2011 Medicare & You Booklet

8/6/2019 2011 Medicare & You Booklet

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C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S

&Medicare

You

2011This is the ocial U.S. governmentMedicare handbook with important

inormation about the ollowing:

What's new

Medicare costsWhat Medicare covers

Health and prescription drug plans

Your Medicare rights

Signing up to get future handbooks

electronically


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Welcome to Medicare & You 2011Im onored and excied o announce e 2011 Medicare andbooke bes and ocialsource o answers o your Medicare quesions. A e Deparmen o Heal and Human

Services, were doing more an ever o carry Medicare ino e uure.

Te Aordable Care Ac makes many improvemens o Medicare. Moreover, i guaraneesa you will coninue o ave your basic Medicare benesweer you ge em rougOriginal Medicare or a Medicare Advanage Plan.

As an example o e ypes o improvemens underway, i you ave Medicare prescripiondrug coverage wi a coverage gap (also known as e donu ole), e new law will reducea gap over several years o make prescripion drugs even more aordable. I you reac ecoverage gap in 2010, you may qualiy o ge a one-ime $250 rebae ceck. I you reac ecoverage gap in 2011, you may ge a 50% discoun on brand-name prescripion drugs wen

you buy em. Tere will be addiional savings in e coverage gap eac year roug 2020,wen e donu ole is closed compleely. Te new law also prevens Medicare AdvanagePlans rom carging you more an Original Medicare or cancer reamen and cerain oerservices a you mig need.

I you ave Original Medicare, you will now be able o ge a yearly wellness exam and mosprevenive services or ree. I youre in a Medicare Advanage Plan, ceck wi your plan osee i ese benes will also be ree or you.

Docors, ospials, and Medicare Advanage Plans will ave new incenives o improvee qualiy o care you receive. Tere will be beer coordinaion o your care aer yourediscarged rom a ospial o ensure a you ge e services you need aer your ospialsay. I will also be easier o nd ou wic long-erm care ospials, inpaien reabiliaiveospials, and ospice care programs provide beer care in your area.

Tese are jus a ew o e exciing new canges o elp improve your eal care now andin e uure, wile coninuing o keep you ealy, Medicare srong, and your personalinormaion sae.

I you ave quesions, visi Medicares new and improved Web sie a www.medicare.gov, orcall 1-800-MEDICARE (1-800-633-4227). You can also call your local Sae Heal InsuranceAssisance Program (SHIP) or area agency on aging, or visi e Adminisraion on Aging awww.aoa.gov.

Sincerely,

/s/

Kaleen Sebelius

Secreary

U.S. Deparmen oHeal and Human Services

/s/

Donald M. Berwick, MD

Adminisraor

Ceners or Medicare & MedicaidServices
http://www.medicare.gov/http://www.aoa.gov/http://www.aoa.gov/http://www.medicare.gov/


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3

Tools to Help You Find What You Need

in This Handbook

Please keep this handbook or uture reerence. Inormaionwas correc wen i was prined. Call 1-800-MEDICARE(1-800-633-4227), or visi www.medicare.govo ge e moscurren inormaion. Y users sould call 1-877-486-2048.

Higligs imporaninormaion

Trougouandbook

Higligs preveniveservices

Pages 2945

Higligs inormaionrelaed o Medicare Par A

Trougouandbook

Higligs inormaionrelaed o Medicare Par B

Trougouandbook

Higligs inormaionrelaed o Medicare Par D

Trougouandbook

able oContents

Lis o opics by secion Pages 57

Index Alpabeical lis o opics Pages 811

Mini ableso Contents

Lis o opics wiin eacsecion

Pages 17, 47, 85,93, 109, 115

Blue wordsin the text

Blue words in e exare explained in eDeniions secion

Pages 127130

Medicare & You isn a legal documen. Ocial Medicare Program legalguidance is conained in e relevan saues, regulaions, and rulings.
http://www.medicare.gov/http://www.medicare.gov/


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4

Want to Save?

Extra Help is available!

Many people qualiy o ge Exra Help paying eirMedicare prescripion drug coss bu don knowi. Mos wo qualiy and join a Medicare drug planwill ge 95% o eir coss covered. Don miss ouon a cance o save. Exra Help and oer programs(like Medicare Savings Programs) may elp make

your eal care and prescripion drug coss moreaordable. See pages 8592 or more inormaionabou Exra Help and oer programs.

Choose to get uture handbooks electronically.

Save ax dollars and elp e environmen by signingup o access your uure Medicare & You andbookselecronically (also called e eHandbook). Visiwww.MyMedicare.govo reques eHandbooks.

Well send you an email nex Ocober wen enew eHandbook is available. You won ge a copyo your andbook in e mail i you coose o gei elecronically.

Did your household get more than one copy o

Medicare & You?

Tis may appen i ere is a slig dierence inow your or your spouses address is enered in

Social Securiy or e Railroad Reiremen Boards(RRB) mailing sysem. I you would like o ge onlyone copy in e uure, call 1-800-MEDICARE(1-800-633-4227), and say Agen. Y users souldcall 1-877-486-2048. I you ge RRB benes, call yourlocal RRB oce or 1-877-772-5772.
http://www.mymedicare.gov/http://www.mymedicare.gov/


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ContentsMedicare & You 2011

12What you needto know in 20114

Get your handbook

electronically 26What Medicare

covers

Continued_

5

2 Welcome to Medicare & You 2011

3 Tools to Help You Find What You Needin This Handbook

4 Want to Save?

8 Index

12 What You Need to Know in 201114 Medicare Basics14 What Is Medicare?

14 The Dierent Parts o Medicare

15 Your Medicare Coverage Choices at a Glance

16 Where to Get Your Medicare Questions Answered

17 Medicare Part A and Part B(Signing Up and Whats Covered)

18 Signing Up or Part A and Part B

24 How Much Does Part A Coverage Cost?

25 How Much Does Part B Coverage Cost?

27 Part A-Covered Services

30 Part B-Covered Services

45 Preventive Services Checklist

46 Whats NOT Covered by Part A and Part B?


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6

Contents (continued)

47 Your Medicare Choices48 Decide How to Get Your Medicare48 Need Help Deciding?

50 Things to Consider When Choosing or Changing Your Coverage

51 Original Medicare

52 What You Pay

57 Medigap (Medicare Supplement Insurance) Policies

60 Medicare Advantage Plans (Part C)

63 Who Can Join?65 What You Pay

66 How Do Medicare Advantage Plans Work?

68 Join, Switch, or Drop a Medicare Advantage Plan

70 Other Medicare Health Plans

72 Medicare Prescription Drug Coverage (Part D)

72 Who Can Get Medicare Drug Coverage?

73 Join, Switch, or Drop a Medicare Drug Plan

75 What You Pay78 What is the Part D Late Enrollment Penalty?

80 Important Drug Coverage Rules

84 How Other Insurance Works with Medicare

85 Get Help Paying Your Health and Prescription Drug Costs86 Extra Help Paying or Medicare Prescription Drug Coverage (Part D)

90 Medicare Savings Programs (Help with Medicare Costs)

91 Medicaid

91 State Pharmacy Assistance Programs (SPAPs)

92 Programs o All-Inclusive Care or the Elderly (PACE)

92 Supplemental Security Income (SSI) Benets

92 Programs or People Who Live in the U.S. Territories

92 Childrens Health Insurance Program


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8

IndexNOTE: Te page number sown in bold provides e mos deailed inormaion.

AAbdominal Aortic Aneurysm 30, 45

Acupuncture 46

Advance Beneciary Notice 101

Advance Directives 113114

ALS (Amyotrophic Lateral Sclerosis) 18

Ambulance Services 30, 44

Ambulatory Surgical Center 30, 114

Appeal 95101

Articial Limbs 41

Assignment 5354

BBalance Exam 36

Barium Enema 32, 45

Benet Period 127, 132

Bills 52, 84, 117118Blood 27, 30, 132133

Bone Mass Measurement (Bone Density) 31, 45

Braces (arm/leg/back/neck) 41

Breast Exam 39, 45

CCardiac Rehabilitation 31

Cardiovascular Screenings 31, 45

Caregiving 122

Cataract 35

Catastrophic Coverage 7677

Childrens Health Insurance Program (CHIP) 92, 122

Chiropractic Services 31

Claims 51,53, 103, 116

Clinical Laboratory Services 31, 133

Clinical Research Studies 28, 31, 62

COBRA 2122,82

C (continued)Colonoscopy 32, 45

Colorectal Cancer Screenings 32, 45

Community-Based Programs 111

Contract (private) 55

Coordination o Benets 16, 84

Cosmetic Surgery 46

Costs (copayments, coinsurance, deductibles, andpremiums) 13, 2627, 29, 4955, 62, 65, 7577,

