MEDICARE CORNER
Are You Having Trouble Falling Asleep?
BY FELICE HANNAH
I have a suggestion. Get comfy
and open the “Medicare and
You” Handbook 2018. Oh dear,
you’re falling asleep at the mere
mention of the name. Okay, I will
refer to it as “that book” in this
article.
This article will highlight important
information and references in
“that book.” You’ll discover that
many questions you have about
Medicare can be found in “that
book.”
YOUR MEDICARE CHOICES
Answers to the following questions
can be found on pages 4–5
of “that book.”
What are the differences in
Original Medicare and Medicare
Advantage Plans (Part C) and can
you enroll in both at the same time?
If I am enrolled in Original
Medicare should I add:
• Part D Plan
• Medigap Policy
If I am enrolled in a Medicare
Advantage Plan, am I covered for:
• Hospitalization
• Part D
ENROLLING IN MEDICARE
Answers to the following questions
can be found on pages 19–28
of “that book”:
• How do I enroll in Medicare Part
A and Part B?
• When should I enroll in Medicare
Part A/Medicare Part B?
• What is meant by “late enrollment
penalties”?
• Is there a monthly premium for
Part A /Part B?
UNDERSTANDING WHAT
MEDICARE COVERS
Note: Medicare does not pay for
custodial care. Medicare pays for
Medically Necessary and Medicare
Approved Services.
Answers to the following questions
can be found on pages 29–59
in “that book”:
• Is there a coinsurance and or
deductible cost for Part A and/
or Part B?
• Do deductibles reset each year?
• What are “Inpatient Benefit
Periods” and can I have more
than one inpatient benefit period
in a calendar year?
• What is meant by “Inpatient and
Outpatient” and how will I know
my status as a patient while in a
hospital?
• How do I qualify for Medicare
approved “Skilled Nursing
Facility and Rehabilitative
Services”? Does Medicare cover
the following?:
• Ambulatory Care Centers
• CPAP therapy
• Diabetes Supply
• Durable Medical Equipment
• Eyeglasses
• Hearing Aides
• Home Health Services
• Shingles Shots
• Immunosuppressive drugs
• Medically necessary care while
traveling outside the U.S.
UNDERSTANDING “ORIGINAL
MEDICARE”
Answers to the following questions
can be found on pages 61¬–64
in “that book”:
• What is a Medicare Summary
Notice?
• What is the difference between
the following doctors and
providers
• and what is my out of pocket
costs for each?
1. Fully accepts “assignment”
2. Participates in Medicare, but
does not fully accept assignment
3. Private Contract doctors and
or other health care providers
UNDERSTANDING MEDICARE
ADVANTAGE PLANS (PART C)
• Information is contained in
the “Evidence of Coverage and
Annual Notice of Change” can
be found on pages 65–78 in
“that book”
• How to read Medicare Advantage
and other Health Plans charts,
can be found on pages 130–131
(Note service area)
• List of Medicare Advantage and
other Health Plans, can be found
on pages 132–133e
• Understanding Medicare
Supplemental Polices (Medigap)
and the coordination with
Original Medicare, see pages
79–82
• List of Medigap Plans and costs
sharing for 2018, see page 80
• Understanding Prescription Drug
Coverage, see pages 83–96
• Knowing Your Rights, see pages
105 -116
• Information regarding Advance
Beneficiary Notice see pages
107-108
Note: The “Evidence of Coverage”
mailed by the Prescription Drug
Plan at the end of each year
(effective the following year) provides
information regarding Drug
Restrictions which reset each year.
Drug Restrictions include:
• Formulary
• Prior Authorization
• Quantity Limits
• Step Therapy
IF YOU NEED ADDITIONAL
ASSISTANCE AND/OR PERSONAL
SERVICE CONTACT:
• To get help 24 hours/seven days
a week, call “Medicare and You”
at 1-800-633-4227; TTY users
1-877-486-2048
• New York State Health
Information Counseling Program
(SHIP) 1-800-701-0501
• New York City Health Insurance
Information Counseling and
Assistance Program (HIICAP),
call 311 Monday–Friday, 9
a.m.–3 p.m.
NEW MEDICARE
CARDS ALERT
• New Medicare Cards will be
mailed out between April 2018
-April 2019.
• Mailing of the new cards take
time so exercise patience.
Although you are an important
person, so are millions of other
Medicare Beneficiaries.
• Social Security numbers will
no longer be used on Medicare
Cards.
• The New Number will be
exclusive to you.
• No one from Medicare or
Social Security will call you
about the new Medicare
Card to verify your personal
information.
• Make sure that your mailing
address is up to date
with the Social Security
Administration.
20 NORTH SHORE TOWERS COURIER ¢ April 2018