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What is long-term care insurance (LTCI)?

Long-term care insurance (LTCI) is a contractual arrangement that pays a selected dollar amount per day for a selected period of time for skilled, intermediate, or custodial care in nursing homes and other settings (such as home health care).

Social Security: Demographic Realities Create Big Challenges

Providing retirement benefits was a key provision of the Social Security Act of 1935. Older Americans were especially financially vulnerable during the Great Depression, and Social Security was enacted partly to provide them with some continuing income after retirement.

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Report Fraud

senior man talking on a telephoneIf you suspect errors, fraud, or abuse when you use Medicare—or if someone tries to sell you a product or service you don’t need—report it. Learn what to look for, and get details about preventing and detecting fraud.

What do I need to have to report errors, fraud, or abuse?

Before you report errors, fraud, or abuse, carefully review the facts and have the following information ready:

  • The provider’s name and any identifying number you may have.
  • Information on the service or item you are questioning.
  • The date the service or item was supposedly given or delivered.
  • The payment amount approved and paid by Medicare.
  • The date on your Medicare Summary Notice.
  • Your name and Medicare number (as listed on your Medicare card).
  • The reason you think Medicare should not have paid.
  • Any other information you have showing why Medicare should not have paid.

Where do I report errors, fraud, or abuse?

To report suspected errors, fraud, or abuse, you can contact either:

HHS Office of Inspector General
Call: 800-447-8477
TTY: 800-377-4950
Online: Report Fraud Online
Mail: HHS Tips Hotline
P.O. Box 23489
Washington, DC 20026-3489

Or

Centers for Medicare & Medicaid Services
Call: 800-633-4227
TTY: 877-486-2048
Mail: Medicare Beneficiary Contact Center
P.O. Box 39
Lawrence, KS 66044

How to replace a Medicare Card. - Call Social Security - (800) 772-1213 

MyMedicare.gov allows you to order a replacement Medicare card. To do so, select the Order Card button located on the Replacement Medicare Card tab from the My Account page.

Replacement Medicare cards can only be sent to the address of record on file with the Social Security Administration. Please make sure that your address on the Replacement Medicare Card tab is your current address before ordering a replacement Medicare card.

It may take up to 4 weeks for you to receive your new Medicare card.

If you choose to receive an entitlement letter by checking the check box located on the Replacement Medicare Card tab from the My Account page, you will receive an entitlement letter within 14 days of your successful replacement Medicare card request.

For your protection, you will not be able to order a replacement Medicare card, if one has been ordered in the last 30 days.

If your Medicare card is lost, stolen or damaged, you can ask for a new one at www.SSA.gov

  • The Medicare card looks like the red, white and blue card shown here.

  • Your Medicare card is your proof that you have Medicare health insurance.

  • You can use this application only to request a Medicare card. If you need a Medicaid card, please contact your state Medicaid office.

 