86, 127129, 131134

Coverage Determination (Part D) 98100

Coverage Gap 12, 7677, 86

Covered Services (Part A and Part B) 2645, 132133

Creditable Prescription Drug Coverage 50, 56, 7273,

7879, 8283, 87, 128

Custodial Care 28, 110, 128

DDenitions 127130

Demonstrations/Pilot Programs 71

Dental Care and Dentures 46, 60, 92

Department o Deense 16

Department o Health and Human Services (Ofce o

Inspector General) 16, 106107

Department o Veterans Aairs 16, 78, 83, 111

Depression (see Mental Health Care) 38

Diabetes 33, 3637, 45

Dialysis (Kidney Dialysis) 14, 19, 37, 6264, 6667,

113, 118119

Discrimination 94,108

Disenroll 62,69, 74

Drug Plan 4849, 56, 59, 62, 67, 7283, 134

Drugs (outpatient) 40, 81

Durable Medical Equipment (like walkers) 12, 27,

3435, 37, 40, 54, 116, 132133

8


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99Index

EEKGs 35, 42

Eldercare Locator 112, 122

Electronic Handbook 4, 119

Electronic Health Record 50, 120

Electronic Prescribing 120

Emergency Department Services 35, 81

Employer Group Health Plan Coverage 2122, 4952,

56, 6364, 70, 72, 78, 82, 84, 110

End-Stage Renal Disease (ESRD) 14, 19, 21, 37, 48,

6264

Enroll

Part A 1823

Part B 1823

Part C 63,6869

Part D 7274

ESRD Network Organization 64

Exception (Part D) 8081, 98100

Extra Help (Help Paying Medicare Drug Costs) 4, 65, 68,

73, 7576, 78, 8689, 128

Eyeglasses 35

FFecal Occult Blood Test 32, 45

Federal Employee Health Benets Program 16, 22, 83

Federally-Qualied Health Center Services 35, 42

Flexible Sigmoidoscopy 32, 45

Flu Shot 36, 45

Foot Exam 36

Formulary 50, 75, 80, 98, 128

Fraud 12,104107

GGap (Coverage) 7677, 86

General Enrollment Period 21

Glaucoma Test 36, 45

HHealth Care Proxy 113114

Health Inormation Technology (Health IT) 120121

Health Maintenance Organization (HMO) 66, 130

Hearing Aids 36, 46

Help with Costs 65, 7576, 8689

Hepatitis B Shot 36, 45

HIV Screening 36, 45

Home Health Care 14, 2627, 37, 54, 91, 101, 110, 119,

132133

Hospice Care 14, 27, 60, 97, 132

Hospital Care (Inpatient Coverage) 14, 26, 28, 132133

IIdentity Thet 104, 107

Indian Health Service 78, 83

Inpatient 14, 2628, 33, 38, 44, 132133

Institution 6768, 73, 87, 89, 128

JJoin

Medicare Drug Plan 7274

Medicare Health Plan 63, 6869

KKidney Dialysis 14, 19, 37, 6264, 6667, 113,

118119

Kidney Disease Education Services 37

Kidney Transplant 14, 19, 37, 43, 6364

LLietime Reserve Days 129, 132

Limited Income 24, 56, 65, 8692Living Will 113

Long-Term Care 110112

Low-Income Subsidy (LIS) (Extra Help) 4, 65, 68, 73,

7576, 78, 8689, 128

NOTE: Te page number sown in bold provides e mos deailed inormaion.


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10 Index

MMammogram 37, 45, 6667

Medicaid 67, 71, 84, 8689, 9192, 107, 111, 116

Medical Equipment 12, 29, 3435, 37, 54, 116,132133

Medical Nutrition Therapy 37, 45

Medical Savings Account (MSA) Plans 61, 68, 72

Medically Necessary 2730, 33, 129

Medicare

Part A 14,1824, 2628, 131132

Part B 14, 1823, 25, 2945, 131, 133

Part C 14, 6069, 134

Part D 14, 56, 7283, 8689, 134

Medicare Advantage Plans (like an HMO or PPO) 14,

6069, 134

Medicare Authorization to Disclose Personal Health

Inormation 117

Medicare Beneciary Ombudsman 108

Medicare Card (replacement) 16

Medicare Cost Plan 70, 129

Medicare Drug Integrity Contractor (MEDIC) 104, 106

Medicare Prescription Drug Coverage 14, 56, 7283,

8689

Medicare Savings Programs 86, 90

Medicare SELECT 57

Medicare Summary Notice (MSN) 5253, 96, 106

Medigap (Medicare Supplement Insurance) 15, 22,

5759, 63, 82

Mental Health Care 28, 38, 132133

NNon-doctor Services 38

Nurse Practitioner 38

Nursing Home 27, 71, 89, 110112, 116,119, 122

Nutrition Therapy Services 37, 45

OOccupational Therapy 27, 3738, 133

Ofce or Civil Rights 16, 103, 108

O (continued)

Ofce o Inspector General 16, 106107

Ofce o Personnel Management 16, 83

Ombudsman (Medicare Beneciary) 108

Original Medicare 15, 49, 5156

Orthotic Items 41

Outpatient Hospital Services 39, 133

Oxygen 34, 116

PPap Test 39, 45

Payment Options (premium) 75, 131

Pelvic Exam 39, 45Penalty (late enrollment)

Part A 21,24

Part B 25

Part D 7879, 134

Personal Health Record 121

Physical Exam 30, 35, 39, 45

Physical Therapy 2728, 37, 40, 133

Physician Assistant 38

Pilot/Demonstration Programs 71, 129

Pneumococcal Shot 40, 45

Power o Attorney 113

Preerred Provider Organization (PPO) Plan 66

Prescription Drugs 1415, 40, 4950, 6667, 7283,

128, 134

Preventive Services 12, 2945, 116, 130

Primary Care Doctor 51, 6667, 130

Privacy Notice 102103

Private Contract 55

Private Fee-or-Service (PFFS) Plans 67

Programs o All-Inclusive Care or the Elderly (PACE) 71,

92, 111

Prostate Screening (PSA Test) 41, 45

Proxy (Health Care) 113114

Publications 122

Pulmonary Rehabilitation 41

NOTE: Te page number sown in bold provides e mos deailed inormaion.


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12 What You Need to Know in 2011

Pay Less or Preventive Services See pages 2945.

You will pay no deducible or coinsurance or mos prevenive services.

Durable Medical Equipment (DME) See pages 3435.

I you live in cerain areas, you may ave o ge your durable medicalequipmen (suc as walkers) rom specic suppliers. Tis program willelp save you and Medicare money and make sure a you ge qualiyequipmen and supplies.

New Yearly Wellness Exam See page 39.

You can ge a wellness exam eac year o elp you say ealy.

New Dates to Change Plans See pages 13, 68, and 73.

Find ou wen you can make canges o your eal and prescripiondrug coverage.

Help in the Prescription Drug Coverage Gap See page 76.

I you reac e coverage gap in your Medicare prescripion drugcoverage, you may qualiy or savings on brand-name and generic drugs.

Fighting Medicare Fraud See pages 105107.

Find ou wa Medicare is doing and wa you can do o proec againsraud, wase, and abuse.

Ways to Manage Your Health Inormation Online See pages 120121.

Tere are ools o elp you manage your eal inormaion wilereducing paperwork and errors, and improving your qualiy o care.

What You Pay or MedicareSee pages

131134.

Medicare Par A and Par B premiums, deducibles, copaymens, andcoinsurance are on pages 131133. Inormaion abou Medicare Par Cand Par D coss is on page 134.

Medicare Health and Prescription Drug Plans

Visi www.medicare.gov/nd-a-plan, or call 1-800-MEDICARE(1-800-633-4227) o nd plans in your area. Y users sould call1-877-486-2048.

Blue words

in the textare dened

on pages

127130.
http://www.medicare.gov/find-a-planhttp://www.medicare.gov/find-a-plan


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13What You Need to Know in 2011

Coverage and Costs Change Yearly.Your Medicare eal or prescripion drug plan can cange ow muc icoss and wa i covers eac year. Even i your plans cos and coverage saye same, your eal or nances may ave canged. Review your plan eacyear o make sure i will sill mee your needs. I youre saised wi yourcurren coverage, you don need o cange plans.

Fall Open Enrollment Period

Mark your calendar with these important dates!

Note: Te Open Enrollmen Period daes will cange o give you more

ime i you wan o coose and join a Medicare eal or prescripiondrug plan.

September 2011

Compare your coverage wi oeravailable opions o see i eres a beercoice or you. See page 15.

October 15, 2011

December 7, 2011

You can cange your Medicare ealor prescripion drug coverage or 2012.

See pages 68 and 73 or oer imes wenyou can swic your coverage.

January 1, 2012

New coverage begins i you swiced orjoined a plan. New coss and coveragecanges also begin i you kep yourexising coverage.

Is your eal or drug plan leaving Medicare? Heal and prescripiondrug plans can decide no o paricipae in Medicare or e coming year.Your plan will send you a leer i i leaves Medicare or sops providingcoverage in your area. See page 94 or more inormaion abou your rigsand opions.

APRIL

7372

October

1


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14 Medicare Basics

What Is Medicare?Medicare is eal insurance or e ollowing:

People 65 or older

People under 65 wi cerain disabiliies People o any age wi End-Sage Renal Disease (ESRD) (permanen kidney

ailure requiring dialysis or a kidney ransplan)

The Dierent Parts o MedicareTe dieren pars o Medicare elp cover specic services:

Medicare Part A (Hospital Insurance)

Helps cover inpaien care in ospials

Helps cover skilled nursing aciliy, ospice, and ome eal care

See pages 2628.

Medicare Part B (Medical Insurance)

Helps cover docors services, ospial oupaien care, and ome eal care

Helps cover some prevenive services o elp mainain your eal and o keepcerain illnesses rom geing worse

See pages 2945.

Medicare Part D (Medicare Prescription Drug Coverage)

A prescripion drug opion run by Medicare-approved privae insurance companies

Helps cover e cos o prescripion drugs

May elp lower your prescripion drug coss and elp proec agains iger coss ine uure

See pages 7283.

Medicare Advanage Plans (like an HMO or PPO) are eal plans run byMedicare-approved privae insurance companies. Medicare Advanage Plans (alsocalled Par C) include Par A, Par B, and usually oer coverage like Medicareprescripion drug coverage (Par D), someimes or an exra cos. See pages 6069.


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15Medicare Basics

Your Medicare Coverage Choices at a GlanceTere are wo main ways o ge your Medicare coverage: Original Medicare ora Medicare Advanage Plan. Use ese seps o elp you decide wic way o

ge your coverage.

Part AHospialInsurance

Part BMedicalInsurance

Medigap(MedicareSupplemenInsurance)policy

Part DPrescripionDrug Coverage

Part CCombines Par A, Par B, andusuallyPar D

ORIGINAL MEDICARE MEDICARE ADVANTAGE PLAN

(like an HMO or PPO)

Step 2: Decide i you need o add drug coverage

Step 3: Decide i you need o addsupplemenal coverage

End

End

Step 1: Decide ow you wan o ge your coverage

Part DPrescripionDrug Coverage(i no alreadyincluded)

or

Start

I you join a Medicare AdvantagePlan, you dont need and cant besold a Medigap policy.

See page 49 or more details.


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16 Medicare Basics

Where to Get Your Medicare Questions Answered

1800MEDICARE

o ge general or claims-specic Medicare

inormaion and imporan eleponenumbers. I you need elp in a languageoer an Englis or Spanis, say Agen oalk o a cusomer service represenaive.1-800-633-4227Y 1-877-486-2048www.medicare.gov

State Health Insurance Assistance Program

(SHIP)

o ge ree personalized Medicare counseling

on decisions abou coverage; elp wiclaims, billing, or appeals; and inormaionon programs or people wi limied incomeand resources. See pages 123126.Call 1-800-MEDICARE o ge e eleponenumbers o SHIPs in oer saes.

