Your Guide on the Road to Medicare

Medicare Hospice Benefits

>>Click HERE for Printable Version or to Read Medicare Hospice Benefits Publication>>

New to Medicare? Low Income? Don't Have a Drug Plan Yet? Need to Pick Up Your Prescriptions?

The LI NET Program ensures that individuals with Medicare’s low-income subsidy (LIS), or “Extra Help,” who are not yet enrolled in a Part D prescription drug plan are still able to obtain immediate prescription drug coverage. 

>>Click HERE for Instructions for Pharmacy>>

https://www.cms.gov/files/document/medicarelinetbrochurefinal09182012508pdf.pdf 

Medicare and Vaccines: updated August 2014

DIABETES SCREENING

Medicare will pay for diabetes screening tests for the purpose of early detection for persons at risk for diabetes. Since these are clinical laboratory tests, the beneficiary will not be responsible for a deductible or coinsurance.

The screening includes:

• Fasting glucose test; and
• Other tests that may be deemed appropriate after
  consulting with appropriate organizations

A person is at risk if they have any of the following risk factors:

• High blood pressure or high cholesterol
• Obesity
• Previously elevated impaired fasting glucose
  or previously impaired glucose tolerance

At least two of the following characteristics:

• Overweight
• Family history of diabetes
• History of gestational diabetes,
  or delivery of a baby over 9 pounds
• 65 years of age or older

MEDICARE INTERNET SITE

You may use My Medicare to:
    * View claim status (excluding Part D claims),
    * Order a duplicate Medicare Summary Notice (MSN) or replacement Medicare card,
    * View eligibility, entitlement and preventive services information,
    * View enrollment information including prescription drug plans,
    * View or modify your drug list and pharmacy information,
    * View address of record with Medicare and Part B deductible status, and
    * Access online forms, publications and messages sent to you by CMS.

    

In order to use this service, you must be a registered user.

MEDICARE PRESCRIPTION DRUG "EXTRA HELP"

 Are you struggling to afford costs related to your Medicare prescription drug plan? If you are a Medicare beneficiary with limited income and assets, you may be eligible to receive “Extra Help,” also known as the Low Income Subsidy (LIS). Social Security offers Extra Help to reduce costs related to Medicare prescription drug plans such as monthly premiums, annual deductibles, and prescription co-payments. Contact your SHINE counselor to see if you qualify for Extra Help!

ARE YOU A HOSPITAL INPATIENT OR OUTPATIENT?

If You Have Medicare—Ask !

Did you know that even if you stay in the hospital overnight, you might still be considered an “outpatient”? Your hospital status (whether the hospital considers you an “inpatient” or outpatient”) affects how much you pay for hospital status may also affect whether Medicare will cover care you get in a skilled nursing
Facility (SNF).

An inpatient admission begins the day you’re formally admitted to the hospital with a doctor’s order. The day before you’re discharged is your last inpatient day. You’re an outpatient if you’re getting emergency department services, observation services, lab tests, or X-rays, and the doctor hasn’t written an order to admit you as an impatient even if you spend the night at the hospital.

If you’re in the hospital more than a few hours,
always ask your doctor or the hospital staff if you’re an inpatient or an outpatient.

Medicare Part A (Hospital Insurance) covers inpatient hospital services. Generally, this means you pay a one-time deductible for all of your hospital services for the first 60 days you’re in the hospital.

Medicare Part B (Medical Insurance) covers most of your doctor services when you’re an inpatient. You pay 20% of the Medicare-approved amount for doctor services after paying the Part B deductible.

Medicare Part B covers outpatient hospital and doctor services. Generally, this means you pay a co-payment For each outpatient hospital service. This amount may vary by service.

For more detailed information on how Medicare covers hospital services, including premiums, deductibles and co-payments, call 1-800-MEDICARE (1-800-633-4227).

Medicare Rights

As a hospital inpatient, you have the right to:

• Receive Medicare covered services. This includes medically necessary hospital services and services you may need after you are discharged, of ordered by your doctor. You have a right to know about these services, who will pay for them and where you can get them.
• Be involved in any decisions about your hospital stay, and know who will pay for it.

