No matter how you get your Medicare, you have certain rights and protections designed to: ■ Protect you when you get health care. ■ Make sure you get the health care services that the law says you can get. ■ Protect you against unethical practices. ■ Protect your privacy.
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Do You Know Your Medicare Rights and protections?
No matter how you get your Medicare, you have certain rights and protections designed to: ■ Protect you when you get health care. ■ Make sure you get the health care services that the law says you can get. ■ Protect you against unethical practices. ■ Protect your privacy.
What do you need to know about Medicare?
Every company or agency that works with Medicare must obey the law, and can’t treat you differently because of your race, color, national origin, disability, age, or sex (or gender identity). See page 2 for more information. ■ Have your personal and health information kept private.
What are my rights if I'm in a Medicare Advantage plan?
If you’re in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, in addition to the rights and protections described in Section 1, you have the right to: ■ Choose health care providers within the plan, so you can get the health care you need. ■ Get a treatment plan from your doctor.
What is “Medicare Rights&protections?
“Medicare Rights & Protections” isn’t a legal document. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and rulings. Paid for by the Department of Health & Human Services.
How can I protect myself from Medicare?
Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Call the fraud hotline of the Department of Health and Human Services Office of the Inspector General at 1-800-HHS-TIPS (1-800-447-8477). TTY users can call 1-800-377-4950.
How can Medicare problems be solved?
Call 1-800-MEDICARE (1-800-633-4227) You can call 1-800-MEDICARE and speak with a representative to ask questions about Medicare or get help resolving problems with Medicare. We made a test call to this number and were greeted by a polite Medicare representative after being on hold for about 90 seconds.
Why should we keep Medicare?
#Medicare plays a key role in providing health and financial security to 60 million older people and younger people with disabilities. It covers many basic health services, including hospital stays, physician services, and prescription drugs.
What is the best resource to understand Medicare?
The best resource is Medicare's Plan Finder, a comprehensive list of the Part D and Medicare Advantage plans (called “Medicare Health Plans”) available in your area.
How can Medicare be improved?
Increase traditional Medicare coverage, including for oral health, vision, and audiology services. Improve access to Medigap plans so people with pre-existing conditions are not locked out. Add an out-of-pocket cap on Part D expenses and strengthen low-income assistance.
Is Medicare a crisis?
A report from Medicare's trustees in April 2020 estimated that the program's Part A trust fund, which subsidizes hospital and other inpatient care, would begin to run out of money in 2026.
What would happen without Medicare?
Payroll taxes would fall 10 percent, wages would go up 11 percent and output per capita would jump 14.5 percent. Capital per capita would soar nearly 38 percent as consumers accumulated more assets, an almost ninefold increase compared to eliminating Medicare alone.
What are some of the biggest challenges with Medicare today?
Top concerns for Medicare beneficiaries: Part B, appeals and affordable medications. The top concerns of Medicare enrollees include navigating Part B, appealing Medicare Advantage (MA) denials and affording meds, according to an annual report from the Medicare Rights Center.
What are the advantages and disadvantages of Medicare?
The takeaway Medicare Advantage offers many benefits to original Medicare, including convenient coverage, multiple plan options, and long-term savings. There are some disadvantages as well, including provider limitations, additional costs, and lack of coverage while traveling.
Why are Medicare plans so confusing?
Medicare can seem confusing because they have tried to develop a system to accomodate a variety of lifestyles and financial situations across the country. In addition, they work to give Medicare beneficiaries as many options as possible when they move or if their health or financial conditions change.
How do you explain Medicare?
Medicare is the federal government program that provides health care coverage (health insurance) if you are 65+, under 65 and receiving Social Security Disability Insurance (SSDI) for a certain amount of time, or under 65 and with End-Stage Renal Disease (ESRD).
What is the goal of Medicare Advantage?
One of the main goals of MA plans is to manage health care in order to reduce costs while also providing necessary care. An MA plan must provide enrollees in that plan with coverage of all services that are covered by Medicare Parts A and B, plus additional benefits beyond those covered by Medicare.
What rights do you have with original Medicare?
If you have Original Medicare, in addition to the rights and protections described in Section 1, you have the right to: ■ See any doctor or specialist (including women’s health specialists), or go to any Medicare-certified hospital, that participates in Medicare.
What to do when you ask your Medicare plan how it pays its doctors?
When you ask your plan how it pays its doctors, the plan must tell you. Medicare doesn’t allow a plan to pay doctors in a way that could interfere with you getting the care you need. ■ Request an appeal to resolve differences with your plan.
What is Medicare Beneficiary Ombudsman?
The Medicare Beneficiary Ombudsman is a person who reviews and helps you with your Medicare complaints. They make sure information about Medicare coverage and rights and protections is available to all people with Medicare. The Medicare Beneficiary Ombudsman shares information with the Secretary of Health and Human Services, Congress, and other organizations, and uses Medicare beneficiary feedback and experiences to provide recommendations for improvement to the Medicare program.
How to appeal a Medicare claim?