Source:  Medicare.gov & SSA.gov

CMS Forms

CMS 10003-NDMCP NOTICE OF DENIAL OF MEDICAL COVERAGE/PAYMENT ("INTEGRATED DENIAL NOTICE") 2013-06-01
CMS 10036 Inpatient Rehabilitation Facility-Patient Assessment Instrument 2006-01-01
CMS 10055 SKILLED NURSING FACILITY ADVANCED BENEFICIARY NOTICE   N/A
CMS 10069 Medicare Waiver Demonstration Application 2010-12-01
CMS 10095DENC Detailed Explanation of Non-Coverage 2006-12-01
CMS 10095NOMNC NOTICE OF MEDICARE NON-COVERAGE 2006-12-01
CMS 10106 1-800-Medicare Authorization to Disclosure Personal Health Information 2015-07-01
CMS 10114 NATIONAL PROVIDER IDENTIFIER (NPI) APPLICATION/UPDATE FORM 2012-03-01
CMS 10115 SECTION 1011 PROVIDER ENROLLMENT APPLICATION 2013-11-01
CMS 10123 EXPEDITED REVIEW NOTICE-NOTICE OF MEDICARE PROVIDER NON-COVERAGE 2008-02-29
CMS 10124 EXPEDITED REVIEW NOTICE-DETAILED EXPLANATION OF NON-COVERAGE 2008-02-29
CMS 10125 DME Information Form - External Infusion Pumps DME 09.03 2005-09-30
CMS 10126 DME Information Form - Enteral and Parenteral Nutrition DME 10.03 2005-09-30
CMS 10130A Section 1011 Provider Payment Determination 2006-01-01
CMS 10130B Request for Section 1011 Hospital On-Call Payments to Physicians 2005-05-01
CMS 10146 Notice of Denial of Medicare Prescription Drug Coverage English/Spanish 2011-01-01
CMS 10156 Retiree Drug Subsidy 2005-08-01
CMS 10164 Centers for Medicare and Medicaid Services EDI Registration Form; and EDI Enrollment Form 2006-03-01
CMS 10175 Electronic File Interchange Organization (EFIO) Certification Statement 2006-08-01
CMS 10198 Creditable Coverage Disclosure to CMS On-line Form and Instructions 2007-02-01
CMS 10221 Independent Diagnostic Testing Facilities-Site Investigation 2012-08-01
CMS 10252 DATA USE AGREEMENT (DUA) CERTFICATE OF DISPOSITION (COD) FOR DATA ACQUIRED FROM THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) 2012-05-29
CMS 10269 CMN Positive Airway Pressure (PAP)Devices for Obstructive Sleep Apnea 2009-12-01
CMS 10287 Medicare Quality of Care Complaint Form 2014-07-01
CMS 116 CLINICAL LABORATORY IMPROVEMENT AMENDMENTS OF 1988 (CLIA) APPLICATION FOR CERTIFICATION 2015-05-01
CMS 1450 UB-04 Uniform Bill 2007-03-01
CMS 1490S PATIENT'S REQUEST FOR MEDICAL PAYMENT (English/Spanish) 2005-01-01
CMS 1500 Health Insurance Claim Form 2012-02-01
CMS 1515A-OBSOLETE HHA Functional Assessment Instrumental 2013-05-01
CMS 1539 MEDICARE/MEDICAID CERTIFICATION AND TRANSMITTAL 1984-07-01
CMS 1541B RESPONSIBILITIES OF MEDICARE PARTICIPATING HOSPITALS IN EMERGENCY CASES INVESTIGATION REPORT 2014-09-01
CMS 1557 SURVEY REPORT FORM - CLIA 1992-09-01
CMS 1561 HEALTH INSURANCE BENEFIT AGREEMENT 2001-07-01
CMS 1561A HEALTH INSURANCE BENEFIT AGREEMENT-RURAL HEALTH CLINIC 2002-04-01
CMS 1563 Monthly Intermediary Report on Medicare Secondary Payer Savings 1997-11-01
CMS 1564 MONTHLY CARRIER REPORT ON MEDICARE SECONDARY PAYER SAVINGS 1997-11-01
CMS 1572A HHA SURVEY AND DEFICIENCIES REPORT 1990-08-01
CMS 1592 SMI PREMIUM ACCTG FORM 1986-07-01
CMS 1666 REGIONAL OFFICE REQUEST FOR ADDITIONAL INFORMATION 1980-04-01
CMS 1696 APPOINTMENT OF REPRESENTATIVE 2012-06-01
CMS 1728 HOME HEALTH AGENCY COST REPORT 2001-06-01
CMS 1763 REQ FOR TERMINATION OF PREMIUM HI/SMI 1997-05-01
