Beneficiary Education Articles

Date	Article Title	Article
01/02/2008	Medicare Health And Prescription Drug Plan Enrollees Expected To Experience Smooth Transition To 2008	Medicare beneficiaries who have chosen to change their health and drug coverage for 2008 should experience very few difficulties when getting their covered prescription drugs through Medicare Part D, the Centers for Medicare & Medicaid Services (CMS) announced today. Click here to read the article in its entirety.
03/20/2007	Revised Auto-Enrollment Letters and Memorandum to Plans	The Centers for Medicare & Medicaid Services (CMS) has revised the auto-enrollment letter for beneficiaries, with a copy of this letter posted on the CMS Partnership Website at http://www.cms.hhs.gov/partnerships/downloads/autoenrollmentletter.pdf. The purpose of the auto-enrollment notice is to inform people with Medicare and full Medicaid coverage about the change in their drug coverage from Medicaid to Medicare. The notice explains that these individuals will be enrolled in a Medicare Prescription Drug Plan if they haven't joined a plan on their own, what plan Medicare will enroll them in, and their costs in the plan. It will also notify them that their Medicaid isn't creditable prescription drug coverage. The notice includes a one-page letter printed on yellow paper, on one page (front and back) of questions and answers about Medicare prescription drug coverage.
06/07/2006	Medicare Posts Hospital Payment Information	Important Step Toward Transparency in Health Care Costs and Quality: To help consumers, providers, and payers make more informed health care decisions, the Department of Health and Human Services through its Centers for Medicare & Medicaid Services (CMS) today posted information on what Medicare pays for 30 common elective procedures and other hospital admissions. President Bush directed the data be made publicly available to all Americans as part of the Administration’s commitment to make health care more affordable and accessible. The new information posted by CMS at http://www.cms.hhs.gov/HealthCareConInit/01_Overview.asp#TopOfPage shows the range of payments by county and the number of cases treated at each hospital for a variety of treatments provided to seniors and people with disabilities in fiscal year 2005. These include 30 common elective procedures including heart operations and implanting cardiac defibrillators, hip and knee replacements, kidney and urinary tract operations, gallbladder operations and back and neck operations, and for common non-surgical admissions. Please click the following link to read more from the HHS Press Release http://www.hhs.gov/news/press/2006pres/20060601a.html. Click on the CMS Fact Sheet at http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=1872. Also, you can read more helpful information on the CMS webpage for Health Care Consumer Initiatives located at http://www.cms.hhs.gov/HealthCareConInit/01_Overview.asp#TopOfPage.
03/16/2006	Medicare Expands National Coverage For Bariatric Surgery Procedures	The Centers for Medicare & Medicaid Services (CMS) announced February 21, 2006, that it is expanding Medicare’s national coverage of bariatric surgery for all Medicare beneficiaries. For seniors, who have experienced high complication rates in some settings, Medicare will cover the procedure only in high-volume centers that achieve low mortality rates. To review this press release in its entirety click on : http://new.cms.hhs.gov/apps/media/press/release.asp?Counter=1786 For a list of facilities certified to perform bariatric surgery procedures for Medicare patients: http://www.cms.hhs.gov/MedicareApproved Facilitie/BSF/list.asp#TopOfPage (To narrow your search, click on ‘Show only items whose State is’ by selecting your state in the drop down box.)

Most Commonly Asked Medicare Part A Questions

(Last Updated June 6, 2005)

Change of Address? Lost Medicare Card?

If you have a change of address, or need to request a replacement for your lost or damaged Medicare card you must contact the Social Security Office.

When Medicare is not Primary

When Other Insurance Pays Before Medicare

Medicare is not always the primary payer of your health care bills. Sometimes other insurers have to pay before Medicare. Hospitals, doctors, and other providers of health care services need to know if you are covered by other insurance that should pay before Medicare. Some examples in which Medicare pays secondary are listed below. For more details, you can ask the Social Security Office for a copy of Medicare and other health benefits. If you have other insurance that should pay before Medicare, you should tell your doctor and other providers when you receive health care services.

1. (a)You are 65 or older;
   (b)You or your spouse are currently working for an
        employer with 20 or more employees; and
   (c)You have group health insurance based on that employment.

2. (a) You are under age 65 and are disabled;
   (b) You or any member of your family is currently working for an employer with
        100 or more employees; and
   (c) You have group health insurance based on that employment.

3. You have Medicare because of permanent kidney failure

4. You have an illness or injury that is covered under workers' compensation, the federal black lung program, no-fault insurance, or any liability insurance.

Medicare Secondary Payer Q and A

Q. What is Medicare Secondary Payer (MSP):
A. A program created to help determine who pays primary (first).

Q. Why am I asked the same questions each time I receive health services?
A. Insurance information can change on a daily basis and should be verified on a daily basis. As a result, health care providers are required to ask questions each time services are provided.

