MEDICARE CORNER
Review and Reminders
NOTE: If you receive your health
care coverage from any of the following
Agencies check with your
Human Resource Administrator:
• Before making any changes in
your health care plan or prescription
drug coverage
• For Explanation of your costs
sharing
AGENCIES
• Federal Employees Health
Benefits (FEHB) Program
• TRICARE
• Veterans’ Health Insurance
• Railroad Retirement Insurance
• Indian Health Services (IHS)
• Union Retiree Health Coverage
• Employee Retiree Health
Coverage
AS PER NEW YORK CITY OFFICE
OF LABOR RELATIONS
(NYC OLR)
“In order to maintain maximum
coverage through the City of New
York Health Benefits Program, all
retirees are required to enroll in
Medicare Parts A and B immediately
upon becoming eligible due
to age or disability.”
For updated information on
health benefits, health plans, forms,
including IRMAA forms and other
related information, visit the NYC
OLR website www.nyc.gov/olr
REMINDERS (ORIGINAL MEDICARE)
1.Doctors /Providers /Services
To Locate Medicare Fully
Participating and/or Non-
Participating (Accepts
Assignment) Doctors or
Providers visit the following
website: Medicare.gov/physician
or Medicare.gov/supplier
or call 1-800-Medicare
2. Medicare Summary
Notices (MSN)
If you are enrolled in Original
Medicare you will receive
Medicare Summary Notices
every three months in the mail.
It is NOT a bill. The column
referring to “you may be billed”
does not necessarily mean “you
will be billed.” MSN informs you
about services billed to Medicare
and how much you may owe a
provider including the Part B
deductible. Review your MSN.
If you have not received a listed
service or equipment, report this
to 1-800-MEDICARE.
3 . D u r a b l e M e d i c a l
Equipment (DME)
DME suppliers enrolled in
Medicare must follow Medicare
guidelines and rules. They must
submit “claims for services”
directly to Medicare. If the
DME supplier is not enrolled
in Medicare, there is no limit to
the amount you can be charged
and there is no oversight of the
equipment by Medicare. To
locate a Medicare Approved
DME Supplier, visit the website:
Medicare.gov/supplierdirectory
or call 1-800-Medica
4. FULLY PARTICIPATING
MEDICARE DOCTORS OR
PROVIDERS…
By law accept Medicare
Approved Amount as payment
in full for services. They bill
Medicare directly. You may be
charged the Part B Deductible
and copayments where
indicated.
5. NON-PARTICIPATING
DOCTORS OR PROVIDERS (
ACCEPTS ASSIGNMENT)…
Are not required by law to
accept Medicare Approved
Amount as payment in full.
They can require you to pay at
the time you receive services.
They cannot charge above the
“limiting amount charge.” The
Limiting Amount in New York
City is 15% above the Medicare
Approved Amount.
The “limiting amount charge”
does not apply to equipment or
supplies or what Medicare does
not cover. Non-Participating
Doctors or Providers are
required to submit a “claim
for Medicare covered services
directly to Medicare.
6. Opt-Out Doctors or Providers
Doctors or Providers not
enrolled in the Medicare
Program are referred to as Opt-
Out. To receive their services
you and the Doctor or Provider
have entered into a signed
contract which you will pay in
full all charges for services you
receive.
Medicare does not pay for services
you receive from Opt-Out
Doctors or Providers. Exception
is when an Opt-Out Doctor or
Provider provides emergency
medically necessary care.
7. Concierge Care
You are required by the Doctor
to pay a Membership Fee prior
to receiving services. These
Doctors are required to follow
Medicare Rules.
8. Medicare Advantage Plans
Doctors /Providers/Services
Are referred to as PART C
or MA Plans. MA Plans are
Medicare Approved Private
Plans. You are required to follow
the rules of your MA Plan .
You will have a Medicare Card
and a card from your MA Plan.
In most cases you are required
to use the card issued by your
MA Plan. Your Medicare Part B
and Part A services are covered
by the MA Plan not by Original
Medicare.
Official U.S. Government Site for Medicare and Medicaid Services is https www medicare gov.
20 NORTH SHORE TOWERS COURIER ¢ April 2019
/supplier
/olr
/olr
/supplier