Social Security

o ge a replacemen Medicare card; cangeyour address or name; ge inormaion abouPar A and/or Par B eligibiliy, enilemen,

and enrollmen; apply or Exra Help wiMedicare prescripion drug coss; askquesions abou premiums; and repor adea.1-800-772-1213Y 1-800-325-0778www.socialsecuriy.gov

Coordination o Benets Contractor

o ge inormaion on weer Medicare oryour oer insurance pays rs and o repor

canges in your insurance inormaion.1-800-999-1118Y 1-800-318-8782

Department o Deense

o ge inormaion abou RICARE orLie and e RICARE Parmacy Program.1-866-773-0404 (FL)Y 1-866-773-04051-877-363-1303 (Parmacy)Y 1-877-540-6261

www.ricare.mil/mybene

Department o Health and Human

Services

Oce o Inspector GeneralI yoususpec Medicare raud.1-800-447-8477Y 1-800-377-4950www.sopmedicareraud.govOce or Civil RightsI you inkyou were discriminaed agains or iyour eal inormaion privacy rigswere violaed.1-800-368-1019Y 1-800-537-7697

www.s.gov/ocr

Department o Veterans Aairs

I youre a veeran or ave served in eU.S. miliary.1-800-827-1000Y 1-800-829-4833www.va.gov

Ofce o Personnel Management

o ge inormaion abou e Federal

Employee Heal Benes Program orcurren and reired Federal employees.1-888-767-6738Y 1-800-878-5707www.opm.gov/insure

Railroad Retirement Board (RRB)

I you ave benes rom e RRB, callem o cange your address or name,ceck eligibiliy, enroll in Medicare,replace your Medicare card, and repor

a dea.Local RRB oce or 1-877-772-5772

Quality Improvement Organization

(QIO)

o ask quesions or repor complainsabou e qualiy o care or aMedicare-covered service or i youink your service is ending oo soon.Call 1-800-MEDICARE o ge eelepone number or your QIO.
http://www.medicare.gov/http://www.socialsecurity.gov/http://www.tricare.mil/mybenefithttp://www.stopmedicarefraud.gov/http://www.hhs.gov/ocrhttp://www.va.gov/http://www.opm.gov/insurehttp://www.opm.gov/insurehttp://www.va.gov/http://www.hhs.gov/ocrhttp://www.stopmedicarefraud.gov/http://www.tricare.mil/mybenefithttp://www.socialsecurity.gov/http://www.medicare.gov/


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17

SECTION 1

Medicare Part Aand Part B

(Signing Up and

Whats Covered)

Section 1 includes inormation about the ollowing:

Signing Up or Par A and Par B . . . . . . . . . . . . . . . . . 18

How Muc Does Par A Coverage Cos? . . . . . . . . . . . . . 24

How Muc Does Par B Coverage Cos? . . . . . . . . . . . . . 25

Wa Does Par A (Hospial Insurance) Cover? . . . . . . . . . 26

Wa Does Par B (Medical Insurance) Cover? . . . . . . . . . 29

Prevenive Services Cecklis . . . . . . . . . . . . . . . . . . . 45

Was NO Covered by Par A and Par B? . . . . . . . . . . . 46


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18 Section 1Medicare Part A and Part B

Signing Up or Part A and Part BTis secion explains ow and wen o sign up and wy you migdecide o wai o ge Par B.

Some People Get Part A and Part B

Automatically In mos cases, i youre already geing benes rom Social

Securiy or e Railroad Reiremen Board (RRB), you willauomaically ge Par A and Par B saring e rs day o emon you urn 65. I your birday is on e rs day o emon, Par A and Par B will sar e rs day o e prior mon.

I youre under 65 and disabled, you auomaically ge Par A andPar B aer you ge disabiliy benes rom Social Securiy orcerain disabiliy benes rom e RRB or 24 mons.

You will ge your red, wie, and blueMedicare card in e mail 3 monsbeore your 65 birday or your25 mon o disabiliy. I you donwan Par B, ollow e insrucionsa come wi e card, and send

e card back. I you keep e card,you keep Par B and will pay Par Bpremiums.

I you live in Puero Rico and you ge benes rom Social Securiyor e RRB, you will auomaically ge Par A. I you wan Par B,you will need o sign up or i. Conac your local Social Securiyoce or RRB or more inormaion.

I you ave ALS (Amyoropic Laeral Sclerosis, also called LouGerigs disease), you auomaically ge Par A and Par B emon your disabiliy benes begin.

I you ave Par A and RICARE (coverage or acive-duymiliary or reirees and eir amilies), you mus ave Par B okeep your RICARE coverage. See page 23.


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19Section 1Medicare Part A and Part B

Some People Need to Sign Up or Part A and

Part B I you aren geing Social Securiy or RRB benes (or

insance, because youre sill working) and you wan Par Aor Par B, you will need o sign up (even i youre eligible oge Par A premium-ree). See page 24. I youre no eligibleor premium-ree Par A, you can buy Par A and Par B.You sould conac Social Securiy 3 mons beore you urn65. I you worked or a railroad, conac e RRB o sign up.

I you ave End-Sage Renal Disease (ESRD),you sould visi your local Social Securiyoce, or call Social Securiy a 1-800-772-1213

o sign up or Par A and Par B. Y userssould call 1-800-325-0778. For moreinormaion, visi p://go.usa.gov/lovo

view e bookle, Medicare Coverage oKidney Dialysis and Kidney ransplanServices. You can also call 1-800-MEDICARE(1-800-633-4227) o nd ou i a copy canbe mailed o you. Y users sould call1-877-486-2048.

Call Social Securiy a 1-800-772-1213 or more inormaionabou your Medicare eligibiliy, and o sign up or Par Aand/or Par B. I youre 65 or older, you can also apply orpremium-ree Par A and Par B online awww.socialsecuriy.gov/reiremen. Te wole process canake less an 10 minues.

I you ge RRB benes, call e RRB a 1-877-772-5772.

For general inormaion abou enrolling, visiwww.medicare.gov/MedicareEligibiliy. You can also ge ree,personalized eal insurance counseling rom your SaeHeal Insurance Assisance Program (SHIP). Seepages 123126 or e elepone number.


are dened

on pages

127130.
http://go.usa.gov/lovhttp://www.socialsecurity.gov/retirementhttp://www.medicare.gov/MedicareEligibilityhttp://www.medicare.gov/MedicareEligibilityhttp://www.socialsecurity.gov/retirementhttp://go.usa.gov/lov


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When Can You Sign Up?

Initial Enrollment Period

You can sign up wen youre rs eligible or Par B. (For example, i

youre eligible or Par B wen you urn 65, is is a 7-mon perioda begins 3 mons beore e mon you urn 65, includes emon you urn 65, and ends 3 mons aer e mon you urn 65.)

3 monthsbeore

e monyou urn 65

2 monthsbeore

e monyou urn 65

1 monthbeore

e monyou urn 65

Te monyou urn

65

1 monthaer

you urn 65

2 monthsaer

you urn 65

3 monthsaer

you urn 65

Sign up early o avoid a delay ingeing coverage or Par B services.o ge Par B coverage e mon youurn 65, you mus sign up during ers ree mons beore e monyou urn 65.

I you wai unil e las our mons o your IniialEnrollmen Period o sign up or Par B, your sardae or coverage will be delayed.

I you enroll in Par B during e rs ree mons o your IniialEnrollmen Period, your coverage sar dae will depend on your birday:

I your birdayisnt on e rs day o e mon, your Par B coveragesars e rs day o your birday mon. For example, Mr. Greens65 birday is July 20, 2011. I e enrolls in April, May, or June, iscoverage will sar on July 1, 2011.

I your birdayis on e rs day o e mon, your coverage will sare rs day o e prior mon. For example, Mr. Kims 65 birday isJuly 1, 2011. I e enrolls in Marc, April, or May, is coverage will saron June 1, 2011. o read e car correcly, use e mon beore yourbirday as e mon you urn 65.

I you enroll in Par B e mon you urn 65 or during e las 3 monso your Iniial Enrollmen Period, your Par B sar dae will be delayed.For example, Mrs. Simpson urns 65 in July. Wen er coverage sarsdepends on e mon se enrolls:

Month she enrolls Month coverage starts

July Augus 1

Augus Ocober 1

Sepember December 1

Ocober January 1


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When Can You Sign Up? (continued)


are dened

on pages

127130.

General Enrollment Period

I you didn sign up or Par A and/or Par B (or wic you pay

monlypremiums) wen you were rs eligible, you can sign upbeween January 1Marc 31 eac year. Your coverage will beginJuly 1. You may ave o pay a iger premium or lae enrollmen.See pages 2425.

I you sign up duringthese months

Your coverage willbegin on

January

July 1February

Marc

Special Enrollment Period

I you didn sign up or Par A and/or Par B (or wic you paymonly premiums) wen you were rs eligible because yourecovered under a group eal plan based on curren employmen,you can sign up or Par A and/or Par B as ollows:

Anytime that youor your spouse (oramily member i

youre disabled) areworking, and yourecovered by a grouphealth plan throughthe employer or unionbased on that work

Or

During the 8-monthperiod that beginsthe month aer theemployment endsor the group healthplan coverage ends,whichever happensrst

Usually, you don pay a lae enrollmen penaly i you sign up

during a Special Enrollmen Period. Tis Special Enrollmen Perioddoesn apply o people wi End-Sage Renal Disease (ESRD). Seepage 19. You may also qualiy or a Special Enrollmen Period iyoure a voluneer serving in a oreign counry.

Note: I you ave COBRA coverage or a reiree eal plan, youdon ave coverage based on curren employmen. Youre noeligible or a special enrollmen period wen a coverage ends.


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When Can You Sign Up? (continued)

Medigap Open Enrollment Period

You ave a 6-mon Medigap (Medicare Supplemen Insurance)

policy open enrollmen period wic sars e rs mon yourebo 65 and enrolled in Par B. Tis period gives you a guaraneedrig o buy any Medigap policy sold in your sae. Once is periodsars, i can be delayed or replaced. See pages 5759.

o learn more deails abou enrollmen periods, read e ac seeUndersanding Medicare Enrollmen Periods by visiingp://go.usa.gov/lsi. You can also call 1-800-MEDICARE(1-800-633-4227) o nd ou i a copy can be mailed o you.Y users sould call 1-877-486-2048.

