decide to drop your entire Medigap policy, you need to be careful about the timing. For example, you may want a completely different Medigap policy—not just your old Medigap policy without the prescription drug coverage. Or you might decide to switch to a Medicare Advantage Plan that offers prescription drug coverage.

You have to pay a late enrollment penalty when you join a new Medicare drug plan if:

• You drop your entire Medigap policy and the drug coverage wasn't creditable prescription drug coverage, or
• You go 63 days or more in a row before your new Medicare drug coverage begins

To learn more about the costs of MediGap: https://www.medicare.gov/supplement-other-insurance/medigap/costs/medigap-plan-costs.html

January: National Glaucoma Awareness Month

THE MEDICARE BLOG

THE OFFICIAL BLOG FOR THE U.S. MEDICARE PROGRAM. FOR MORE INFORMATION, PLEASE VISIT WWW.MEDICARE.GOV

01.15.17

by Centers for Medicare & Medicaid Services

KEEP AN EYE OUT FOR GLAUCOMA

Are you at a high risk of getting glaucoma? Glaucoma is an eye disease that causes loss of vision—usually side vision—by damaging the optic nerve, which sends information from your eyes to your brain.

Fortunately, you can help prevent vision loss by finding and treating problems early—and Medicare can help. We cover a glaucoma screening once every 12 months for people at high risk for glaucoma. You’re considered at high risk if you answer “yes” to one or more of these questions:

• Do you have diabetes or a family history of glaucoma?
• Are you African American and 50 or older?
• Are you Hispanic American and 65 or older?

January is National Glaucoma Awareness Month—the perfect time to check on your eye health.