CMS 1771 ATTENDING PHYSICIANS STATEMENT AND DOCUMENTATION FOR MEDICARE EMERGENCY 1977-09-01
CMS 179 TRANSMITTAL AND NOTICE OF APPROVAL OF STATE PLAN MATERIAL 1992-07-01
CMS 1856 Request for Certification in the Medicare and/or Medicaid Program to Provide Outpatient Physical Therapy and/or Speech Pathology Services 2006-12-11
CMS 1880 REQUEST FOR CERTIFICATION AS SUPPLIER OF PORTABLE XRAY SERVICES 1980-10-01
CMS 1882 PORTABLE XRAY SURVEY REPORT 2009-02-01
CMS 1893 OUTPATIENT PHYSICAL THERAPY - SPEECH PATHOLOGY SURVEY REPORT 2013-01-01
CMS 18F APPLICATION FOR HOSPITAL INSURANCE (English / Spanish) 1991-02-01
CMS 1957 SSO REPORT OF STATE BUY IN PROBLEM 1994-03-01
CMS 1960 REQUEST FOR EVIDENCE OF MEDICAL NECESSITY 1969-05-01
CMS 1965 REQUEST FOR HEARING - PART B MEDICARE CLAIM 2003-05-01
CMS 1980 CARRIER OR INTERMEDIARY REQUEST FOR SSO ASSISTANCE 1978-03-01
CMS 1984 HOSPICE COST REPORT 2005-02-01
CMS 20014 NOTICE OF EXCLUSIONS FROM MEDICARE BENEFITS - SKILLED NURSING FACILITY (NEMB-SNF)   N/A
CMS 20017 ADVISORY PANEL ON HOSPITAL OUTPATIENT PAYMENT 2012-07-01
CMS 20027 MEDICARE REDETERMINATION REQUEST FORM 2010-12-29
CMS 20031 TRANSFER (ASSIGNMENT) OF APPEAL RIGHTS 2005-05-01
CMS 20033 MEDICARE RECONSIDERATION REQUEST FORM 2010-12-29
CMS 20034A/B REQUEST FOR MEDICARE HEARING BY AN ADMINISTRATIVE LAW JUDGE 2015-03-01
CMS 20037 APPLICATION FOR ACCESS TO CMS COMPUTER SYSTEMS 2010-06-01
CMS 20040 Regional Office Meeting/Speaker Request Form 12/01/05
CMS 20041 Speech Invitation Request Background Information 12/01/05
CMS 20042 Section 1011 Dispute Resolution Request 2012-04-01
CMS 20056 Medicare Adminstration Observation 2013-02-01
CMS 2007 PROVIDER TIE IN NOTICE 1982-03-01
CMS 2088-92 OUTPATIENT REHAB PROVIDER COST REPORT 2004-12-01
CMS 209 LABORATORY PERSONNEL REPORT (CLIA) 1992-09-01
CMS 216 ORGAN PROCUREMENT ORGANIZATION-HISTO-COMPATIBILITY LAB STATEMENT OF REIMBURSABLE COSTS 2005-11-01
CMS 2178 HI/SMI ENTITLEMENT PROBLEM REFERRAL 2006-09-01
CMS 222 INDEPENDENT RURAL HEALTH CLINIC WORKSHEET 2005-01-01
CMS 2384 THIRD PARTY PREMIUM BILLING REQUEST, MEDICARE 2003-11-01
CMS 2501 RECONSIDERATION DETERMINATION 1972-01-01
CMS 2540-96 SNF AND SNF HEALTH CARE COMPLEX COST REPORT 2006-05-01
CMS 2552-96 COST REPORT FOR ELECTRONIC FILING OF HOSPITALS 2004-05-01
CMS 2567 STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION 1999-02-01
CMS 2567B POST-CERTIFICATION REVISIT REPORT 1992-09-01
CMS 2628 (35 KB) Foreign HI Claim or Emergency Services Accessibility Documentation and Determination 1986-05-01
CMS 265 INDEPENDENT RENAL DIALYSIS FACILITY COST REPORT 2005-03-01
CMS 2690 REQ FOR CANCELLATION OF SMI 1978-03-01
CMS 2728 ESRD MEDICAL EVIDENCE REPORT MEDICARE ENTITLEMENT AND/OR PATIENT REGISTRATION 2006-03-01
CMS 2744A ESRD FACILITY SURVEY (DIALYSIS UNIT ONLY) 2004-02-01
CMS 2744B END STAGE RENAL DISEASE MEDICAL INFORMATION SYSTEM ESRD FACILITY SURVEY (TRANSPLANT CENTERS ONLY) 2004-02-01
CMS 2746 ESRD DEATH NOTIFICATION 2006-08-01
CMS 2786M FIRE SAFETY SURVEY - RATING RESIDENTS - 2000 CODE 2013-02-01
CMS 2786R FIRE SAFETY SURVEY REPORT 2000 CODE - HEALTH CARE - MEDICARE - MEDICAID 2013-02-01
CMS 2786S FIRE SAFETY SURVEY REPORT SHORT FORM - MEDICARE - MEDICAID 2013-02-01
CMS 2786T FIRE/SMOKE ZONE EVALUATION WORKSHEET FOR HEALTH CARE FACILITIES - 2000 CODE 2013-02-01