Should You Get Part B?Te ollowing inormaion can elp you decide i you wan o sign upor Par B.

Employer or Union CoverageI you or your spouse (or amilymember i youre disabled) is still workingand you ave coverageroug an employer (including e Federal Employee HealBenes Program) or union, conac your employer or union benes

adminisraor o nd ou ow your insurance works wi Medicare.I may be o your advanage o delay Par B enrollmen. Wen eemploymen ends, ree ings appen:

1. You may ge o elec COBRA coverage, wic coninues youreal coverage roug e employers plan (in mos cases oronly 18 mons) and probably a a iger cos o you.

2. You ave 8 mons o sign up or Par B wiou a penaly.See page 21. Tis period will run weer or no you elecCOBRA. I you elec COBRA, don wai unil your COBRA endso enroll in Par B. I you enroll in Par B aer e 8 mons, youmay ave o pay a penaly. See page 25.

3. Wen you sign up or Par B, your Medigap open enrollmenperiod begins. See page 58.
http://go.usa.gov/lsihttp://go.usa.gov/lsi


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Should You Get Part B? (continued)

RICAREI you ave Par A and RICARE (coverage oracive-duy miliary or reirees and eir amilies),you must have

Part B to keep your RICARE coverage. However, i youre anacive-duy service member, or e spouse or dependen cild o anacive-duy service member, e ollowing applies o you:

You don ave o enroll in Par B o keep your RICAREcoverage wile e service member is on acive duy.

Beore e acive-duy service member reires, you mus enroll inPar B o keep RICARE wiou a break in coverage.

You can ge Par B during a special enrollmen period i you aveMedicare because youre 65 or older, or youre disabled.


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How Much Does Part A Coverage Cost?You usually don pay a monlypremium or Par A coverage iyou or your spouse paid Medicare axes wile working.

I you aren eligible or premium-ree Par A, you may be able obuy Par A i you mee one o e ollowing condiions:

Youre 65 or older, and youre eniled o (or enrolling in) Par Band mee e ciizensip and residency requiremens.

Youre under 65, disabled, and your premium-ree Par Acoverage ended because you reurned o work. (I youre under 65and disabled, you can coninue o ge premium-ree Par A or upo 8.5 years aer you reurn o work.)

Note: Te 2011 premium amoun or people wo buy Par A is$450.

In mos cases, i you coose o buyPar A, you mus also avePar B and pay monly premiums or bo. I you ave limiedincome and resources, your sae may elp you pay or Par Aand/or Par B. See page 90. Call Social Securiy a 1-800-772-1213or more inormaion abou e Par A premium. Y users souldcall 1-800-325-0778.

Part A Late Enrollment PenaltyI you aren eligible or premium-ree Par A, and you don buy iwen youre rs eligible, your monly premium may go up 10%.You will ave o pay e iger premium or wice e number oyears you could ave ad Par A, bu didn sign-up. For example,i you were eligible or Par A or 2 years bu didn sign-up, youwill ave o pay e iger premium or 4 years. Usually, you donave o pay a penaly i you mee cerain condiions a allowyou o sign up or Par A during a Special Enrollmen Period. Seepages 2122.


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How Much Does Part B Coverage Cost?You pay e Par B premium eac mon. Mos people will pay esandard premium amoun. However, i your modied adjusedgross income as repored on your IRS ax reurn rom 2 years ago(e mos recen ax reurn inormaion provided o Social Securiyby e IRS) is above a cerain amoun, you may pay more.

Your modied adjused gross income is your adjused gross incomeplus your ax exemp ineres income. Eac year, Social Securiywill noiy you i you ave o pay more an e sandard premium.Weer you pay e sandard premium or a iger premium cancange eac year depending on your income. I you ave o pay aiger amoun or your Par B premium and you disagree (even

i you ge RRB benes), call Social Securiy a 1-800-772-1213.Y users sould call 1-800-325-0778. You can also view e acsee Medicare Par B Premiums: Rules For Beneciaries WiHiger Incomes by visiing www.socialsecuriy.gov/pubs/10536.pd.

See page 131 or e 2011 Par B premium amouns and o nd ou iyour Par B premium will be iger based on your income.

Part B Late Enrollment Penalty

I you don sign up or Par B wen youre rs eligible, you mayave o pay a lae enrollmen penaly or as long as you aveMedicare. Your monly premium or Par B may go up 10% oreac ull 12-mon period a you could ave ad Par B, bu didnsign up or i. Usually, you don pay a lae enrollmen penaly i youmee cerain condiions a allow you o sign up or Par B during aspecial enrollmen period. See pages 2122.

I you have limited income and resources, see page 90 orinormation about help paying your Medicare premiums.
http://www.socialsecurity.gov/pubs/10536.pdfhttp://www.socialsecurity.gov/pubs/10536.pdf


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What Services Does Medicare Cover?Medicare covers cerain medical services and supplies in ospials,docors oces, and oer eal care seings. Services are eiercovered under Par A or Par B. I you ave bo Par A and Par B,you can ge all o e Medicare-covered services lised in is secion,weer you ave Original Medicare or a Medicare eal plan.

See pages 2728 or e Par A-covered services lis.

See pages 3044 or e Par B-covered services lis.

What Does Part A (Hospital Insurance) Cover?Par A elps cover e ollowing:

Inpaien care in ospials

Inpaien care in a skilled nursing aciliy (no cusodial or long ermcare)

Hospice care services

Home eal care services

Inpaien care in a Religious Nonmedical Heal Care Insiuion

See pages 2728 or more inormaion on Par A-covered services.

You can nd ou i you ave Par A by looking a your Medicare

card. I you ave Original Medicare, you will use is card o ge yourMedicare-covered services. I you join a Medicare eal plan, youmus use e card rom e plan o ge your Medicare-covered services.

What You Pay or Part ACovered ServicesCopaymens, coinsurance, and deducibles may apply or eac servicein e car on e nex wo pages. See page 132 or specic costs andother inormation about these services.

I you join a Medicare Advanage Plan (like an HMO or PPO) or aveoer insurance (like a Medigap policy, or employer or union coverage),your coss may be dieren. Conac e plans youre ineresed in ond ou abou e coss, or visi www.medicare.gov/nd-a-plan.
http://www.medicare.gov/findaplanhttp://www.medicare.gov/findaplan


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Part ACovered Services

Blood In mos cases, e ospial ges blood rom a blood bank a no carge,and you won ave o pay or i or replace i. I e ospial as o buy

blood or you, you mus eier pay e ospial coss or e rs 3unis o blood you ge in a calendar year or ave e blood donaed byyou or someone else.

Home

Health

Services

Limied o medically-necessarypar-ime or inermien skillednursing care, or pysical erapy, speec-language paology, ora coninuing need or occupaional erapy. A docor enrolled inMedicare, or cerain eal care providers wo work wi e docor,mus see you beore e docor can ceriy a you need ome ealservices. Ta docor mus order your care, and a Medicare-ceried

ome eal agency mus provide i. Home eal services may alsoinclude medical social services, par-ime or inermien ome ealaide services, and medical supplies or use a ome. You mus beomebound, wic means a leaving ome is a major eor. Fordurable medical equipmen inormaion, see pages 3435.

Hospice

Care

For people wi a erminal illness. Your docor mus ceriy ayoure expeced o live 6 mons or less. Coverage includes drugsor pain relie and sympom managemen; medical, nursing, and

social services; cerain durable medical equipmen and oer coveredservices as well as services Medicare usually doesn cover, suc asspiriual and grie counseling. A Medicare-approved ospice usuallygives ospice care in your ome or oer aciliy were you live like anursing ome.

Hospice care doesn pay or your say in a aciliy (room and board)unless e ospice medical eam deermines a you need sor-erminpaien says or pain and sympom managemen a can beaddressed a ome. Tese says mus be in a Medicare-approved

aciliy, suc as a ospice aciliy, ospial, or skilled nursing aciliywic conracs wi e ospice. Medicare also covers inpaienrespie care wic is care you ge in a Medicare-approved aciliy soa your usual caregiver can res. You can say up o 5 days eac imeyou ge respie care. Medicare will pay or covered services or ealproblems a aren relaed o your erminal illness. You can coninueo ge ospice care as long as e ospice medical direcor or ospicedocor receries a youre erminally ill.


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Part ACovered Services

Hospital

Stays

(Inpatient)

Includes semi-privae room, meals, general nursing, drugs aspar o your inpaien reamen, and oer ospial services and

supplies. Examples include inpaien care you ge in acue careospials, criical access ospials, inpaien reabiliaion aciliies,long-erm care ospials, inpaien care as par o a qualiyingclinical researc sudy, and menal eal care. Tis doesnt includeprivae-duy nursing, a elevision or elepone in your room (iere is a separae carge or ese iems), or personal care iemslike razors or slipper socks. I also doesn include a privae room,unless medically necessary. I you ave Par B, i covers e docorsservices you ge wile youre in a ospial.

Note: Staying overnight in a hospital doesnt always meanyoure an inpatient. Youre considered an inpaien e day adocor ormally admis you o a ospial wi a docors order.Being an inpaien or an oupaien afects your out-o-pocketcosts. Always ask i youre an inpaien or an oupaien. For moreinormaion, view e publicaion Are You a Hospial Inpaien orOupaien? I You Have MedicareAsk! ap://go.usa.gov/im9. You can also call 1-800-MEDICARE(1-800-633-4227) o nd ou i a copy can be mailed o you.Y users sould call 1-877-486-2048.

ReligiousNonmedical

Health Care

Institution

(Inpatient

care)

Medicare will only cover e non-medical, non-religious ealcare iems and services (like room and board) in is ype o aciliy

or people wo qualiy or ospial or skilled nursing aciliy care,bu or wom medical care isn in agreemen wi eir religiousbelies. Non-medical iems and services like wound dressings oruse o a simple walker during your say don require a docorsorder or prescripion. Medicare doesn cover e religious aspecso care.

