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Medicare Information

Medicare covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital , or skilled nursing facility for medically necessary services, and transportation in any other vehicle could endanger your health.

Medicare covers one alcohol misuse screening per year for adults with Medicare (including pregnant women) who use alcohol, but don’t meet the medical criteria for alcohol dependency.

Medicare covers voluntary Advance Care Planning as part of the Yearly  “Wellness” visit. This is planning for care you would want to get if you become unable to speak for yourself.

Medicare covers a one-time screening abdominal aortic aneurysm ultrasound for people at risk. You must get a referral from your doctor or other practitioner. You pay nothing for the screening if the doctor or other qualified health care provider accepts assignment .

Assignment - An agreement by your doctor, provider, or supplier to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance.

Benefit period - The way that Original Medicare measures your use of hospital and skilled nursing facility (SNF) services. A benefit period begins the day you’re admitted as an inpatient in a hospital or SNF. The benefit period ends when you haven’t received any inpatient hospital care (or skilled care in a SNF) for 60 days in a row. If you go into a hospital or a SNF after one benefit period has ended, a new benefit period begins. You must pay the inpatient hospital deductible for each benefit period. There’s no limit to the number of benefit periods.

Coinsurance - An amount you may be required to pay as your share of the cost for services after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).

Co-payment - An amount you may be required to pay as your share of the cost for a medical service or supply, like a doctor’s visit, hospital outpatient visit, or prescription drug. A co-payment is usually a set amount, rather than a percentage. For example, you might pay $10 or $20 for a doctor’s visit or prescription drug.

Creditable prescription drug coverage - Prescription drug coverage (for example, from an employer or union) that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. People who have this kind of coverage when they become eligible for Medicare can  generally keep that coverage without paying a penalty, if they decide to enroll in Medicare prescription drug coverage later.

Critical access hospital - A small facility that provides outpatient  services, as well as inpatient services on a limited basis, to people in rural areas.

Custodial care - Non-skilled personal care, like help with activities of daily living like bathing, dressing, eating, getting in or out of a bed or chair, moving around, and using the bathroom. It may also include the kind of health-related care that most people do themselves, like using eye drops. In most cases, Medicare doesn’t pay for custodial care.

Deductible - The amount you must pay for health care or prescriptions before Original Medicare, your prescription drug plan, or your other insurance begins to pay.

Demonstrations - Special projects, sometimes called “pilot programs” or “research studies,” that test improvements in Medicare coverage, payment, and quality of care. They usually operate only for a limited time, for a specific group of people, and in specific areas.

Extra Help - A Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance.

Formulary - A list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

Inpatient rehabilitation facility - A hospital, or part of a hospital, that provides an intensive rehabilitation program to inpatients.

Institution - For the purposes of this publication, an institution is a facility that provides short-term or long-term care, like a nursing home, skilled nursing facility (SNF), or rehabilitation hospital. Private residences, like an assisted living facility or group home, aren’t considered institutions for this purpose.

Lifetime reserve days - In Original Medicare, these are additional days that Medicare will pay for when you’re in a hospital for more than 90 days. You have a total of 60 reserve days that can be used during your lifetime. For each lifetime reserve day, Medicare pays all covered costs except for a daily coinsurance.

Long-term care - Services that include medical and non-medical care provided to people who are unable to perform basic activities of daily living, like dressing or bathing. Long-term supports and services can be provided at home, in the community, in assisted living, or in nursing homes. Individuals may need long-term supports and services at any age. Medicare and most health insurance plans don’t pay for long-term care.

Long-term care hospital - Acute care hospitals that provide treatment for patients who stay, on average, more than 25 days. Most patients are transferred from an intensive or critical care unit. Services provided include comprehensive rehabilitation, respiratory therapy, head trauma treatment, and pain management.

Medically necessary - Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.

Medicare-approved amount - In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference.

Medicare health plan - Generally, a plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan. Medicare health plans include all Medicare Advantage Plans, Medicare Cost Plans, and Demonstration/Pilot Programs. Programs of All-inclusive Care for the Elderly (PACE) organizations are special types of Medicare health plans that can be offered by public or private entities and provide Part D and other benefits in addition to Part A and Part B benefits.

Medicare plan - Any way other than Original Medicare that you can get your Medicare health or prescription drug coverage. This term includes all Medicare health plans and Medicare Prescription Drug Plans.

Premium - The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage.

Preventive services - Health care to prevent illness or detect illness at an early stage, when treatment is likely to work best (for example, preventive services include Pap tests, flu shots, and screening mammograms).

Primary care doctor - The doctor you see first for most health problems. He or she makes sure you get the care you need to keep you healthy. He or she also may talk with other doctors and health care providers about your care and refer you to them. In many Medicare Advantage Plans, you must see your primary care doctor before you see any other health care provider.

Primary care practitioner - A doctor who has a primary specialty in family medicine, internal medicine, geriatric medicine, or pediatric medicine; or a nurse practitioner, clinical nurse specialist, or physician assistant.

Referral - A written order from your primary care doctor for you to see a specialist or get certain medical services. In many Health Maintenance Organizations (HMOs), you need to get a referral before you can get medical care from anyone except your primary care doctor. If you don’t get a referral first, the plan may not pay for the services.

Service area - A geographic area where a health insurance plan accepts members if it limits membership based on where people live. For plans that limit which doctors and hospitals you may use, it’s also generally the area where you can get routine (non-emergency) services. The plan may disenroll you if you move out of the plan’s service area.