Report any concerns you have about the quality of care you receive to the Quality Improvement Organization
(QIO) at Masspro at 1-800-252-5533 (TTY 1-800-439-2370.)

Your Medicare discharge rights: During your hospital stay, the hospital staff will be working with you to prepare you for safe discharge and arrange for services you may need after you leave the hospital. When you no longer need inpatient hospital care,
your doctor or the hospital staff will inform you of your planned discharge date.

If you think you are being discharged too soon:

• You can talk to the hospital staff, your doctor and your managed care plan about your concerns.
• You also have the right to an appeal, that is , a review of your case by a Quality Improvement Organization (QIO). The QIO is an outside reviewer hired by Medicare to look at your case to decide whether you are ready to leave the hospital. To appeal, you must contact the QIO no later than your planned discharge date and before you leave the hospital.
• If you do not appeal, but decide to stay in the hospital past your planned discharge date, you may have to pay for any services you receive after that date.

To file an appeal or report any concerns you have about the quality of care you receive
Masspro 1-800-252-5533 (TTY 1-800-439-2390)

between 8:30 AM—5:00 PM

(If you call this helpline outside of normal business hours, be sure to listen carefully to the after-hours helpline message and follow the instructions.)
(published by the Department of Health & Human Services Centers for Medicare & Medicaid Services)

Medicare Appeals

AN IMPORTANT RIGHT FOR MEDICARE BENEFICIARIES

Sometimes, Medicare beneficiaries feel they have been released from hospital, nursing home, home health agency or hospice care before they are ready to leave. All Medicare beneficiaries, whether covered under Original Medicare or a Medicare Advantage Plan, have appeal rights. This means that trained medical professionals will review the beneficiary’s medical record and decide whether the beneficiary has been released too soon or whether the timing of the release was correct.

Below are some steps to follow if you feel you are being released from a hospital, nursing home, home
health agency or hospice too soon:

• Talk to your doctor about continuing your care.
• Ask your case manager or social worker for an official (written) Medicare notice.
• Follow the instructions on the notice. Masspro‘s helpline telephone number will be on the notice.
• Masspro will ask you for your views and review your medical record.
• You’ll be informed of Masspro’s decision first by phone and then by mail. At that time, you will also receive information about other appeal rights.

Call Masspro’s helpline at 1-800-252-5533, or Medicare at 1-800-MEDICARE (1-800-633-4227). You can call or you can ask a friend or family member to call for you.

$4.00 Medications

Wal-Mart, Target, Hannafords and Walgreen's all have a variety of generic medications offered for $4.00 each a month ! Also, for those with computers, you can go to www.needymeds.org to get free or no cost medications.

Extra Help from Social Security:

 

Extra Help is for Medicare recipients with limited income and resources. Some people qualify for full Extra Help, and some qualify for partial Extra Help, depending on income. Extra Help pays all or most of prescription drug plan monthly premiums and annual deductibles, and lowers the prescription drug copayments.
If you have Medicare, you can qualify for Extra Help if:

• you meet the Extra Help resource and income limits. See Extra Help Income and Resource Limits on the Social Security web site for current limits.
• you have MassHealth Standard (dual eligible), Medicare Buy-In (QMB, SLMB, or QI), or SSI. Medicare recipients in these categories automatically qualify for full Extra Help and do not have to file an application.

For more information about Extra Help:

• call Social Security at 1-800-772-1213 (TTY 1-800-325-0778). Social Security can answer your questions, send you an application, or take your application over the phone.
• see Understanding The Extra Help With Your Medicare Prescription Drug Plan on the Social Security web site, for income and resource limits, how to apply, tips on completing the application, and additional information.
• go to Extra Help with Medicare Prescription Drug Plan Costs to apply online on the Social Security web site.

For more info see MassResources.org>>

Lahey Health Senior Care

Need help with your prescriptions? MCPHS pharmacy outreach program

A community service project of the Massachusetts College of Pharmacy and Health Sciences

Call toll-free

1.866.633.1617

http://www.mcphs.edu/impact/community-service-programs/pharmacy-outreach-program