Q. What will happen if I do not answer the health care provider's questions regarding other insurance coverage?
A. You can be billed for the services.

Q. Why do providers ask questions about an accident?
A. If other insurance exists, the other insurance, not Medicare should be billed first (example: auto insurance, home owners,worker's compensation, medical payment coverage)

Medicare Deductible, Coinsurance, and Premium Rates for Calendar Year 2008

Beneficiaries who use covered Part A services may be subject to deductible and coinsurance requirements. A beneficiary is responsible for an inpatient hospital deductible amount, which is deducted from the amount payable by the Medicare program to the hospital, for inpatient hospital services furnished in a spell of illness. When a beneficiary receives such services for more than 60 days during a spell of illness, he or she is responsible for a coinsurance amount equal to one-fourth of the inpatient hospital deductible per-day for the 61st-90th day spent in the hospital. An individual has 60 lifetime reserve days of coverage, which they may elect to use after the 90th day in a spell of illness. The coinsurance amount for these days is equal to one-half of the inpatient hospital deductible. A beneficiary is responsible for a coinsurance amount equal to one-eighth of the inpatient hospital deductible per day for the 21st through the 100th day of skilled nursing facility services furnished during a spell of illness.

Most individuals age 65 and older, and many disabled individuals under age 65, are insured for Health Insurance (HI) benefits without a premium payment. The Social Security Act provides that certain aged and disabled persons who are not insured may voluntarily enroll, but are subject to the payment of a monthly premium. Since 1994, voluntary enrollees may qualify for a reduced premium if they have 30-39 quarters of covered employment. When voluntary enrollment takes place more than 12 months after a person's initial enrollment period for HI benefits, the monthly premium increases by 10 percent.

Under Supplementary Medical Insurance (SMI), all enrollees are subject to a monthly premium. Most SMI services are subject to an annual deductible and coinsurance (percent of costs that the enrollee must pay),which are set by statute. When SMI enrollment takes place more than 12 months after a person's initial enrollment period, the monthly premium increases by 10 percent for each full 12 month period during which the individual could have been enrolled, but was not.

  

2008 Medicare Part A Deductible, Coinsurance, & Premium Amounts:
Deductible	$1.024.00 per benefit period
Coinsurance	$256.00 a day for days 61-90 in each period
	$512.00 a day for days 91-150 for each "Lifetime Reserve" day used
	$128.00 a day in a Skilled Nursing Facility for days 21-100 in each benefit period
Premium	$423.00 per month for those who must pay a premium
	$465.30 per month for those who must pay both a premium and a 10% increase
	$233.00 per month for those who have 30-39 quarters of coverage
	$256.30 per month for those who have 30-39 quarters of coverage and must pay a 10% increase
2008 Medicare Part B Deductible, Coinsurance, & Premium Amounts:
Standard Premium	$96.00 per year
Deductible	$135.00 per year
Coinsurance	20%

Individual Income = Beneficiaries who file an individual tax return (including those who are single, head of household, qualifying widow(er) with a dependent child, or married filing separately who lived apart from their spouse for the entire taxable year).
Joint Income = Beneficiaries who are married and lived with their spouse at any time during the taxable year, also filing a joint tax return.
Married but File Separate = Beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate tax return from their spouse.

Medicare Summary Notice (MSN)

The Medicare Summary Notice (MSN) is a notice to explain the decision that was made on the payment or inability to make payment on your Medicare claim. The MSN is for your records. Remember that the MSN is not a bill. DO NOT send money to Medicare or to the providers of service until you receive a bill.

Tips about the Medicare Summary Notice (MSN)

• If you are not due a payment check from Medicare, your Medicare Summary Notices (MSN) will now be mailed to you on a quarterly basis. You will no longer receive a monthly statement in the mail for these types of MSNs. You will now receive a statement every 90 days summarizing all of your Medicare claims. You may receive a bill from your provider before you receive an MSN. Compare the MSN with the bill from your provider to ensure you paid the appropriate amount for your services.
• You owe the Deductible and Coinsurance plus the Non-covered charges…unless the Notes advises that you do not.
• The notes section on the back of the claim refers to the Notes Section Column on the front of the MSN if there is further information about your claim. A letter will appear in this column to tell you where to look for further information in the Notes explanation section on the last page of the MSN.
• $0.00 in the Non-covered Charges = Medicare approved all of the charges. If a portion of your claim or all had not been approved you should see a letter in the Notes Section Column( see explanation in bullet above).

Medicare Coordination of Benefits Contractor

On November 1, 1999, The Centers for Medicare & Medicaid Services gave the Coordination of Benefits, (COB) Contract to GHI., Group Health Inc., of New York. The COB Contractor will handle other payer activity for Medicare to pay your claims right so mistakes do not occur. This includes determining if Medicare should pay first or second on your health care bills. This will save the Medicare Trust Fund money and will allow Medicare to pay claims right the first time.

For more information concerning the COB Contractor, log onto CMS's website at: