Medicare - ANSWER-The federal health insurance program for:
− People age 65 and older
− People of any age with end stage renal disease
− Certain
... [Show More] disabled people under age 65
Medicare Prefix A - ANSWER-A - Primary wage earner
Medicare Prefix B - ANSWER-B - Entitled to benefits through
spouse
Medicare Prefix C - ANSWER-C - Child
Medicare Prefix D - ANSWER-D - Widow
Medicare Prefix D1 - ANSWER-D1 - Widower
Medicare Prefix W - ANSWER-W - Disabled widow
Medicare Prefix W1 - ANSWER-W1 - Disabled widower
Medicare Part A - ANSWER-Hospital Insurance (Part A) helps pay for inpatient hospital services, skilled nursing facility services, home health services, and hospice care
Medicare Part B - ANSWER-Medical Insurance (Part B) helps pay for doctor services, outpatient hospital services, medical equipment and supplies, and other health services and supplies.
Medicare Part C - ANSWER-Medicare Part C is a Medicare Advantage plan. These are private insurance companies offering plans, mostly to seniors, such as HMOs and PPOs
Medicare Part D - ANSWER-Medicare Part D (Medicare Prescription Drug Coverage) helps cover prescription drugs. (This coverage may lower your prescription drug costs.)
Carriers and Fiscal Intermediaries - ANSWER-Private insurance organizations called Medicare
carriers and fiscal intermediaries handle claims and interpret reimbursement regulations under the Original Medicare Plan.
Medicare Covered Services - ANSWER-Medicare (Part A) Hospital Insurance helps pay for
necessary medical care and services furnished by Medicare-certified hospitals, skilled nursing facilities, home health agencies, and hospices.
Inpatient Hospital Care - Medicare Part A - ANSWER-helps pay for up to 90 days of inpatient
hospital care in each benefit period. Covered services include semi-private room and meals, general nursing services, operating and recovery room costs, intensive care, drugs, laboratory tests, X-rays, and all other necessary medical services and supplies.
Pre-admission Diagnostic Services - ANSWER-Medicare's three day (AKA: 72 Hour) Rule requires
that pre-admission testing and diagnostic services provided to a beneficiary by the admitting hospital within three days prior to the admission are included in the inpatient payment. They are not to be billed as separate outpatient charges unless there is no Part A coverage. For example, if a patient is admitted on a Wednesday, services provided by the hospital on Sunday, Monday, or Tuesday are included in the inpatient Part A payment. This provision includes visits to the Emergency department but does not apply to ambulance services.
Benefit Periods - ANSWER-The number of days that Medicare covers care in hospitals and skilled nursing facilities is measured in benefit periods. A benefit period begins on the first day
of services as a patient in a hospital or skilled nursing facility and ends 60 days after discharge from the hospital or skilled nursing facility provided that 60 days has not been interrupted by skilled care in any other facility. There is no limit to the number of benefit
periods. The beneficiary must pay the inpatient hospital deductible for each benefit period.
Life Time Reserve Days - ANSWER-Medicare will pay for an additional 60 days of hospitalization when a beneficiary is an inpatient in a hospital for greater than 90 days. The 60 days
can be used only once in a lifetime. For each lifetime reserve day, Medicare pays all covered charges except for the daily co-insurance.
Important Message from Medicare (IMM) - ANSWER-Given to all Medicare beneficiaries who are inpatients in participating hospitals.
Skilled Nursing Facility Care - ANSWER-if medically necessary, Part A helps pay for up to 100
days in a participating skilled nursing facility in each benefit period. Medicare pays all approved charges for the first 20 days; patients pay a coinsurance amount for days 21 through 100. Covered services include semi-private room and meals, skilled nursing services, rehabilitation services, drugs, and medical supplies.
Home Health Care - ANSWER-If medically necessary, Medicare pays the full-approved cost of covered home health care services. This includes part-time or intermittent skilled nursing services prescribed by a physician for treatment or rehabilitation of homebound patients. The only amount patients pay for home health care is a 20 percent coinsurance charge for medical equipment such as a wheelchair or walker.
Hospice Care - ANSWER-(not covered by a Senior Medicare HMOs) assists with care for terminally ill beneficiaries who select the hospice care benefit. There are no deductibles, but beneficiaries pay limited costs for drugs and inpatient respite care.
Medicare (Part B) Medical Insurance - ANSWER-helps pay for doctors services, outpatient hospital services (including emergency room visits), ambulance transportation, diagnostic tests, laboratory services, some preventive care like mammography and Pap smear screening, outpatient therapy services, durable medical equipment and supplies, and a variety of other health services. Part B also pays for home health care services for which Part A does not pay. Medicare Part B pays 80 percent of approved charges for most covered services. Beneficiaries are responsible for paying a $100 deductible per calendar year and the remaining 20 percent of the Medicare approved charge. Patients will have to pay limited additional charges (15 percent over Medicare's approved amount) if their physician does not accept assignment. The limiting charge only applies to certain services and does not apply to supplies or equipment.
Medicare Part C Insurance - ANSWER-Medicare beneficiaries can elect to assign their Medicare benefits to a private insurance company that has special coverage for seniors usually an HMO or PPO.
Medicare Part D Insurance - ANSWER-(Medicare Prescription Drug Coverage) helps cover
prescription drugs. This coverage may lower your prescription drug costs. Medicare's open enrollment is from November 15 to December 31, 2007. People with Medicare can enroll in a drug plan, review their health care and drug coverage, and make changes. There's even extra help available for people with limited income and resources. The extra help is worth up to $3,600 for some people to help pay for their drug coverage.
Medicare Non-Covered Services - ANSWER-Except for certain limited cases in Canada and Mexico, Medicare does not pay for treatment outside the United States.
Advance Beneficiary Notice (ABN) - ANSWER-notice that a care provider should give a Medicare beneficiary to sign in the following cases: Medicare may not consider the health care services being provided as medically necessary; there is a good possibility that Medicare will not pay for the service provided and the patient may be billed for this service.
If the ABN has not been signed before service is rendered and Medicare does not pay for it, the patient cannot be held responsible for paying for that service. If the ABN was signed, the patient may be billed for the services. [Show Less]