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Useful Resources
Minnesota Consumer Awareness Education and Resource Guide for 1998
CHAPTER VII: Appendix
| 1998 MEDlCARE DEDUCTIBLES, COINSURANCE, AND PREMIUM AMOUNTS |
| Part A Deductible |
1998$
$764 (per benefit period) |
1997
$760 |
| Coinsurance for days 61-90 |
$191 per day (per benefit period |
$190 |
Coinsurance for days 91-150
(nonrenewable lifetime reserve days) |
$382 per day |
$380 |
| Skilled nursing facility co-ins (days 21-100) |
$ 95.50 per day (per benefit period) |
$ 95 |
| Medicare Part B Deductible |
$100 per year |
$100 |
| Medicare Part B Premium |
$ 43.80 |
$ 43.80 |
The Part A premiums is $309 per month for those with less than 30 quarters of coverage.
It is $170 per month for those with 30 or more quarters of coverage. [It should be noted
this premium is paid only by individuals who are not otherwise eligible for "premium
free" hospital insurance.]
PREVENTIVE CARE SERVICES
(1998 Added Medicare Benefits) |
Yearly screening mammograms
[females over 40; no Part B deductible] |
Effective Date
1-1-98 |
| Yearly pap smears w/pelvic and breast exam[females at high risk; others every 3 yr.;no Part B deductible] |
1-1-98 |
| [over age 50; frequency not determined]Colorectal cancer screening |
1-1-98 |
| Flu and pneumonia vaccination Pays [extended through the end of 2002] |
100% |
| Bone mass/density measurement |
7-1-98 |
| Diabetes outpatient education/monitoring |
7-1-98 |
Tips To Prevent Fraud
- DON’T ever give out your Medicare Health Insurance Claim Number (on your Medicare card) except to your doctor or other Medicare provider.
- DON’T allow anyone, except appropriate medical professionals, to review your medical records or recommend services.
- DON’T contact your physician to request a service that you do not need.
- DO be careful in accepting Medicare services that are represented as being free.
- DO be cautious when you are offered free testing or screening in exchange for your Medicare card number.
- DO be cautious of any provider who maintains they have been endorsed by the Federal government or by Medicare.
- DO avoid a provider of health care items or services who tells you that the item or service is not usually covered, but they know how to bill Medicare to get it paid.
It is in your best interest and that of all citizens to report suspected fraud. Health care fraud, whether against Medicare or private insurers, increases everyone’s health care costs, much the same as shoplifting increases the costs of the food we eat and the clothes we wear. If we are to maintain and sustain our current health care system, we must work together to reduce costs.
Medicare Summary Notice [MSN]
How to read your Medicare Summary Notice
- Inpatient / Outpatient Claims
- Newly designed
- Additional information
- Enhanced customer information
How to read your MSN
- Date the MSN was sent.
- Refer to the Customer Service Information box if you have questions about your MSN. For all inquiries, include your Medicare number, the date of the notice, and the specific date of service you have questions about.
- Your Medicare Number should match the number on your Medicare card.
- If your Name and Address are incorrect on your MSN, please contact both the Medicare intermediary shown on your MSN and the Social Security Administration immediately.
- Read the Help Stop Fraud message for information on ways to protect yourself and Medicare against fraud and abuse.
- Part A Hospital Insurance - Inpatient Claims or Part B Medicare Insurance - Outpatient Claims. The Inpatient claims (for hospitals and skilled nursing facilities) and Outpatient claims are listed separately.
- Dates of Service shows when services were provided. You may use these dates to compare with the dates shown on your hospital bill.
- Each claim is assigned a Claim Number, which you may be asked to provide when calling regarding your MSN.
- Benefit Days Used shows the number of days used in the benefit period. See the back of your MSN for an explanation of benefit periods.
Note: For Part B Medical Insurance - Outpatient Facility Claims (not shown here), the column will be titled Services Provided and will give a brief description of the service or supply provided.
- Non-Covered Charges shows the charges for services denied or excluded by the Medicare program for which you may be billed.
- The amount applied to your Deductible and Coinsurance.
- You May Be Billed. This is the total amount the provider is allowed to bill you. It combines the deductible, the coinsurance and any non-covered charges. If you have supplemental insurance, it may pay all or part of this amount.
- See Notes Section. If a letter appears in this column, refer to the Notes Section. Please see item 15 in this pamphlet.
- Provider’s Name and Address shows the name of the facility where you received services. The referring doctor’s name will also be shown. The address shown is the billing address which may be different from where you received the service(s).
- The Notes Section gives more detailed information about your claim.
- The Deductible Information section shows how much of your Part A and/or Part B deductible has been met.
- The General Information section provides important Medicare news and information.
- Appeals Information, such as how and when to request an appear, is shown here. See the back of your MSN for more information and how to get help with appeal requests.
Note: The Medicare Handbook provides more information about coverage and other services. For a free copy, call the Medicare contractor listed in the Customer Service box on your MSN.
Reminder: Do Not Send Money to Medicare or Provider from information on your MSN.
| Medicare Summary Notice (1) June 16, 199 |
(2) BENEFICIARY NAME
(4) STREET ADDRESS 4
CITY, STATE, ZIP CODE
HELP STOP FRAUD: Protect your Medicare Medicare,
US XXXXX-XXXX
(5) Number as you would a credit card number. |
CUSTOMER SERVICE7 INFORMATION
(3)Your Medicare Number:111-11-1111A
If you have questions, write or call: Medicare
555 Medicare Blvd
Suite 200
Medicare Building
Local: (XXX) XXX-XXXX
Toll-free: 1-800-XXX-XXXX
TTY for Hearing
Impaired: 1-800-XXX-XXXX |
This is a summary of claims processed from 1/15/97 through 6/15/97.
| (6) PART A HOSPITAL INSURANCE - INPATIENT CLAIMS |
| (7) |
(9) |
(10) |
(11) |
(12) |
(13) |
Dates of Service 4/25/97-
05/09/97 |
Benefit Days Used |
Non-Covered Charges |
Deductible and Coinsurance |
You May Be Billed |
See Notes Section |
Claim number (8) 12345-
84956-
84556-
456210
Care Hospital, 124 Sick Lane
Dallas, TX 75555
Referred by: Paul Jones, M.D.
|
14 days |
$0.00 |
$760.00 |
$760.00 |
a,b |
(15) Notes Section:
a You have 46 full days remaining in this benefit period.
b $760.00 was applied to your inpatient deductible. |
Deductible Information; (16)
- You have met the Part A deductible for this benefit period.
General Information: (17)
- If you were offered free items or services but Medicare was billed, please call our Fraud Hotline at 1-800-XXX-XXXX
| (18) Appeals Information - Part A (Inpatient) |
Appeals Information - Part B (Outpatient) |
| If you disagree with any claims decision on PART A of this notice, you can request an appeal by August 16, 1997. Follow the instructions below: |
If you disagree with any claims decision on PART B of this notice, you can request an appeal by December 16, 1997. Follow the instructions below: |
1) Circle the item(s) you disagree with and explain why you disagree.
2) Send this notice, or a copy, to the address in the "Customer Service Information" box on Page 1.
3) Sign Here _____________________________________
Phone number (____) _____________________ |
INSERT EOMB OR SMN EXAMPLES
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