CMS 2786U FIRE SAFETY SURVEY REPORT - AMBULATORY SURGICAL CENTERS & END STAGE RENAL DISEASE MEDICARE 2013-02-01
CMS 2786V FIRE SAFETY SURVEY REPORT - 2000 LSC ICF/MR - SMALL FACILITIES SMALL FACILITIES 2013-02-01
CMS 2786W FIRE SAFETY SURVEY REPORT - 2000 LSC ICF/MR - LARGE FACILITIES 2013-02-01
CMS 2786X FIRE SAFETY SURVEY REPORT - 2000 LCF ICF/MR APARTMENT HOUSE 2013-02-01
CMS 2786Y FIRE SAFETY SURVEY REPORT - 2000 LSC ICF/MR - SMALL FSES 2013-02-01
CMS 2802 REQUEST FOR VALIDATION OF ACCREDITATION 2011-02-01
CMS 2802B REQUEST FOR VALIDATION OF ACCREDITATION SURVEY FOR HOSPICE 2011-02-01
CMS 2802C REQUEST FOR VALIDATION OF ACCREDITATION SURVEY FOR HOME HEALTH AGENCY 2011-02-01
CMS 2802D REQUEST FOR VALIDATION OF ACCREDITATION SURVEY FOR AMBULATORY SURGICAL CENTER 2011-02-01
CMS 2802E REQUEST FOR VALIDATION OF ACCREDITATION FOR CRITICAL ACCESS HOSPITAL SURVEY 2011-02-01
CMS 2802F Authorization for State Agency Psychiatric Hospital Validation Survey 2011-11-01
CMS 287 HOME OFFICE COST STATEMENT 1995-11-01
CMS 2878 ACCREDITED HOSPITAL ALLEGATIONS REPORT 1986-04-01
CMS 29 VERIFICATION OF CLINIC DATA – RURAL HEALTH CLINIC PROGRAM 2011-11-01
CMS 3070G ICF/IID Survey Report 2013-03-01
CMS 3070H ICF/IID Deficiencies Report 2013-03-01
CMS 3070I INDIVIDUAL OBSERVATION WORKSHEET 1995-10-01
CMS 339 PROVIDER COST REPORT REIMBURSEMENT QUESTIONNAIRE 2006-04-30
CMS 3509 ALJ MEDICARE CASE FOLDER (CMS) 2002-08-02
CMS 352 PART A RECONSIDERATION INPUT RECORD 1986-06-01
CMS 353 PART A PREHEARING INPUT RECORD 1986-06-01
CMS 359 CORF REPORT FOR CERTIFICATION TO PARTICIPATE IN MEDICARE 2003-07-01
CMS 36 CONSENT FOR HOME VISIT (English/Spanish) 1990-12-01
CMS 360 CORF SURVEY REPORT 2008-12-01
CMS 36P CONSENT FOR HOME VISIT FOR PACE SERVICES EVALUATION 2002-07-01
CMS 370 HEALTH INSURANCE BENEFITS AGREEMENT-AMBULATORY SURGICAL CENTER 2002-04-01
CMS 377 AMBULATORY SURGICAL CENTER REQUEST FOR CERTIFICATION IN MEDICARE 2010-12-01
CMS 378 AMBULATORY SURGICAL CENTER SURVEY REPORT 1997-01-01
CMS 379 FINANCIAL STATEMENT OF DEBTOR 2007-07-01
CMS 381 MODEL LETTER REQUESTING IDENTIFICATION OF EXTENSION LOCATIONS 2005-12-01
CMS 383 HEALTH INSURANCE CASE SUMMARY 1982-12-01
CMS 384 QIO CASE SUMMARY 1992-03-01
CMS 4040 REQUEST FOR ENROLLMENT IN SUPPLEMENTARY MEDICAL INSURANCE (English / Spanish) 1991-08-01
CMS 40B Application for Enrollment in Medicare - Part B (Medical Insurance) 2014-04-21
CMS 416 Early ad Periodic Screening Diagnostic and Treatment Participation Report 1999-06-01
CMS 417 HOSPICE REQUEST FOR CERTIFICATION IN MEDICARE 2010-08-01
CMS 43 APPLICATION FOR HEALTH INSURANCE UNDER MEDICARE FOR INDIVIDUAL WITH CHRONIC RENAL DISEASE 1981-08-01
CMS 437 PSYCHIATRIC UNIT CRITERIA WORKSHEET 2006-04-01
CMS 437A REHAB UNIT CRITERIA WORKSHEET 2012-06-01
CMS 437B REHAB HOSPITAL CRITERIA WORKSHEET 2012-06-01
CMS 460 MEDICARE PARTICIPATING PHYSICIAN OR SUPPLIER AGREEMENT 2010-04-01
CMS 462L ADVERSE ACTI0N EXTRACT FOR SNFs AND NFs 1995-07-01
CMS 484 CERTIFICATE OF MEDICAL NECESSITY - Oxygen DME 484.03 2005-09-30
CMS 500 NOTICE OF MEDICARE PREMIUM PAYMENT DUE (English / Spanish) 2011-09-01
CMS 5011A-B REQUEST FOR MEDICARE HEARING BY ADMINISTRATIVE LAW JUDGE 2005-08-01
CMS 576 Organ Procurement Request for Designation as an OPO 1993-01-01