Skilled nursing facility (SNF) care - Skilled nursing care and rehabilitation services provided on a continuous, daily basis, in a skilled nursing facility. Examples of SNF care include physical therapy or intravenous injections that can only be given by a registered nurse or doctor.

TTY - A TTY (teletypewriter) is a communication device used by people who are deaf, hard-of-hearing, or have a severe speech impairment. People who don’t have a TTY can communicate with a TTY user through a message relay center (MRC). An MRC has TTY operators available to send and interpret TTY messages.


Source:  Medicare & You 2017

What is the Medicare open enrollment period?

The Medicare open enrollment period is the time during which people with Medicare can make new choices and pick plans that work best for them.

 Medicare and You 2017

 

The official government booklet tells you:

Summary of Medicare benefits, coverage decisions, rights and protections, and answers to the most frequently asked questions about Medicare.
 
 

 

Diabetes screenings

Medicare covers these screenings if your doctor determines you’re at risk for diabetes. You may be eligible for up to 2 diabetes screenings each year. You pay nothing for the test if your doctor or other qualified health care provider accepts assignment.

Diabetes self ‑management training

Medicare covers diabetes outpatient self-management training to teach you to cope with and manage your diabetes. The program may include tips for eating healthy, being active, monitoring blood sugar, taking medication, and reducing risks. You must have diabetes and a written order from your doctor or other health care provider. You pay 20% of the Medicare-approved amount, and the Part B deductible applies.

Diabetes supplies

Medicare covers blood sugar testing monitors, blood sugar test strips, lancet devices and lancets, blood sugar control solutions, and therapeutic shoes (in some cases). Medicare only covers insulin if it’s medically necessary and you use an external insulin pump to administer the insulin. You pay 20% of the Medicare -approved amount , and the Part B deductible applies.

Medicare Comments - Part B

Medicare Covered Services

Abdominal aortic aneurysm screening

Medicare covers a one-time screening abdominal aortic aneurysm ultrasound for people at risk. You must get a referral

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Advance Care Planning

Medicare covers voluntary Advance Care Planning as part of the Yearly  “Wellness” visit. This is planning for care you

Read more

Alcohol misuse screening and counseling

Medicare covers one alcohol misuse screening per year for adults with Medicare (including pregnant women) who use

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Ambulance Services

Medicare covers ground ambulance transportation when you need to be transported to a hospital, critical access hospital

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Ambulatory surgical centers

Medicare covers the facility service fees related to approved surgical procedures provided in an ambulatory surgical

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Blood

If the provider gets blood from a blood bank at no charge, you won’t have to pay for it or replace it. However, you’ll

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Bone mass measurement (bone density)

This test helps to see if you’re at risk for broken bones. It’s covered once every 24 months (more often if medically

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Breast cancer screening ( mammograms)

Medicare covers screening mammograms to check for breast cancer once every 12 months for all women with Medicare who

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Cardiac rehabilitation

Medicare covers comprehensive programs that include exercise, education, and counseling for patients who meet at least

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Cardiovascular disease (behavioral

Medicare will cover one visit per year with a primary care doctor in a primary care setting (like a doctor’s office) to

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Cardiovascular disease screenings

These screenings include blood tests that help detect conditions that may lead to a heart attack or stroke.

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Cervical and vaginal cancer screenings

Part B covers Pap tests and pelvic exams to check for cervical and vaginal cancers. As part of the pelvic exam,

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Chemotherapy

Medicare covers chemotherapy in a doctor’s office, freestanding clinic, or hospital outpatient setting for people with

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Chiropractic services (limited coverage)

Medicare covers manipulation of the spine if medically necessary to correct a subluxation (when one or more of the

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Chronic Care Management Services

If you have 2 or more chronic conditions that are expected to last at least a year, Medicare may pay for a health care

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Clinical research studies

Clinical research studies test how well different types of medical care work and if they’re safe. Medicare covers some

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Colorectal cancer screenings

Medicare covers these screenings to help find precancerous growths or find cancer early, when treatment is most

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Continuous Positive Airway Pressure

Medicare covers a 3-month trial of CPAP therapy if you’ve been diagnosed with obstructive sleep apnea. Medicare may

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Defibrillator (implantable automatic)

Medicare covers these devices for some people diagnosed with heart failure. If the surgery takes place in an outpatient

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Depression screening

Medicare covers one depression screening per year. The screening must be done in a primary care setting (like a

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Diabetes screenings

Medicare covers these screenings if your doctor determines you’re at risk for diabetes. You may be eligible for up to 2

Read more

Diabetes self‑management training

Medicare covers diabetes outpatient self-management training to teach you to cope with and manage your diabetes.

Read more

Diabetes supplies

Medicare covers blood sugar testing monitors, blood sugar test strips, lancet devices and lancets, blood sugar control

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Doctor and other health care provider

Medicare covers medically necessary doctor services (including outpatient services and some doctor services you get

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Durable medical equipment (DME)

Medicare covers items like oxygen equipment and supplies, wheelchairs, walkers, and hospital beds ordered by a doctor

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EKG or ECG (electrocardiogram) screening

Medicare covers a one-time screening EKG/ECG if referred by your doctor or other health care provider as part of your

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Emergency department services

These services are covered when you have an injury, a sudden illness, or an illness that quickly gets much worse.

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Eyeglasses (limited)

Medicare covers one pair of eyeglasses with standard frames (or one set of contact lenses) after cataract surgery that

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Medicare & You 2017 Guide

Medicare & You Guide

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