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SpokaneInnovaging2014

Medicare If you believe that your rights have been vio- Medicare........................................ 800-633-4227 Commissioner at 800-562-6900. ChapterOffice of the Insurancelated in any way call the ........................................ TTY 877-486-2048 Medicare is a comprehensive federal health care Part A of Medicare is free for people who have 40 1MEDICARE PART A – HOSPITAL INSURANCE www.medicare.gov insurance program administered by the Health or more quarters of Medicare covered employment. Care Financing Administration, providing hospital People who don’t meet the requirements for cov- and medical insurance to persons entitled to Social ered employment can pay a premium of $426.00 Security (SS) benefits. To be eligible you must be 65 per month for coverage. or older (and have received SS); have permanent If you are not sure if you have Part A, look on your kidney failure (at any age); or be under 65 years red, white and blue Medicare card. It will show and have been on SS for 24 months. Apply three Part A (Hospital Insurance) on the lower left corner months before you need the coverage. of your card. You can also call Social Security. The original purpose of Medicare was to increase Benefits begin when you enter the hospital and access to health care and reduce its financial end when you have been out of the hospital or fa- burden on older, retired, or disabled Americans. cility with skilled nursing care for 60 consecutive Medicare was never intended to pay 100 per- days. If you are re-admitted within that 60 days, cent of all medical expenses, but is a benefit that you are still in the same benefit period and would will cover some of the services you may need as not pay another deductible. If you are admitted to you age. a hospital after that benefit period ends, an entirely new benefit period begins and a new deductible Ensure any services you use are with Medicare- is owed. certified providers. Another valuable resource is to contact the billing clerk at the hospital or Cost: For 2014, Part A pays for all hospital-covered skilled nursing facility providing services to clarify services up to 60 days per benefit period except for your benefits. the first $1,216 for which you are responsible. For 61-90 days, the co-payment is $304 per day. For As a Medicare beneficiary, you have certain guar- 91-150 days, the beneficiary pays $608 per day. anteed rights – In a skilled nursing facility, (if your doctor has certi- 1. The right to receive emergency care when and fied you need skilled nursing), the beneficiary pays where you need it, without prior approval. nothing days 1-20; days 21-100 cost the beneficiary 2. The right to information about all treatment $152 per day; after 100 days, the patient pays all options from your health care provider in costs. Covered services may include semi-private language clear to you. rooms, meals, regular nursing services, rehabilita- tion services, blood transfusions (except the first 3. The right to appeal if Medicare does not pay three pints of blood), drugs and medical supplies, for a covered service you have been given, or and equipment (e.g., wheelchairs). if your doctor or hospital does not give you a service that you believe should be covered. Medicare Home Health Care can be covered under Part A or Part B, but under most circumstances there 4. The right to know how your Medicare is no deductible, co-pay, or difference in covered health plan pays its doctors (you must services under either coverage. You need physician request this information). certification and a home health care plan to access 5. The right to have any personal information these benefits. Home health care services may in- that Medicare collects kept private, and to clude part-time skilled nursing care, physical ther- know why Medicare needs it. apy, speech-language therapy, home health aide services, durable medical equipment, and medical 6. The right to choose a women’s health supplies used in the home. specialist from your plan’s list of doctors. MEDICARE PART B – MEDICAL INSURANCE 7. The right, if you have a complex or serious medical condition, to have enough visits to a Part B assists in covering services deemed medically specialist to deal with your need. and some other medical services that Part A does notnecessary including doctors, outpatient hospital care, 8. The right to file a grievance if you have cover, such as the services of physical and occupa- concerns or problems with your plan which tional therapists, and some home health services. Part are not about payment or service requests. B also helps cover some preventive services. 11


SpokaneInnovaging2014
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