Skilled

NursingFacility Care

Includes semi-privae room, meals, skilled nursing and

reabiliaive services, and oer services and supplies a aremedically necessary aer a 3-day minimum inpatient ospialsay or a relaed illness or injury. An inpaien ospial say beginse day youre ormally admied wi a docors order and doesninclude e day youre discarged. o qualiy or care in a skillednursing aciliy, your docor mus ceriy a you need daily skilledcare like inravenous injecions or pysical erapy. Medicaredoesnt cover long-erm care or cusodial care.
http://go.usa.gov/im9http://go.usa.gov/im9


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What Does Part B (Medical Insurance) Cover?Par B elps cover medically-necessaryservices like docors services andess, oupaien care, ome eal services, durable medical equipmen,and oer medical services. Par B also covers some prevenive services.Look a your Medicare card o nd ou i you ave Par B.

Pages 3044 include a lis o common Par B-covered services. Medicaremay cover some services and ess more oen an e imerames lisedin e cars i needed o diagnose a condiion. o nd ou i Medicarecovers a service no on is lis, visi www.medicare.gov/coverage,or call 1-800-MEDICARE (1-800-633-4227). Y users sould call1-877-486-2048.

You will see this apple next to the preventive services on the list. Use ececklis on page 45 o ask your docor or oer eal care provider wicprevenive services you need.

What You Pay or Part BCovered ServicesTe cars on e ollowing pages give general inormaion abou wa youpay i you ave Original Medicare and see docors or providers wo accepassignmen. You will pay more or docors or providers wo don accepassignmen. See page 54. I youre in a Medicare Advantage Plan (like

an HMO or PPO) or have other insurance, your costs may be diferent.Contact your plan or benets administrator directly to nd out aboutthe costs.

Under Original Medicare, i e Par B deducible applies you mus pay allcoss unil you mee e yearly Par B deducible beore Medicare begins opay is sare. Ten, aer your deducible is me, you ypically pay 20% oe Medicare-approved amoun o e service. Tere is no yearly limi orwa you pay ou-o-pocke. See page 133 or the Part B deductible andcoinsurance amounts.

NEWYou pay noing or mos prevenive services i you ge e servicesrom a docor or oer eal care provider wo acceps assignmen. Forsome prevenive services, you will pay noing or e service, bu you mayave o paycoinsurance or e oce visi wen you ge ese services.


are dened

on pages

127130.
http://www.medicare.gov/coveragehttp://www.medicare.gov/coverage


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Part BCovered Services

Abdominal

Aortic

AneurysmScreening

A one-ime screening ulrasound or people a risk. You mus gea reerral or i as par o your one-ime Welcome o Medicare

pysical exam. See page 39. You pay noing or e screening ie docor acceps assignmen.

Ambulance

Services

Ground ambulance ransporaion wen you need o beranspored o a ospial or skilled nursing aciliy ormedically-necessaryservices, and ransporaion in anyoer veicle could endanger your eal. Medicare may payor ambulance ransporaion in an airplane or elicopero a ospial i you need immediae and rapid ambulanceransporaion a ground ransporaion can provide.

In some cases, Medicare may pay or limied non-emergencyambulance ransporaion i you ave orders rom your docorsaying a ambulance ransporaion is medically necessary.Medicare will only cover services o e neares appropriaemedical aciliy a is able o give you e care you need.You pay 20% o e Medicare-approved amoun, and e Par Bdeducible applies.

Ambulatory

Surgical

Centers

Faciliy ees or approved surgical procedures provided in anambulaory surgical cener (aciliy were surgical procedures

are perormed, and e paien is released wiin 24 ours).Excep or cerain prevenive services (or wic you paynoing), you pay 20% o e Medicare-approved amoun obo e ambulaory surgical cener and e docor wo reasyou, and e Par B deducible applies. You pay all aciliyees or procedures Medicare doesn allow in ambulaorysurgical ceners.

Blood In mos cases, e provider ges blood rom a blood banka no carge, and you won ave o pay or i or replace i.

However, you will pay a copaymen or e blood processing andandling services or every uni o blood you ge, and e Par Bdeducible applies. I e provider as o buy blood or you, youmus eier pay e provider coss or e rs 3 unis o bloodyou ge in a calendar year or ave e blood donaed by you orsomeone else.

You pay a copaymen or addiional unis o blood you ge as anoupaien (aer e rs 3), and e Par B deducible applies.


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Bone Mass

Measurement

(Bone Density)

Helps o see i youre a risk or broken bones. Tis serviceis covered once every 24 mons (more oen imedically

necessary) or people wo ave cerain medical condiionsor mee cerain crieria. You pay noing or is es i edocor acceps assignmen.

Cardiac

Rehabilitation

Medicare covers compreensive programs a includeexercise, educaion, and counseling or paiens wo meecerain condiions. Medicare also covers inensive cardiacreabiliaion programs a are ypically more rigorous ormore inense an regular cardiac reabiliaion programs.You pay e docor 20% o e Medicare-approved amoun

i you ge e services in a docors oce. In a ospialoupaien seing, you also pay e ospial a copaymen.

Cardiovascular

Screenings

Blood ess a elp deec condiions a may lead o aear aack or sroke. Tis service is covered every 5 yearso es your coleserol, lipid, and riglyceride levels. You paynoing or e ess, bu you generally ave o pay 20% o eMedicare-approved amoun or e docors visi.

Chiropractic

Services

(limited)

Helps correc a subluxaion (wen one or more o e boneso your spine move ou o posiion) using manipulaion o e

spine. You pay 20% o e Medicare-approved amoun, ande Par B deducible applies. Note: You pay all coss or anyoer services or ess ordered by a ciropracor.

Clinical

Laboratory

Services

Includes cerain blood ess, urinalysis, some screeningess, and more. You pay noing or ese services, bu yougenerally ave o pay 20% o e Medicare-approved amounor e docors visi.

Clinical

Research

Studies

ess ow well dieren ypes o medical care work and iey are sae. Medicare covers some coss, like docor visis

and ess, in qualiying clinical researc sudies. You pay 20%o e Medicare-approved amoun, and e Par B deducible

applies. Note: I youre in a Medicare Advanage Plan, seepage 62 or more inormaion.


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Colorectal

Cancer

Screenings

o elp nd precancerous grows or nd cancer early,wen reamen is mos eecive. One or more o e

ollowing ess may be covered. alk o your docor. Fecal Occul Blood esOnce every 12 mons i 50 or

older. You pay noing or e es, bu you generally aveo pay 20% o eMedicare-approved amounor edocors visi.

Flexible SigmoidoscopyGenerally, once every 48 monsi 50 or older, or 120 mons aer a previous screeningcolonoscopy or ose no a ig risk. You pay noing oris es i e docor acceps assignmen.

ColonoscopyGenerally once every 120 mons (igrisk every 24 mons) or 48 mons aer a previousfexible sigmoidoscopy. No minimum age. You pay noingor is es i e docor acceps assignmen.

Barium EnemaOnce every 48 mons i 50 or older(ig risk every 24 mons) wen used insead o asigmoidoscopy or colonoscopy. You pay 20% o eMedicare-approved amoun or e docors services. In a

ospial oupaien seing, you also pay e ospial acopaymen.

Defbrillator

(Implantable

Automatic)

For some people diagnosed wi ear ailure. You paye docor 20% o e Medicare-approved amoun or edocors services. You also pay e ospial a copaymenbu no more an e Par A ospial saydeducible (seepage 132) i you ge e device as a ospial oupaien. TePar B deducible applies.


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Diabetes

Screenings

Medicare covers ese screenings i you ave anyo e ollowing risk acors: ig blood pressure

(yperension), isory o abnormal coleserol andriglyceride levels (dyslipidemia), obesiy, or a isoryo ig blood sugar (glucose). ess may also becovered i you mee oer requiremens, like beingoverweig and aving a amily isory o diabees.

Based on e resuls o ese ess, you may be eligibleor up o wo diabees screenings every year. You paynoing or e es, bu you generally ave o pay 20%o e Medicare-approved amoun or e docors visi.

Diabetes

SelManagement

Training

For people wi diabees wi a wrien order roma docor or oer eal care provider. You pay 20%o e Medicare-approved amoun, and e Par Bdeducible applies.

Diabetes Supplies Includes blood sugar esing moniors, blood sugar essrips, lance devices and lances, blood sugar conrolsoluions, and erapeuic soes (in some cases).Insulin is covered only i used wi an exernal insulinpump. You pay 20% o e Medicare-approved amoun,and e Par B deducible applies.

Note: Insulin and cerain medical supplies used oinjec insulin, suc as syringes, and some oral diabeicdrugs may be covered by Medicare prescripion drugcoverage (Par D).

Doctor Services Services a are medically necessary(includesoupaien and some docor services you ge wenyoure a ospial inpaien) or covered preveniveservices. Excep or cerain prevenive services, you pay20% o e Medicare-approved amoun, and e Par Bdeducible applies.


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Durable

Medical

Equipment(like

walkers)

Iems suc as oxygen equipmen and supplies, weelcairs, walkers, andospial beds ordered by a docor or oer eal care provider enrolled

in Medicare or use in e ome. Some iems mus be rened. You pay20% o e Medicare-approved amoun, and e Par B deducibleapplies. In all areas o the country, you must get your coveredequipment or supplies and replacement or repair services rom aMedicare-approved supplier or Medicare to pay.

For more inormaion, visi p://go.usa.gov/lo o view a copy oMedicare Coverage o Durable Medical Equipmen and Oer Devices.You can also call 1-800-MEDICARE (1-800-633-4227) o nd ou i acopy can be mailed o you. Y users sould call 1-877-486-2048.

NewMedicare is pasing in a new program called compeiivebidding o elp save you and Medicare money; ensure a youconinue o ge qualiy equipmen, supplies, and services; and elplimi raud and abuse. In some areas o the country i you needcertain items, you must use specic suppliers, or Medicare wontpay or the item and you likely will pay ull price. Its importantto see i youre afected by this new program to ensure Medicarepayment and avoid any disruption o service.