For more information on appeals: — Visit Medicare.gov/appeals. — Visit Medicare.gov/publications to view or print the booklet “Medicare Appeals,” or call 1‑800‑MEDICARE (1‑800‑633‑4227) to find out if a copy can be mailed to you. TTY users can call 1‑877‑486‑2048. — If you have a Medicare Advantage Plan, other Medicare health plan, or a Medicare Prescription Drug Plan, read your plan materials. — Call the SHIP in your state. To get the most up‑to‑date SHIP phone numbers, visit shiptacenter.org, or call 1‑800‑MEDICARE. ■ File complaints (sometimes called “grievances”), including complaints about the quality of your care.
How to request Medicare handbook?
TTY users can call 1‑877‑486‑2048. To request the Medicare & You handbook in an alternate format, visit Medicare.gov/ medicare‑and‑you. For all other Centers for Medicare & Medicaid Services (CMS) publications: 1. Call 1‑844‑ALT‑FORM (1‑844‑258‑3676). TTY users can call 1‑844‑716‑3676. 2. Send a fax to 1‑844‑530‑3676. 3. Send an email to [email protected]. 4. Send a letter to: Centers for Medicare & Medicaid Services Offices of Hearings and Inquiries (OHI) 7500 Security Boulevard, Room S1‑13‑25 Baltimore, MD 21244‑1850 Attn: Customer Accessibility Resource Staff
What is ESRD in Medicare?
If you have End-Stage Renal Disease (ESRD) and have a complaint about your care,call the ESRD Network for your state. ESRD is permanent kidney failure that requires a regular course of dialysis or a kidney transplant. To get this phone number, visit Medicare.gov/contacts, or call 1‑800‑MEDICARE.
What happens if you disagree with a Medicare decision?
If you disagree with this decision, you have the right to file an appeal.
What does Medicare check?
If you have Original Medicare, check your MSN. This notice shows the health care services, supplies, or equipment you got, what you were charged, and how much Medicare paid. If you’re in a Medicare health plan, check the statements you get from your plan.
When you get health care services, record the dates on a calendar and save the receipts and statements you get from?
When you get health care services, record the dates on a calendar and save the receipts and statements you get from providers to check for mistakes. Compare this information with the claims Medicare processed to make sure you or Medicare weren’t billed for services or items you didn’t get.
Why is Medicare reform important?
There are two broad reasons for reforming Medicare. The first is to reduce costs in the program. This saves money for taxpayers and extends the program's solvency. Typically, this points to changes in benefit structures and payment schedules or to increases in revenue. The second reason for reform is to deliver better value to beneficiaries. Doing so might involve some benefit changes, but it also can include the various experiments being conducted to incentivize higher-value care.
How many people are covered by Medicare?
In particular, Medicare — our socialized health-insurance scheme for the elderly and disabled — covers 55 million people. That's 17% of the American population, or roughly the population of England. The program accounts for 15% of the federal budget and 3% of our economy.
What was the Doc Fix?
Prior to the 1990s, physician payments in Medicare were (as hospital payments once were) based on prevailing charges in the market. This had the same result as it did with hospital payments — everyone raised their prices. In 1989, legislators enacted a so-called "volume performance standard" (VPS), which modified payment growth rates based on whether service volume grew faster or slower than a target rate. Even this didn't put enough of a brake on cost growth to satisfy lawmakers' desires, however. From 1990 to '97 (the VPS's seven years of operation), per-beneficiary cost growth in Medicare exceeded real GDP by over four percentage points. The VPS was soon replaced with the "sustainable growth rate" (SGR) mechanism. The SGR took cost-growth calculation a step further, tying growth in physician payments to costs, the number of Medicare fee-for-service beneficiaries, changes in benefits, and the 10-year average growth rate of real GDP per capita.
How much of Medicare is covered by disability?
After all of these changes, today's Medicare program looks radically different than it did at its inception. Sixteen percent of the Medicare population is covered due to disabilities rather than age (up from 7% in 1973); over 20% are dually enrolled in Medicare and Medicaid; and roughly one-third of enrollees receive coverage through the MA program. Most beneficiaries, however, still face a benefit design based on mid-20th-century health insurance.
How much would Medicare pay after the trust fund is exhausted?
After the trust fund's exhaustion, Medicare would only be able to pay for 87% of required benefits. Medicare's actuaries note that, as of the issuance of their report, closing the program's 75-year actuarial deficit would require an immediate 25% increase in Medicare's payroll-tax rate (from 2.9% to 3.63%) or an immediate reduction of expenditures by 16%. Given that painful policy changes of this sort are usually implemented on some delay, these numbers would likely be larger in magnitude in a more realistic scenario.
When did Medicare+Choice become Medicare Advantage?
The 1990s formalized the inclusion of private plans as an option in Medicare (then called Medicare+Choice) — which now stand to serve as the primary vehicle for further modernizing reforms. In 2003, a major overhaul of the program once again took place: Prescription-drug coverage was added through private insurers in the Part D program, and Medicare+Choice was substantially transformed and renamed Medicare Advantage (MA). Finally, in 2010, Obamacare made further changes to reimbursements in the program and reformed how MA plans are paid.
Is Medicare for all inevitable?
