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.
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
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
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
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
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.