Tis program is efective in the ollowing states:CA, FL, IN, KS, KY, MO, NC, OH, PA, SC, X

In certain areas in the states listed above, you need to use specicsuppliers or Medicare to pay or the ollowing items:

Oxygen supplies and equipmen

Sandard power weelcair, scooer, and relaed accessories

Cerain complex reabiliaive power weelcairs and relaedaccessories

Mail-order diabees supplies Eneral nuriens, equipmen, and supplies

Hospial beds and relaed accessories

Coninuous Posiive Airway Pressure (CPAP) devices andRespiraory Assis Devices (RADs) and relaed suppliesand accessories

Walkers and relaed accessories

Suppor suraces including cerain maresses and overlays

(Miami, For Lauderdale, and Pompano Beac only)
http://go.usa.gov/lohhttp://go.usa.gov/loh


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Durable

Medical

Equipment(like walkers)

(continued)

I youre currently renting or need durable medicalequipment or supplies and have any questions

about whats covered or about suppliers, you can getinormation in one o the ollowing ways:

Visi www.medicare.gov/supplier. Medicare-approvedsuppliers are lised. Te specic suppliers you need ouse or is new program will ave a symbol beside eirnames.

Call 1-800-MEDICARE (1-800-633-4227). Y userssould call 1-877-486-2048.

Call your Sae Heal Insurance Assisance Program(SHIP) or ree eal insurance counseling andpersonalized elp undersanding ese canges. See pages123126 or e elepone number.

EKG Screening Medicare covers a one-ime screening EKG i orderedby your docor as par o your one-ime Welcome oMedicare pysical exam. See page 39. You pay e docor20% o e Medicare-approved amoun, and e Par B

deducible applies. An EKG is also covered as a diagnosices. See page 42. I you ave e es a a ospial ora ospial-owned clinic, you also pay e ospial acopaymen.

Emergency

Department

Services

Wen you ave an injury, a sudden illness, or an illnessa quickly ges muc worse. You pay a speciedcopaymen or e ospial emergency deparmen visi,and you pay 20% o e Medicare-approved amoun ore docors services. Te Par B deducible applies.

Eyeglasses

(limited)

One pair o eyeglasses wi sandard rames (or one seo conac lenses) aer caarac surgery a implans aninraocular lens. You pay 20% o e Medicare-approvedamoun, and e Par B deducible applies.

Federally

Qualifed

Health Center

Services

Includes many oupaien primary care and preveniveservices you ge roug cerain communiy-based organizaions. Generally, you pay 20% o eMedicare-approved amoun.
http://www.medicare.gov/supplierhttp://www.medicare.gov/supplier


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Flu Shots Generally covered once per fu season in e all or winer.You pay noing or e fu so i e docor or oer eal

care provider acceps assignmen or giving e so. You paynoing i your docor acceps assignmen or giving e so.

Foot Exams and

Treatment

I you ave diabees-relaed nerve damage and/or mee ceraincondiions. You pay e docor 20% o e Medicare-approvedamoun, and e Par B deducible applies. In a ospialoupaien seing, you also pay e ospial a copaymen.

Glaucoma Tests Covered once every 12 mons or people a ig risk or eeye disease glaucoma. Youre a ig risk i you ave diabees,a amily isory o glaucoma, are Arican-American and 50

or older, or are Hispanic and 65 or older. An eye docor wois legally allowed by e sae mus do e ess. You pay edocor 20% o e Medicare-approved amoun, and e Par Bdeducible applies or e docors visi. In a ospial oupaienseing, you also pay e ospial a copaymen.

Hearing and

Balance Exams

I your docor orders ese ess o see i you need medicalreamen. You pay e docor 20% o e Medicare-approvedamoun, and e Par B deducible applies. In a ospialoupaien seing, you also pay e ospial a copaymen.

Note: Medicare doesn cover earing aids and exams or ingearing aids.

Hepatitis B

Shots

Covered or people a ig or medium risk or Hepaiis B.Your risk or Hepaiis B increases i you ave emopilia,End-Sage Renal Disease (ESRD), or cerain condiions aincrease your risk or inecion. Oer acors may increase yourrisk or Hepaiis B, so ceck wi your docor. You pay noingor e so i e docor acceps assignmen.

HIV Screening Medicare covers HIV (Human Immunodeciency Virus)

screening or people wi Medicare o any age wo ask ore es, pregnan women, and people a increased risk ore inecion. Medicare covers is es once every 12 monsor up o 3 imes during a pregnancy. You pay noing ore es, bu you generally ave o pay e docor 20% o eMedicare-approved amoun or e docors visi.


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Home Health

Services

Covers medically-necessarypar-ime or inermien skillednursing care, or pysical erapy, speec-language paology,

or a coninuing need or occupaional erapy. A docorenrolled in Medicare, or cerain eal care providers wowork wi e docor, mus see you beore e docor canceriy a you need ome eal services. Ta docor musorder your care, and a Medicare-ceried ome eal agencymus provide i. Home eal services may also includemedical social services, par-ime or inermien omeeal aide services, durable medical equipmen, and medicalsupplies or use a ome. You mus be omebound, wicmeans a leaving ome is a major eor. You pay noing or

covered ome eal services. For Medicare-covered durablemedical equipmen inormaion, see pages 3435.

Kidney Dialysis

Services and

Supplies

For people wi End-Sage Renal Disease (ESRD). Medicarecovers dialysis eier in a aciliy or a ome wen your docororders i. You pay 20% o e Medicare-approved amounpersession, and e Par B deducible applies.

Kidney Disease

Education

Services

Medicare may cover up o six sessions o kidney diseaseeducaion services i you ave Sage IV cronic kidneydisease, and your docor reers you or e service. You

pay 20% o e Medicare-approved amoun, and e Par Bdeducible applies.

Mammograms

(screening)

A ype o X-ray o ceck women or breas cancer. Medicarecovers screening mammograms once every 12 monsor women 40 and older. Medicare covers one baselinemammogram or women beween 3539. You pay noing ore es i e docor acceps assignmen.

Medical

NutritionTherapy

Services

Medicare may cover medical nuriion erapy and cerainrelaed services i you ave diabees or kidney disease, or youave ad a kidney ransplan in e las 36 mons, and yourdocor reers you or e service. You pay noing or eseservices i e docor acceps assignmen.


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Outpatient Medical

and Surgical

Services andSupplies

For approved procedures (like X-rays, a cas, or sices).You pay e docor 20% o e Medicare-approved

amoun or e docors services. You also pay e ospiala copaymen or eac service you ge in a ospialoupaien seing. For eac service, e copaymen canbe more an e Par A ospial say deducible. Seepage 132. Te Par B deducible applies, and you pay allcarges or iems or services a Medicare doesn cover.

Pap Tests and Pelvic

Exams (includes

clinical breast exam)

Cecks or cervical, vaginal, and breas cancers. Medicarecovers ese screening ess once every 24 mons, oronce every 12 mons or women a ig risk, and or

women wo ave Medicare and are o cild-bearing agewo ave ad an exam a indicaed cancer or oerabnormaliies in e pas 3 years. You pay noing or ePap lab es, Pap es specimen collecion, and pelvic andbreas exams i e docor acceps assignmen.

Physical Exams

Note: Your rs yearlyWellness exam canake place wiin12 mons o yourWelcome o Medicarepysical exam.

Medicare covers two types o physical examsonewhen youre new to Medicare and one each yearaer that.

Welcome to Medicare physical examA one-ime

review o your eal, educaion and counselingabou prevenive services, and reerrals or oer carei needed. Medicare will cover is exam i you get itwithin the rst 12 months you have Part B. You paynoing or e exam i e docor acceps assignmen.Wen you make your appoinmen, le your docorsoce know a you would like o scedule yourWelcome o Medicare pysical exam. Keep in mind,you dont need to get the Welcome to Medicarephysical exam beore getting a yearly Wellness

exam. Yearly Wellness examI youve ad Par B or

longer an 12 mons, you can ge a yearly wellnessvisi o develop or updae a personalized prevenionplan based on your curren eal and risk acors.You pay noing or is exam i e docor accepsassignmen. Tis exam is covered once every 12 mons.


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Physical

Therapy

Evaluaion and reamen or injuries and diseasesa cange your abiliy o uncion wen your docor

ceries your need or i. Tere may be limis on eseservices and excepions o ese limis. You pay 20%o e Medicare-approved amoun, and e Par Bdeducible applies.

Pneumococcal

Shot

Helps preven pneumococcal inecions (like cerain ypeso pneumonia). Mos people only need is so once ineir lieime. alk wi your docor. You pay noing i edocor or supplier acceps assignmen or giving e so.

PrescriptionDrugs (limited)

Includes a limied number o drugs suc as injecions youge in a docors oce, cerain oral cancer drugs, drugsused wi some ypes o durable medical equipmen (likea nebulizer or exernal inusion pump) and under verylimied circumsances, cerain drugs you ge in a ospialoupaien seing. You pay 20% o e Medicare-approvedamoun or ese covered drugs.

I e covered drugs you ge in a ospial oupaienseing are par o your oupaien services, you pay ecopaymen or e services. However, i you ge oer ypeso drugs in a ospial oupaien seing (someimes calledsel-adminisered drugs or drugs you would normallyake on your own), wa you pay depends on weer youave Par D or oer prescripion drug coverage, weeryour drug plan covers e drug, and weer e ospialsparmacy is in your drug plans nework. Conac yourprescripion drug plan o nd ou wa you pay or drugsyou ge in a ospial oupaien seing a aren coveredunder Par B. See page 81 or more inormaion.

Oer an e examples above, you pay 100% or mosprescripion drugs, unless you ave Par D or oer drugcoverage.


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Prostate Cancer

Screenings

Medicare covers a digial recal exam and ProsaeSpecic Anigen (PSA) es once every 12 mons

or men over 50 (coverage or is es begins eday aer your 50 birday). You pay noingor e PSA es. You pay e docor 20% o eMedicare-approved amoun, and e Par Bdeducible applies or e docors visi. In a ospialoupaien seing, you also pay e ospial acopaymen.

Prosthetic/Orthotic

Items

Includes arm, leg, back, and neck braces; aricialeyes; aricial limbs (and eir replacemen pars);some ypes o breas proseses (aer masecomy);and proseic devices needed o replace an inernalbody par or uncion (including osomy supplies,and pareneral and eneral nuriion erapy) wenyour docor orders i. For Medicare o cover yourproseic or oroic, you mus go o a suppliera is enrolled in Medicare. You pay 20% oe Medicare-approved amoun, and e Par Bdeducible applies.