What is less inevitable is the direction that these changes will take. Some wish to see a "Medicare-for-all" system, which would implement a universal socialized health-insurance scheme. In the 2016 presidential election, this was a key pillar of Senator Bernie Sanders's health-care platform.
Why do you need a caregiver agreement?
Setting up a caregiver agreement may be a good way to obtain services that would not be covered by Medicaid. Under this type of agreement, a trusted family member or friend may leave his or her job and care for the older person. The services may be paid in advance to help to reduce the countable income for Medicaid eligibility. To be accepted by Medicaid, a caregiver agreement under which the caregiver will be paid in advance must include the following features:
What is asset protection trust?
An asset protection trust allows the assets to be distributed to the same people when you die so that your loved ones won’t have to pay capital gains tax on the amount that your assets have increased in value during your lifetime. Assets that are transferred to an asset protection trust do not belong to you.
What happens if your income exceeds the Medicaid limit?
Income trusts. When you apply for Medicaid, there is a strict limit on your income. If your income exceeds the limits, it must be handled properly so that you can obtain and keep your eligibility for Medicaid. You can fix this problem by establishing a qualified income or pooled income trust.
How long does it take for Medicaid to transfer to a trust?
However, transfers to trusts that occur within five years of when you need Medicaid will be subject to the look-back period. This makes it important for you to plan well in advance of when you think that you might need care. 2. Income trusts. When you apply for Medicaid, there is a strict limit on your income.
What is elder care direction?
Elder Care Direction may take the time to explain these different options to you. 1. Asset protection trust. Asset protection trusts are set up to protect your wealth. While you are able to transfer assets to your family members, there are some disadvantages to doing so. An asset protection trust allows the assets to be distributed to ...
Can you get Medicaid if you give away your assets?
If you try to give your assets and income away to try to qualify for Medicaid, Medicaid may disqualify you for benefits for a penalty period. There are several strategies that you can take to protect your assets and money, but they require advanced planning. Elder Care Direction may take the time to explain these different options to you.
Can a healthy spouse be on medicaid?
In some states, a healthy spouse is allowed to refuse to provide financial support for his or her spouse. This makes the ill spouse eligible for Medicaid. When Medicaid begins providing the services, it will have the right to ask for contributions from the healthy spouse.
What is Medicaid planning strategy?
Medicaid-Planning Strategy #2: Income Trusts. When an individual applies for Medicaid, a strict income limit is enforced. If an applicant’s income exceeds this amount, it is considered excess and must be handled appropriately to obtain and maintain Medicaid eligibility.
What is Medicaid trust?
When a trust is properly designed to provide asset protection, the assets transferred to it no longer belong to you. As a result, they are beyond the reach of Medicaid or any other future creditors. That is why this kind of trust is often called a “Medicaid Trust.”.
What happens to Medicaid after death?
Upon the death of the patient, any unearned funds must be paid to Medicaid, up to the amount that Medicaid paid on behalf of the patient’s care.
What is a personal care agreement?
A personal care agreement is an excellent strategy in many cases where seniors want or require extra services that would not be covered by Medicaid and are outside the scope of what a skilled nursing facility or home care company would provide.
How is the penalty for Medicaid look back?
The penalty period is calculated by dividing the amount transferred by Medicaid’s regional monthly rate for nursing home care, yielding a period of time in months that the person is ineligible for coverage.
How much does a senior need to be to get medicaid in New York?
In New York, the annual income limit for a senior to be eligible for Medicaid is $10,308. Learn More: Medicaid Resources by State.
What is the challenge of Medicaid?
The challenge is trying to preserve as much of an applicant’s assets as possible while still helping them qualify for Medicaid. Fortunately, a federal law enacted in 2006 provides the answer: a properly worded and structured annuity or promissory note.
What happens if you gift a property to a medicaid beneficiary?
In other words, if the consequences of a Medicaid penalty outweigh the advantages of gifting the property, the title is changed back into the name of the Medicaid beneficiary in order to allow that person to receive Medicaid benefits.
Can you sell your home before applying for medicaid?
If this is the case, the possibility of selling the home sometime prior to applying for Medicaid or shortly after applying for Medicaid should be considered. If the Medicaid obligation is not significant, perhaps the family could be satisfied with a recovery against the home.
Can a spouse recover from Medicaid if they are alive?
In many states, if the community spouse is alive after the Medicaid beneficiary dies, the state will not attempt recovery even after the death of the community spouse. The home is always protected from recovery as long as the community spouse is alive whether he or she lives in the home or not. In those states that attempt recovery, ...
Can Medicaid go after a house?
There are a number of strategies that can be used. In those states that go after probate property only, anything that keeps the house out of probate will suffice. In other states, some common strategies include the use of irrevocable trusts or transfers before death.
Can Medicaid lien against a spouse while living in the home?
In those states that attempt recovery, the community spouse, if healthy, can employ a number of gifting strategies. This is because Medicaid in these particular states cannot apply a lien against the house while the community spouse is alive and living in the home. This does not mean that if the state is entitled to recovery, it cannot pursue civil action. Whether this happens on a regular basis we don't know.
