Frequently Asked Questions
Question
Does Medicare have a site on the World Wide Web?
Answer
Yes. You can find Medicare at the following address www.medicare.gov
Question
What can I do to help save Medicare?
Answer
Millions of dollars are paid each year by Medicare
to providers or suppliers who have submitted false claims. The most important way to help
Medicare is to monitor the statements Medicare sends you.
Medicare sends an explanation of benefits to you for
any service you receive from a provider or supplier explaining the total charged amount,
the total approved amount, the amount paid and the patient responsibility. If you receive
a statement from Medicare for any doctor you are not familiar with or for any services not
rendered, please contact us and we can review the matter with you. If necessary, we will
contact Medicare to have them investigate your concern.
Question
I am over age 65, but still am employed. Am I
eligible for Medicare?
Answer
Yes, but whether Medicare pays as primary or
secondary depends on your decision (or your spouse's if you are retired and your spouse is
employed). Generally, the employer's health plan is the primary payor, but you have the
option to reject the employer's health plan in favor of Medicare. However, keep in mind
that the employer's health plan is not permitted to offer you coverage that
supplements Medicare covered services while you are employed.
If you elect to keep the employer's health plan as
your primary payor, and you are enrolled in Medicare, then Medicare would pay benefits as
the secondary payor. In the event that you (or your spouse) retire, then you must contact
Medicare to inform them of the retirement date, employer plan and policy number of the
plan so they can update their files -- Medicare will now be your primary payor.
Question
My doctor says he accepts assignment. Does this mean
he accepts what Medicare pays him as payment in full?
Answer
No. When your doctor states he is accepting
assignment, this means he is accepting what Medicare approves. Medicare then pays
80% of the approved amount (assuming you have met the $100 deductible. You still have a
responsibility of 20% to your doctor which your medigap or secondary insurance should
cover.
Question
What is the difference between Medicare Part A and
Medicare Part B?
Answer
Medicare Part A covers Inpatient Hospital Care,
Skilled Nursing Care and Home Health Care. Each is subject to deductibles and co-payments.
Medicare Part B covers Doctor's Services, Outpatient Hospital Care, Durable Medical
Equipment, Ambulance Services and Diagnostic Testing. The Part B deductible is annual and
is currently $100.
Question
Is the Medicare Part A inpatient hospital deductible
an annual deductible?
Answer
No. This deductible is dependent upon the number of
days between hospital stays. Medicare Part A uses a guideline of 60 days to determine
whether you are responsible for the inpatient deductible. If 60 days have expired since
your last hospital stay, then you are responsible for an inpatient deductible. If,
however, you are admitted to a hospital within 60 days of your last stay, you are
not responsible for another inpatient deductible.
Question
My doctor/supplier does not accept assignment with
Medicare. Is he responsible for filing charges to Medicare?
Answer
Yes. By law, effective September 1, 1990, any doctor
or supplier providing medical care covered by Medicare must submit a claim to Medicare for
services rendered to you. You will receive a statement from Medicare (called a Medicare
Explanation of Benefits) explaining how Medicare processed the doctor's/supplier's charge.
Question
Does Medicare cover the cost of pap smears and
mammograms?
Answer
Yes. Meicare will cover one pap smear screening
every three years for preventative care. Medicare will pay more frequently for women at
high risk or if symptoms are present. Medicare will cover breast-cancer screening
(mammograms) if provided by a Medicare approved provider once every 24 months, or as
needed if symptoms are present, for women 65 or older. Women covered by Medicare under age
65 may obtain the benefit more frequently. Remember, Medicare pays 80% of the approved
amount once you have met the $100 deductible.
Question
I have insurance through the employer I retired from
which is secondary to Medicare. When I receive an explanation of benefits from them, they
usually state the amount of their benefit is zero. Why?
Answer
Most employer group plans call this a "carve
out" plan. When the insurance company receives a claim, they process the charge as if
they were primary (the percentage they would be responsible for). This amount is then
compared to Medicare's payment and the difference is paid. If, for example, the amount
they allow is 80% and Medicare has already paid 80%, the difference is 0 and the insurance
company would not pay any benefit on the claim. The co-pay amount you did not receive is
applied to an out-of-pocket maximum. However, once this amount is met (which can be $1000
or more) then the insurance company's responsibility changes from the contracted allowed
amount to 100%.
Question
Will Medicare pay for an annual flu shot?
Answer
Yes. Effective May 1993, Medicare will pay 100% of
the amount they approve. If, however, the physician who provides the vaccine does not
accept assignment with Medicare, you are responsible for the difference between the actual
charge of the shot and what Medicare allows. If you receive a flu vaccine from a facility
that offers the shot free of charge, Medicare will not reimburse you.
Question
Who do I contact if I have lost or misplaced my
Medicare and/or Social Security card?
Answer
You will need to contact the Social Security
Department at 1-800-772-1213. The information they will request from you is your Social
Security number, address and phone number. On average, it usually takes about six weeks to
receive your new card.
Question
Are there any limits on the amounts charged by
providers who do not accept Medicare assignment or am I responsible for the full amount?