CMS 576A Health Insurance Benefits Agreement with Organ Procurement Organization 2006-06-30
CMS 588 Electronic Funds Transfer (EFT) Authorization Agreement 2013-09-01
CMS 632FOI FREEDOM OF INFORMATION ACT REQUEST 2013-03-01
CMS 633 Invoice of Fees for FOIA Services 2008-01-01
CMS 636 TRANSMITTAL NOTICE HEARING CASE 1988-06-01
CMS 643 (28 KB) Hospice Survey AND Deficiencies Report 2008-06-01
CMS 668B Post Lab Survey - CLIA 2012-01-01
CMS 671 LTC Facility Application for Medicare/Medicaid 2002-12-01
CMS 672 Resident Census and Conditions of Residents 2012-05-01
CMS 673 Extended/Partial Extended Survey Worksheet 1995-07-01
CMS 677 Medication Pass Worksheet 1995-07-01
CMS 700 Plan of Treatment for Outpatient Rehab 1991-11-01
CMS 701 Updated Plan of Progress for Outpatient Rehab 1991-11-01
CMS 724 Medicare/Medicaid Psychiatric Hospital Survey Data 1994-09-01
CMS 725 Surveyor Worksheet for Psychiatric Hospital Review:Two Special Conditions 1994-09-01
CMS 726 CMS Death Record Review Data Sheet 1994-09-01
CMS 727 CMS Nursing Complement Data 1994-09-01
CMS 728 CMS Staff Data 1994-09-01
CMS 729 Data Collection Medical Staff Coverage 1994-09-01
CMS 801 Offsite Survey Prep Worksheet 1995-07-01
CMS 802 Roster/Sample Matrix 2012-04-01
CMS 802P Roster/Sample Matrix Provider Instructions 2012-04-01
CMS 802S Roster/Sample Matrix Instruction for Surveyors 2012-04-01
CMS 803 General Observations of Facility 1995-07-01
CMS 804 Kitchen/Food Service Observation 1995-07-01
CMS 805 Resident Review Worksheet 2010-10-01
CMS 806A Quality of Life Assessment--Resident 1995-07-01
CMS 806B Quality of Life Assessment--Group 1995-07-01
CMS 806C Quality of Life Assessment--Family 1995-07-01
CMS 807 Surveyor Notes Worksheet 1995-07-01
CMS 820 IN-CENTER HEMODIALYSIS (HD) CLINICAL PERFORMANCE MEASURES DATA COLLECTION FORM 2005 2005-01-01
CMS 821 PERITONEAL DIALYSIS CLINICAL PERFORMANCE MEASURES DATA COLLECTION FORM 2005 2005-01-01
CMS 838 Medicare Credit Balance Reporting Requirements 2003-10-01
CMS 846 Certificate of Medical Necessity - Pneumatic Compression Devices DME 04.04B 2005-09-30
CMS 847 Certificate of Medical Necessity - Osteogenesis Stimulators - DME 04.04C 2005-09-30
CMS 848 Certificate of Medical Necessity - Transcutaneous Electrical Nerve Stimulator (TENS) - DME 06.03B 2005-09-30
CMS 849 Certificate of Medical Necessity - Seat Lift Mechanisms - DME 07.03A 2005-09-30
CMS 854 Certificate of Medical Necessity - DME 11.02 2005-09-30
CMS 855A Medicare Enrollment Application - Institutional Providers 2011-07-01
CMS 855B Medicare Enrollment Application - Clinics/Group Practices and Certain Other Suppliers 2011-07-01
CMS 855C Medicare Enrollment Application 2014-04-01
CMS 855I Medicare Enrollment Application - Physicians and Non-Physician Practitioners 2011-07-01
CMS 855O Medicare Enrollment Application - Registration For Eligible Ordering and Referring Physicians and Non-Physician Practitioners 2013-01-01
CMS 855POH Annual Report of Physician-Owned Hospital Ownership and/or Investment Interest 2014-05-01
CMS 855R Medicare Enrollment Application - Reassignment of Medicare Benefits 2012-11-01
CMS 855S Medicare Enrollment Application - Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers 2013-01-01
