Posts Tagged ‘Medicare Help’
Medicare is a health insurance program for:
- people age 65 or older,
- people under age 65 with certain disabilities, and
- people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).
Medicare has:
Part A Hospital Insurance – Most people don’t pay a premium for Part A because they or a spouse already paid for it through their payroll taxes while working. Medicare Part A (Hospital Insurance) helps cover inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and some home health care. Beneficiaries must meet certain conditions to get these benefits.
Part B Medical Insurance – Most people pay a monthly premium for Part B. Medicare Part B (Medical Insurance) helps cover doctors’ services and outpatient care. It also covers some other medical services that Part A doesn’t cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.
Beneficiary Notices Initiative
Both Medicare beneficiaries and providers have certain rights and protections related to financial liability under the Fee-for-Service (FFS) Medicare and the Medicare Advantage (MA) Programs. These financial liability and appeal rights and protections are communicated to beneficiaries through notices given by providers.
Use the navigation tool on the left side of this page to link to the following financial liability notices and their instructions: Read the rest of this entry »
Manufacturer reporting of Average Sales Price (ASP) data: A manufacturer’s ASP must be calculated by the manufacturer every calendar quarter and submitted to CMS within 30 days of the close of the quarter. Each report must be certified by one of the following: the manufacturer’s Chief Executive Officer (CEO); the manufacturer’s Chief Financial Officer (CFO); an individual who has delegated authority to sign for, and who reports directly to, the manufacturer’s CEO or CFO.
Manufacturers must report the ASP data to us in Microsoft Excel using the template provided in Addendum A, the ASP Data Form. Both this and the ASP Certification Form (Addendum B), are available in the ‘Downloads’ section below.
Persons with Disabilities: The term “disability” refers to limited physical or cognitive capacity. It includes people with neurological and neuro-developmental conditions, such as disorders of the brain, spinal cord, peripheral nerve, and muscle (e.g., cerebral palsy, epilepsy/seizure disorders, stroke, intellectual disability/mental retardation); moderate to severe developmental delay; muscular dystrophy; and spinal cord injury. These chronic conditions interfere with functional capacity. “Disability” also includes people with other chronic health conditions that interfere with functional capacity.
Having a disability alone may not place someone at higher risk for complications from the H1N1 virus, but other factors may put a person with disabilities at higher risk. You may be at risk if you are a: Read the rest of this entry »
CMS ANNOUNCES MEDICARE PREMIUMS, DEDUCTIBLES FOR 2010
Most Medicare beneficiaries will not see a Part B monthly premium increase as a result of a “hold harmless” provision in the current law. This allows for 73 percent of beneficiaries to be protected from an increase raising the 2010 Part B monthly premiums from $96.40 to $110.50. The Administration continues to urge Congressional action that would protect all beneficiaries from higher Part B premiums and eliminate the inequity of a high premium for the remaining 27 percent of beneficiaries.
By law, the Centers for Medicare & Medicaid Services (CMS) is required to announce the Part A deductibles and Part B premium amount – a notice that is published annually in the Federal Register.
CMS uses five different provider and supplier enrollment applications. In general, Part A providers are required to use the CMS-855A to enroll or update their enrollment information; Part B suppliers (except suppliers of Durable Medical Equipment, and Prosthetics, Orthotics, and Supplies (DMEPOS)) are required to use the CMS-855B to enroll or update their enrollment information; physicians and non-physician practitioners are required to use the CMS-855I to enroll or change their enrollment information; and DMEPOS suppliers are required to use the CMS-855S to enroll or update their enrollment information. In addition to these four enrollment applications, individual practitioners who would like to reassign their benefits to an eligible provider or supplier or terminate an existing reassignment agreement would use the CMS-855R.
To ensure timely processing of your application, make certain to completely fill out the application and provide all required supporting documentation at the time of filing. Section 17 of the Medicare enrollment application lists the supporting documentation that you will need to submit with your enrollment application. Once you have completed the application, you should mail it to the Medicare contractor servicing your state. A contractor can generally process your application within 60 days if you submit a complete application with all required supporting documentation. It will take longer to be enrolled if you are a provider or supplier that requires a State survey or accreditation. If you have any questions about the enrollment process, please contact your Medicare contractor.
Extra Help for People with Limited Income and Resources
If you are not sure if you qualify for extra help paying for Medicare Prescription Drug Coverage, visit these two online resources:
1. Apply Online for Extra Help with Medicare Prescription Drug Plan Costs
If your resources are less than $11,710 (single) or $23,410 (married) and your income is limited, you may qualify for extra help paying for Medicare Prescription Drug Coverage. These resource limits are for 2007 and may increase each year. The resource limits include $1,500 per person for burial expenses. Resources include your savings and stock, but not your home or car. If you haven’t received an application or information about the extra help, and you think you may qualify, you should apply.
Remember, as Department of Health and Human Services Secretary Leavitt says, “If in doubt, fill it out!” You can apply Online by visiting the Help With Medicare Prescription Drug Plan Costs section on the Social Security Administration website. Read the rest of this entry »