Pulmonary

Rehabilitation

Medicare covers a compreensive pulmonaryreabiliaion program i you ave moderae o

very severe cronic obsrucive pulmonary disease(COPD) and ave a reerral rom e docor reaingyour cronic respiraory disease. You pay e docor20% o e Medicare-approved amoun i you ge eservice in a docors oce. You also pay e ospiala copaymen per session i you ge e service in a

ospial oupaien seing.Rural Health Clinic

Services

Includes many oupaien primary care services.You pay 20% o e amoun carged, and e Par Bdeducible applies.

Second Surgical

Opinions

Covered in some cases or surgery a isn anemergency. In some cases, Medicare covers irdsurgical opinions. You pay 20% o e Medicare-approved amoun, and e Par B deducible applies.


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Smoking

Cessation

(counseling tostop smoking)

NEW

Includes up o 8 ace-o-ace visis in a 12-mon period iyoure diagnosed wi an illness caused or complicaed by

obacco use, or you ake a medicine a is aeced by obacco.You pay e docor 20% o e Medicare-approved amoun, ande Par B deducible applies. In a ospial oupaien seing,you also pay e ospial a copaymen.

Medicare coverage o smoking cessaion counseling is nowconsidered a covered prevenive service i you aven beendiagnosed wi an illness caused or complicaed by obacco use.You pay noing or e counseling sessions.

Speech

LanguagePathology

Services

Evaluaion and reamen given o regain and srengen speec

and language skills including cogniive and swallowing skillswen your docor ceries you need i. Tere may be limis onese services and excepions o ese limis. You pay 20% o eMedicare-approved amoun, and e Par B deducible applies.

Surgical

Dressing

Services

For reamen o a surgical or surgically-reaed wound. You pay20% o e Medicare-approved amoun or e docors services.You pay a xed copaymen or ese services wen you ge emin a ospial oupaien seing. You pay noing or e supplies.Te Par B deducible applies.

Telehealth Includes a limied number o medical or oer eal services,like oce visis and consulaions provided using an ineracivewo-way elecommunicaions sysem (like real-ime audioand video) by an eligible provider wo isn a your locaion.Available in some rural areas, under cerain condiions, andonly i youre locaed a one o e ollowing places: a docorsoce, ospial, rural eal clinic, ederally-qualied ealcener, ospial-based dialysis aciliy, skilled nursing aciliy,or communiy menal eal cener. You pay 20% o e

Medicare-approved amoun, and e Par B deducible applies.Tests (other

than lab tests)

Includes X-rays, MRIs, C scans, EKGs, and some oerdiagnosic ess. You pay 20% o e Medicare-approvedamoun, and e Par B deducible applies. I you ge e es a aospial as an oupaien, you also pay e ospial a copaymena may be more an 20% o e Medicare-approved amoun,bu i can be more an e Par A ospial say deducible.See page 132. See Clinical Laboraory Services on page 31 oroer Par B-covered ess.


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Transplants and

Immunosuppressive

Drugs

Includes docor services or ear, lung, kidney,pancreas, inesine, and liver ransplans under cerain

condiions and only in a Medicare-ceried aciliy.Medicare covers bone marrow and cornea ransplansunder cerain condiions.

Immunosuppressive drugs are covered i Medicarepaid or e ransplan, or an employer or uniongroup eal plan was required o pay beoreMedicare paid or e ransplan. You mus avebeen eniled o Par A a e ime o e ransplan,and you mus be eniled o Par B a e ime you

ge immunosuppressive drugs. You pay 20% oe Medicare-approved amoun, and e Par Bdeducible applies.

I youre inking abou joining a Medicare AdvanagePlan and are on a ransplan waiing lis or believe youneed a ransplan, ceck wi e plan beore you joino make sure your docors and ospials are in eplans nework. Also, ceck e plans coverage rules orprior auorizaion.

Note: Medicare drug plans (Par D) may coverimmunosuppressive drugs, even i Medicare or anemployer or union group eal plan didn pay ore ransplan.


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Preventive Services Checklistake is cecklis o your docor or oer eal care provider, and askwic prevenive services are rig or you. You can also keep rack oyour prevenive services by visiing www.MyMedicare.gov. See page 118.

MedicareCovered Preventive Service Details

on page

Notes

Abdominal Aoric Aneurysm Screening 30

Bone Mass Measuremen 31

Cardiovascular Screenings 31

Colorecal Cancer Screenings 32

Fecal Occul Blood es 32

Flexible Sigmoidoscopy 32

Colonoscopy 32

Barium Enema 32

Diabees Screenings 33

Diabees Sel-managemen raining 33

Flu Sos 36

Glaucoma ess 36

Hepaiis B Sos 36HIV Screening 36

Mammogram (screening) 37

Medical Nuriion Terapy Services 37

Pap es and Pelvic Exam(includes breas exam)

39

Physical Exams 39

One-time Welcome to Medicare

physical exam

39

Yearly Wellness exam 39

Pneumococcal So 40

Prosae Cancer Screenings 41

Smoking Cessaion(counseling o sop smoking or peoplewi no sign o disease)

42

For some services, you will need o wai a cerain amoun o ime beore geing e

service again. See e page numbers lised or more inormaion.
http://www.mymedicare.gov/http://www.mymedicare.gov/


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Whats NOT Covered by Part A and Part B?Medicare doesn cover everying. I you need cerain servicesa Medicare doesn cover, you will ave o pay or em yourselunless you ave oer insurance o cover e coss. Even iMedicare covers a service or iem, you generally ave o paydeducibles, coinsurance, and copaymens.

Some o e iems and services a Medicare doesn cover includee ollowing:

Long-erm care. See pages 110112.

Rouine denal care.

Denures.

Cosmeic surgery. Acupuncure.

Hearing aids.

Exams or ing earing aids.

o nd ou i Medicare covers a service you need, visiwww.medicare.gov/coverage. Call 1-800-MEDICARE(1-800-633-4227) or general coverage inormaion. Y userssould call 1-877-486-2048.

Blue words

in the textare dened

on pages

127130.
http://www.medicare.gov/coveragehttp://www.medicare.gov/coverage


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47

SECTION 2

Your

Medicare

Choices

Section 2 includes inormation about the ollowing:

Decide How o Ge Your Medicare . . . . . . . . . . . . . . . . 48

Your Medicare Coverage Coices . . . . . . . . . . . . . . . . . 49

Tings o Consider Wen Coosing orCanging Your Coverage . . . . . . . . . . . . . . . . . . . . 50

Original Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Medigap . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

Medicare Advanage Plans (Par C) . . . . . . . . . . . . . . . . 60

Oer Medicare Heal Plans . . . . . . . . . . . . . . . . . . . 70

Medicare Prescripion Drug Coverage (Par D) . . . . . . . . . 72

How Oer Insurance Works wi Medicare . . . . . . . . . . . 84

Tis handbook has basic inormation. You will need moredetailed inormation than this handbook provides to make achoice. Beore making any decisions, learn as much as you canabout the types o coverage available to you. See page 48 to gethelp with your Medicare decisions.


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48 Section 2Your Medicare Choices

Decide How to Get Your MedicareYou can coose dieren ways o ge your Medicare coverage. I youcoose Original Medicare and you wan prescripion drug coverage,you mus also join a Medicare Prescripion Drug Plan (Par D).I you coose o join a Medicare Advanage Plan (like an HMOor PPO), e plan usually includes Medicare prescripion drugcoverage. I you don coose a Medicare Advanage Plan or oerMedicare eal plan, you will ave Original Medicare. See e nexpage or more inormaion abou your coverage coices, and edecisions you need o make.

Note: I you ave End-Sage Renal Disease (ESRD), you will usuallyge your eal care roug Original Medicare. See page 64 or

more inormaion.

Eac year in e all, you sould review your eal andprescripion needs because your eal, nances, or plans coveragemay ave canged. I you decide oer coverage will beer meeyour needs, you can swic plans during cerain imes. See pages 68and 73. I youre saised wi your curren plans coverage or eollowing year, you don need o cange plans.

Need Help Deciding?1. Visi www.medicare.gov/nd-a-plan o nd and compare plansin your area.

2. Ge ree personalized counseling abou coosing coverage. Seepages 123126 or e elepone number o your Sae HealInsurance Assisance Program (SHIP).

3. Call 1-800-MEDICARE (1-800-633-4227), and say Agen.Y users sould call 1-877-486-2048. I you need elp in alanguage oer an Englis or Spanis, le e cusomer service

represenaive know.

See pages 102103 o nd ou ow Original Medicare or a Medicareplanyou may join uses and releases your personal inormaion.


are dened

on pages

127130.
http://www.medicare.gov/find-a-planhttp://www.medicare.gov/find-a-plan


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50 Section 2Your Medicare Choices

Things to Consider When Choosing or Changing Your Coverage

Coverage Are e services you need covered?

Your other

coverage

Do you ave, or are you eligible or, oer ypes o eal orprescripion drug coverage (like rom a ormer or currenemployer or union)? I so, read e maerials rom your insureror plan, or call em o nd ou ow e coverage works wi, oris aeced by, Medicare. I you ave coverage roug a ormer orcurren employer or union or oer source, alk o your benesadminisraor, insurer, or plan beore making any canges o yourcoverage. I you drop your coverage, you may no be able o gei back.

Cost

How muc are your premiums, deducibles, and oer coss? Howmuc do you pay or services like ospial says or docor visis?Was e yearly limi on wa you pay ou-o-pocke? Your coss

vary and may be dieren i you don ollow e coverage rules.

Doctor and

hospital

choice

Do your docors accep e coverage? Are e docors you wan osee acceping new paiens? Do you ave o coose your ospialand eal care providers rom a nework? Do you need reerrals?

Prescription

drugs

Do you need o join a Medicare drug plan? Do you already avecrediable prescripion drug coverage? Will you pay a penaly i you

join a drug plan laer? Wa will your prescripion drugs cos undereac plan? Are your drugs covered under e plans ormulary? Areere any coverage rules a apply o your prescripions?

Quality o

care

Are you saised wi your care? Te qualiy o care and servicesgiven by plans and oer eal care providers can vary. Medicareas inormaion o elp you compare plans and providers. See

page 119.

Convenience

Were are e docors oces? Wa are eir ours? Wicparmacies can you use? Can you ge your prescripions bymail? Do e docors use elecronic eal records or prescribeelecronically? See page 120.