CMS L457 ACKNOWLEDGMENT OF REQUEST FOR MEDICARE MEDICAL INSURANCE TERMINATION 2003-02-01
CMS L458 ACKNOWLEDGMENT OF REQUEST FOR PREMIUM HOSPITAL INSURANCE TERMINATION 2003-02-01
CMS L564 REQUEST FOR EMPLOYMENT INFORMATION 2014-02-12
CMS R-0235 (66 KB) Data Use Agreement (DUA) (Agreement for use of Centers for Medicare and Medicaid Services (CMS) data containing individual-specific information 2010-06-01
CMS R-0235A (35 KB) Addendum to Data Use Agreement (DUA) 2012-06-01
CMS R-0235L (64 KB) Data Use Agreement (DUA)- Limited Data Sets 2008-02-01
CMS R-0235M Medicaid Agency Data Use Agreement 2007-07-01
CMS R-0235MA Addendum to the Medicaid State Agency Data Use Agreement 2006-03-01
CMS R-0235MC Compliance Plan for Accounting for Disclosures of Privacy Protected Data Released From a System of Records (SOR) Housed in a State-Located Server 2006-03-01
CMS R-0235ST State Data Use Agreement 2006-03-01
CMS R-0235U (48 KB) Data Use Agreement (DUA)- Update to Existing DUA 2010-01-01
CMS R-131 ADVANCE BENEFICIARY NOTICE (ABN) 2011-03-01
CMS R-193 IMPORTANT MESSAGE FROM MEDICARE (IM) 2010-07-01
CMS R-285 Request for Retirement Benefit Information 2006-03-01
CMS R-296 HOME HEALTH ADVANCE BENEFICIARY NOTICE 2009-08-01
CMS-10396 Medication Therapy Management Program Standardize Format 2012-01-20
CMS-10455 Report of a Hospital Death Associated with Restraint or Seclusion 2013-11-01
CMS-R-0235 D1 DSH Data Use Agreement for Cost Reporting Periods Prior to those that include December 8, 2004 2009-12-01
CMS-R-0235 D2 DSH Data Use Agreement for Cost Reporting Periods that Include December 8, 2004 and therafter 2009-12-01

 

 

 

Understanding Social Security

Over 63 million people today receive some form of Social Security benefits. (Source: Fast Facts & Figures About Social Security, 2014) But Social Security is more than just a retirement program. Its scope has expanded to include other benefits as well, such as disability, family, and survivor's benefits.

 

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%). 

Copayment—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 copayment 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—Nonskilled 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 Medicare Advantage Plan, 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 only operate 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 plan 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. This is 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 shortterm or long-term care, such as 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 prevent, 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—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, Demonstration/Pilot Programs and Programs of All-inclusive Care for the Elderly (PACE). 

Medicare plan—Refers to 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. 

Quality Improvement Organization (QIO)—A group of practicing doctors and other health care experts paid by the federal government to check and improve the care given to people with Medicare. 

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. 

 

TTY—A teletypewriter (TTY) 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. 

 

National Medicare Handbook 2015