Financial Info.

Medicare:
Toll free phone number is 1-800-633-4227
Internet address is www.medicare.gov.
TTY/TDD for speech and hearing impaired is 1-877-486-2048

Medicare is a health insurance program for people that are 65 years of age or older. It covers 39 million elderly and disabled Americans and offers two components: Part A, which is sometimes referred to as hospital insurance, and Part B, which is the supplemental medical insurance. There are some instances when younger people with disabilities can qualify for Medicare. It is also for people with permanent kidney failure who need dialysis or a transplant.

The original Medicare Plan is the traditional pay-per-visit plan. You must visit a health care provider that accepts Medicare. After Medicare pays its share, you pay the deductible and your share (co-insurance). Prescription drugs are not covered.

Medicare Part A-Hospital Insurance
Part A helps pay for care in hospitals, nursing homes, hospice care and some home health care. If you have been in a hospital as an inpatient for at least three consecutive days, you must still meet some special requirements before your stay in a nursing home will be covered by Part A. Those requirements are:

· A nursing home is the most appropriate place for your care.

· A physician has ordered that you need skilled services.

· Nursing and/or rehabilitation services are needed daily.

· The skilled services that you receive must be for a condition that was treated while you were at the hospital or for a condition that arose in a nursing home center after your stay at the hospital.

You must be admitted to the nursing home within thirty days from your hospital visit. Your reason for being at the nursing home must also relate to your condition while you were at the hospital. You must have days available in your benefit period.

Medicare Part A covers:

· A semi-private room.

· All meals, including special diets.

· Routine nursing services.

· Drugs, vaccines, x-rays and lab tests.

· Respiratory, physical, occupational and speech therapies.

· Medical supplies, appliances and certain medical equipment.

· Medically related social services.

· Laundry and housekeeping.

· Blood transfusions.

Medicare Part B-Medical Insurance

To enroll in Part B, contact the Social Security Administration at 1-800-772-1213 or the Railroad 1-800-808-0772. TTY for the hearing and speech impaired is 1-800-325-0778.

Medicare Part B helps pay for doctors, out-patient hospital care and some other medical services that Part A does not pay for (outpatient physical and occupational therapy, for example). Part B will cover all doctor's services that are medically necessary. People who take advantage of Part B can receive these services anywhere. Part B is voluntary. If you choose to have Part B, the monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement payment. If a person does not have any of the above mentioned, he/she will be billed by Medicare every three months. There are two different enrollment periods to sign up for Part B if you did not take Part B when you were originally eligible.

General Enrollment Period: January 1 through March 31 of each year. The Part B coverage is effective July 1. Your monthly Part B premium may be higher because it increases 10% for each 12-month period that you could have enrolled, but did not.

Special Enrollment Period: If you did not take Part B because you or your spouse currently works and have group health plan coverage through your current employer or union, you can sign up for Part B during this special enrollment period. If your group health coverage terminates or if you become unemployed, you have eight months to sign up for Part B. This eight-month period starts the month after the employment ends or the group health coverage ends, whichever comes first. Your Part B premium usually does not increase when you sign up for Part B during this Special Enrollment Period.

Medicare Part A Covered Services

Covered Services for Hospital Stays: Semi-private room, meals, general nursing and other hospital services and supplies. Does not cover private nursing, a telephone or television in your room or a private room unless medically necessary.

What you pay: For each benefit period, you pay a total of $812 for 1-60 days. From 61-90 days, you pay $203 per day. From the 91-150 $406 day, a once-in-a-lifetime 60-reserve days benefit is available.

Covered Services for Nursing Home Stays: Once you meet certain criteria, you can qualify for a semi-private room, meals, skilled nursing and rehabilitation services, and other services and supplies.

What you pay: For each benefit period, you pay nothing for the first 20 days. From 21-100 days, you pay $101.50 per day. Beyond the 100th day you pay all costs.

Covered Services for Home Health Care: Once you meet certain criteria, you can qualify for part-time skilled nursing care, physical and speech-language therapy, home health aide services and durable medical equipment (wheelchairs, oxygen, hospital beds), supplies, and other services.

What you pay: You pay nothing for home health care services. You do have to pay for 20% of the durable medical equipment, however.

Covered Services for Hospice Care: Once you meet certain criteria, it covers pain and symptom relief, and support for the terminally ill. Home care is provided. You are also covered for any necessary inpatient care and several services otherwise not covered by Medicare.

What you pay: Limited costs for outpatient drugs and inpatient respite care (care given to the patient so that the usual caregiver can rest).

Covered Services for Blood: From a hospital or nursing home during a covered stay.

What you pay: You pay for the first three pints.

Medicare Part B Covered Services

Covered Services for Medical Expenses: Doctor's services (except routine medical exams); inpatient and outpatient medical and surgical services and supplies; physical, occupational and speech therapy; diagnostic tests; and durable medical equipment.

What you pay: (2002 Part B medical monthly premium is $54.00. This premium can be slightly higher if you enroll late). Once a year you will pay a $100 deductible. Once you pay the deductible, you must pay 20% of the approved amount, except in an outpatient setting. You pay 50% for most outpatient mental health. You also pay 20% for all physical therapy, occupational and speech therapy services.

Covered Services for Clinical Lab Services: Blood tests, urinalysis, and more. What you pay: You 20 % for these services.

Covered Services for Home Health Care: Once you meet certain criteria and you do not have Part A, you can qualify for intermittent skilled care, home health aide services, durable medical equipment and supplies, and other services.

What you pay: You pay nothing for these services but you do have to pay 20% of the approved amount for the durable medical equipment.

Covered Services for Outpatient Hospital Services: Service for a diagnosis or the treatment of an illness or injury.

What you pay: A minimum of 20% of the Medicare payment amount after you pay the deductible.

Covered Services for Blood: As part of a Part B covered service or as an outpatient.

What you pay: For the first three pints of blood then 20% of the approved amount for the additional pints (after you pay the deductible).

Medicare Part B also helps pay for: X-rays, artificial limbs and eyes, arm, leg, back and neck braces, kidney dialysis and transplants, heart, lung and liver transplants (under limited circumstances), preventative services, limited outpatient drugs, emergency care, ambulance (limited), limited chiropractic services, medical supplies and practitioner services.

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