Travel Will e plan cover you in anoer sae or ouside e U.S.?


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52 Section 2Your Medicare Choices Original Medicare

What You PayYour ou-o-pocke coss in Original Medicare depend on e ollowing:

Weer you ave Par A and/or Par B. Mos people ave bo.

Weer your docor or supplier acceps assignmen. See enex page.

Te ype o eal care you need and ow oen you need i.

Weer you coose o ge services or supplies Medicare doesn cover.I you do, you pay all e coss unless you ave oer insurance acovers i.

Weer you ave oer eal insurance (like employer or unioncoverage) a works wi Medicare.

Weer you ave Medicaid or ge sae elp paying yourMedicare coss.

Weer you ave a Medigap (Medicare Supplemen Insurance) policy.

Weer you and your docor sign a privae conrac. See page 55.

For more inormaion on ow oer insurance works wi Medicare,see page 84. For more inormaion abou elp o cover e coss aOriginal Medicare doesn cover, see pages 5759 and 90.

Medicare Summary NoticesI you ge a Medicare-covered service, you will ge a Medicare SummaryNoice (MSN) in e mail every 3 mons. Te MSN sows all yourservices or supplies a providers and suppliers billed o Medicareduring e 3-mon period, wa Medicare paid, and wa you owe eprovider. Te MSN isnt a bill. Read i careully and do e ollowing:

I you ave oer insurance, ceck o see i i covers anying aMedicare didn.

Keep your receips and bills, and compare em o your MSN

o be sure you go all e services, supplies, or equipmen lised.See pages 105107 or inormaion on Medicare raud.

I you paid a bill beore you go your MSN, compare your MSN wie bill o make sure you paid e rig amoun or your services.

I an iem or service is denied, call your docors oce o make sureey submied e correc inormaion. I no, e oce may resubmi.I you wan o le an appeal, see pages 9596.


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Keeping Your Costs Down with Assignment

(continued)Heres wa appens i your docor, provider, or supplier doesnt

accept assignmen: Teyre supposed o submi a claim o Medicare wen ey give you

Medicare-covered services. Tey can carge you or submiinga claim. I ey don submi e claim once you ask em o, call1-800-MEDICARE (1-800-633-4227). Y users sould call1-877-486-2048.

Note: You mig ave o pay e enire carge a e ime o service,and en submi your claim o Medicare o ge paid back using ormCMS-1490S. Visi www.medicare.gov/medicareonlineorms or e

orm and insrucions, or call 1-800-MEDICARE.

Tey may carge you more an e Medicare-approved amoun, buere is a limi called e limiing carge. Tey can only carge youup o 15% over e Medicare-approved amoun. Te limiing cargeapplies only o cerain services and doesn apply o some suppliesand durable medical equipmen.

o nd ou i your docors and suppliers accep assignmen orparicipae in Medicare, visi www.medicare.gov/pysician or

www.medicare.gov/supplier. You can also call 1-800-MEDICARE, orask your docor, provider, or supplier i ey accep assignmen.

Note: I you need ome eal care or durable medicalequipmen, your care mus be ordered by a docor or oereal care provider wo is enrolled in Medicare.
http://www.medicare.gov/medicareonlineformshttp://www.medicare.gov/physicianhttp://www.medicare.gov/supplierhttp://www.medicare.gov/supplierhttp://www.medicare.gov/physicianhttp://www.medicare.gov/medicareonlineforms


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55Section 2Your Medicare Choices Original Medicare

What to Know About Private ContractsA privae conrac is a wrien agreemen beween you anda docor or oer eal care provider wo as decided no oprovide services o anyone roug Medicare. Te privae conraconly applies o e services provided by e docor or oerprovider wo asked you o sign i. You don ave o sign a privaeconrac. You can always go o anoer provider wo gives servicesroug Medicare. I you sign a privae conrac wi your docoror oer provider, e ollowing rules apply:

Medicare wont pay any amount or the services you get romthis doctor or provider.

You will ave o pay e ull amoun o waever is provider

carges you or e services you ge. I you ave a Medigap (Medicare Supplemen Insurance)

policy, i won pay anying or e services you ge. Call yourMedigap insurance company beore you ge e service i youave quesions.

Your provider mus ell you i Medicare would pay or e servicei you go i rom anoer provider wo acceps Medicare.

Your provider mus ell you i e or se as been excludedrom Medicare.

You can be asked o sign a privae conrac or emergency orurgen care.

Youre always ree o ge services no covered by Medicare i youcoose o pay or a service yoursel.

You may wan o conac your Sae Heal Insurance AssisanceProgram (SHIP) o ge elp beore signing a privae conrac wiany docor or oer eal care provider. See pages 123126 or e

elepone number.

See pages 94107 or inormaion abou your appeal rigs andow o proec yoursel and Medicare rom raud.


are dened

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Adding Medicare Drug Coverage (Part D)In Original Medicare, i you dont already have creditableprescription drug coverage (or example, rom a curren or ormeremployer or union) and you would like Medicare prescripiondrug coverage, you mus join a Medicare Prescripion Drug Plan.Tese plans are available roug privae companies under conracwi Medicare. I you don currenly ave crediable prescripiondrug coverage, you sould ink abou joining a MedicarePrescripion Drug Plan as soon as youre eligible. I you don join aMedicare Prescripion Drug Plan wen youre rs eligible and youdecide o join laer, you may ave o pay a lae enrollmen penaly.See pages 7879 or more inormaion.

I you have creditable prescription drug coverage rom anemployer or union, call your employer or unions benesadminisraor beore you make any canges o your coverage.Your employer or union plan will ell you eac year i yourprescripion drug coverage is crediable prescripion drug coverage.I you drop your employer or union coverage, you may no be able oge i back. You also may no be able o drop your employer or uniondrugcoverage wiou also dropping your employer or union health(docor and ospial) coverage. I you drop coverage or yoursel, you

may also ave o drop coverage or your spouse and dependans.

Extra Help Paying or CoveragePeople wi limied income and resources may qualiy or ExraHelp paying eir Medicare prescripion drug coverage coss.See pages 8689 o nd ou i you may qualiy or Exra Help.


are dened

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57Section 2Your Medicare Choices Medigap

Medigap (Medicare Supplement Insurance) PoliciesOriginal Medicare pays or many, bu no all, eal care services andsupplies. A Medigap policy, sold by privae insurance companies, canelp pay some o e eal care coss (gaps) a Original Medicaredoesn cover, like copaymens, coinsurance, and deducibles. SomeMedigap policies also oer coverage or services a Original Medicaredoesn cover, like medical care wen you ravel ouside e U.S. I youave Original Medicare and you buy a Medigap policy, Medicare will payis sare o e Medicare-approved amoun or covered eal care coss.Ten your Medigap policy pays is sare. Medicare doesn pay any o epremiums or a Medigap policy.

Every Medigap policy mus ollow Federal and sae laws designed o

proec you, and i mus be clearly idenied as Medicare SupplemenInsurance. Medigap insurance companies can sell you only asandardized Medigap policy idenied in mos saes by leers.All plans oer e same basic benes bu some oer addiional benes,so you can coose wic one mees your needs.

Note: In Massacuses, Minnesoa, and Wisconsin, Medigap policies aresandardized in a dieren way.

Te types o Medigap Plans that you can buy changed: Tere are wo new Medigap PlansPlans M and N.

Plans E, H, I, and J are no longer available o buy. I you bougPlan E, H, I, or J beore June 1, 2010, you can keep a plan.Conac your plan or more inormaion.

Insurance companies may charge diferent premiums or exactly thesame Medigap coverage. As you sop or a Medigap policy, be sureyoure comparing e same Medigap policy (or example, compare Plan A

rom one company wi Plan A rom anoer company).

In some saes, you may be able o buy anoer ype o Medigap policycalled Medicare SELEC (a Medigap policy a requires you o usespecic ospials and, in some cases, specic docors o ge ull coverage).I you buy a Medicare SELEC policy, you also ave rigs o cangeyour mind wiin 12 mons and swic o a sandard Medigap policy.


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58 Section 2Your Medicare Choices Medigap

More About Medigap Policies You mus ave Par A and Par B.

You pay a monlypremium or your Medigap policy in addiion

o your monly Par B premium. A Medigap policy only covers one person. Spouses mus buy

separae policies.

Is imporan o compare Medigap policies since e coss can varyand may go up as you ge older. Some saes limi Medigap coss.

Te bes ime o buy a Medigap policy is during e 6-monperiod a begins on e rs day o e mon in wic youre65 or older and enrolled in Par B. (Some saes ave addiionalopen enrollmen periods.) Aer is enrollmen period, your

opion o buy a Medigap policy may be limied and i may cosmore. For example, i you urn 65 and are enrolled in Par B inJune, e bes ime or you o buy a Medigap policy is rom Juneo November.

I youre under 65, you won ave is open enrollmen periodunil you urn 65, bu sae law mig give you a rig o buy apolicy beore en.

I you ave a Medigap policy and join a Medicare Advanage Plan(like an HMO or PPO), you may wan o drop your Medigappolicy. Your Medigap policycant be used o pay your MedicareAdvanage Plan copaymens, deducibles, and premiums. I youwan o cancel your Medigap policy, conac your insurancecompany. I you drop your policy o join a Medicare AdvanagePlan, in mos cases you won be able o ge i back.

I you ave a Medicare Advanage Plan, is illegal or anyone osell you a Medigap policy unless youre swicing back o OriginalMedicare. Conac your Sae Insurance Deparmen i is

appens o you.


are dened

on pages

127130.


59/136

59Section 2Your Medicare Choices Medigap

More About Medigap Policies (continued) I you join a Medicare eal plan or e rs ime, and you aren

appy wi e plan, you will ave special rigs o buy a Medigappolicy i you reurn o Original Medicare wiin 12 mons o

joining.

I you ad a Medigap policy beore you joined, you maybe able o ge e same policy back i e company sillsells i. I i isn available, you can buy anoer Medigappolicy.

Te Medigap policy can no longer ave prescripion drugcoverage even i you ad i beore, bu you may be able o

join a Medicare Prescripion Drug Plan.

I you joined a Medicare eal plan wen you were rseligible or Medicare, you can coos

Documents

2011 Medicare & You Booklet