Answer
Most providers who do not accept assignment with
Medicare are limited to charging patients no more than 15% above the Medicare approved
amount. Assuming a patient has met the annual deductible, Medicare will pay the patient
80% of the approved amount and the patient will have a co-pay of 35%. Remember, with
providers who accept assignment, the patient co-pay is only 20% after Medicare pays the
doctor.
Example for a provider who does not accept assignment:
If a doctor's bill is $130 and Medicare approves $90, then the maximum amount the doctor
can bill you is $103.50 ($90 x 115%).
Question
Where can I obtain a list of doctors who accept
assignment with Medicare?
Answer
To obtain a list of doctors accepting assignment
with Medicare, simply contact the carrier for Medicare in the state in which you reside.
For Florida, for example, contact Blue Cross Blue Shield of Florida at 1-800-333-7586.
They will send you a booklet listing all doctors who accept assignment with Medicare for
the country in which you live.
Question
What is a living will and how can it benefit me?
Answer
A living will is a health care directive informing
you physician and hospital that you do not wish to be kept alive by any artificial means
when it becomes apparent there is no hope for recovery. Everyone should consider having a
living will in place. They are available at public libraries, attorneys' offices and MCS
also keeps them on hand.
Question
Does Medicare cover any Dental services?
Answer
Medicare does not cover any dental services related
to the teeth exclusively (i.e., cleanings, fillings, removal or replacement of teeth,
etc.). Medicare may pay for services rendered by a dentist if the medical problem is
beyond the teeth themselves or the structure supporting them.
Question
I am considering a nursing home for a relative but
don't know what to look for in choosing a facility that I would feel comfortable with. Is
there any information that can help me?
Answer
Much consideration should be given when choosing a
facility for a loved one. With so many facilities in the area, the decision is that much
tougher. Of course, word of mouth is always a good recommendation; however, there is a
great booklet from Medicare that came along with the 1995 Medicare Handbook. It's called "Guide
to Choosing a Nursing Home" and gives all kinds of information as to what to look
for in a facility so that it will meet the needs for you and your relative. For a copy,
contact your Medicare Part B carrier; in Florida the toll free number is 1-800-333-7586.
Question
Does Medicare cover ambulance services?
Answer
Basically there are two types of ambulance services:
emergency and non-emergency. Medicare defines emergency transport as the existance of a
condition which is life threatening and that the transportation by any other means could
endanger your health. Medicare will cover this type of transportation as long as the
ambulance service meets Medicare requirements and the transport is to a hospital or
nursing facility. Medicare will not pay for a non-emergency transportation - for example,
a transportation service that takes you from your residence to a doctor's office. Even
though you may be unable to transport yourself, Medicare does not deem this to be life
threatening.
Question
I receive correspondence from my insurance company
that states "This is not a bill." Is this paperwork important?
Answer
Yes. The paperwork you are receiving from your
insurance company is called an Explanation of Benefits. This statement explains who
provided the service, the date of service, the charge for the service, how much of a
benefit will be paid and to whom. Most importantly, these are the papers you need to
forward to MCS so that they can complete your file efficiently.
Question
I will be approaching age 65 shortly, how will I
know when I am covered under Medicare?
Answer
Approximately three months prior to your 65th
birthday you should receive correspondence along with your Medicare card from Social
Security. Simply follow the instructions in the correspondence received and put your
Medicare card in your purse of walled and carry it with you at all times. Your Medicare
card should indicate the following information: your name, Medicare number and effective
date. If you do not receive your card or if you have any questions regarding your Medicare
coverage, call the Social Security office at 1-800-772-1213.
Question
I am approaching age 65 and Medicare will be my
primary insurance carrier. What information can you give me on insurance that supplements
Medicare?
Answer
First, determine whether the company you retired
from (if you were employed) will change from the primary carrier to secondary carrier that
pays after Medicare. Remember, your company's plan is not a true Medicare supplement, also
known as a "Medigap plan." Each plan has its own contract and pays differently -
call your employer and ask questions as to how the plan will pay secondary to Medicare. As
for Medigap policies, effective January 1, 1992, all Medicare supplement policies sold in
Florida must be one of 10 standardized plans - these plans are lettered A through J and
benefits in each plan must be the same for each company. Therefore, your selection of a
policy can be focused on a company's premium, reputation and its ability to process claims
efficiently.
Question
What were the changes in deductibles and co-pays for
Medicare in 1997?
Answer
For Medicare Part A, the changes were as follows:
Inpatient Hospital Deductible (a stay of up to 60 days) changes from $736 to $760.
Inpatient Hospital Co-Insurance (days 61-90) changes from $184 per day to $190 per day.
Skilled Nursing Facility Co-Days (days 21-100) change from $92 per day to $95 per day.
For Medicare Part B, the annual deductible for 1997 remains unchanged at $100.
Question
My doctor says he accepts Medicare assignment. Dose
this mean he accepts what Medicare pays him as payment in full?
Answer
No. When your doctor states he is accepting
assignment, this means he is accepting what Medicare approves. Medicare then pays 80% of
the approved amount (assuming you have met the annual $100 deductible). You still have a
responsibility of 20% to your doctor which your Medigap or secondary insurance should
cover.
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