Omaha Resource Handbook:
Medicare

Medicare is a federal program that pays for certain medical expenses for people aged 65 and over. Those who are disabled or who have End-Stage Renal Disease may also qualify. Medicare is divided into four parts: Part A covers hospital bills. Part B covers doctor bills. Part C provides the option to choose from a number of health care plans. Part D provides the option to choose from a number of prescription drug plans.

With any questions or for information, contact the Medicare office:
www.medicare.gov
1-800-MEDICARE (1-800-633-4227)
1-877-486-2048 (TTY/TDD)
1-816-426-2866 (Regional Office)

or the Social Security Administration:
www.socialsecurity.gov
1-800-772-1213
1-800-325-0778 (TTY/TDD)

Medicare does not cover everything, nor does it always cover the full amount of covered items. For this reason, it may be wise to purchase a Medicare Supplemental Insurance Policy (Medigap) or join an insurance plan (Medicare Select).

Medicare & You is a booklet that lists recent legislation changes and information on Medicare. Because it is necessary to stay current with recent changes, it is important to obtain a copy of the latest issue of this booklet. Medicare & You is revised each year.

In addition, there is the handbook titled A Guide to Health Insurance for People with Medicare. It is a guide for purchasing Medigap Insurance, using Medigap Insurance and understanding other kinds of health insurance available. This handbook will cover in detail what we will briefly outline here in this section. It is an important tool in understanding what to expect from your present coverage and the options you have when planning to purchase a new plan.

Copies of either of these resources can be obtained by calling the Medicare office or found online on the Medicare website.

In this section, we will cover the basics of Medicare Parts A-D as well as some general things to look for in a Medigap or Medicare Select Plan.

Medicare 2006: Part A

Part A (Hospital Insurance) helps pay for care in hospitals and nursing facilities and for home health and hospice care. Part A is premium-free because of Medicare taxes you paid while you were working. Most who qualify are automatically enrolled at age 65.

Medicare (Part A): Hospital Insurance-Covered Services Per Benefit Period⁽³⁾
Service	Benefit	Medicare Pays⁽²⁾	You Pay⁽²⁾
Hospital Stays Semi-private room, meals, general nursing and miscellaneous hospital services and supplies medically necessary.	First 60 days	All but $952	$952
	61 to 90 days	Anything Above	$238
	91 to 150 days ⁽¹⁾	Anything Above	$476
	Beyond 150 days	Nothing	*All Cost*
Post-Hospital Skilled Nursing Facility Care In a facility approved by Medicare, you must have been in a hospital for at least 3 days and enter the facility within 30 days after hospital discharge. ⁽⁴⁾	First 20 days	100% of approved	Nothing
	21 to 100 days	Anything Above	$119
	Beyond 100 days	Nothing	*All Cost*
Home Healthcare	Unlimited as long as you meet medicare conditions	100% of approved amount. 80% of approved durable medical equipment	Nothing for services. 20% of approved amount of durable medical equipment
Hospice Care	for as long as needed	All but limited cost for outpatient drugs and inpatient respite care	Limited cost sharing for outpatient drugs and inpatient respite care
Blood	Blood	All but first 3 pints	For first 3 pints
(1) 60 Reserve Days may be used only once; days used are not renewable. (2) These figures are for 2006 and are subject to change each year. (3) A benefit period begins on the first day you are admitted as an inpatient in a hospital or skilled nursing facility and ends after you have been out of the hospital or skilled nursing facility for 60 days in a row. (4) Medicare and private insurance will not pay for most nursing home care. You pay for custodial care and most care in a nursing home.

Nebraska's Part A Carriers (as of May 2006)

Coverage and claims for hospital and skilled nursing facilities:
Blue Cross/Blue Shield of Nebraska	Mutual of Omaha
www.bcbnse.com	www.mutualmedicare.com
877-869-6503	866-580-5983

Coverage and claims for home health and hospice:
Cahaba
www.cahabagba.com
877-299-4500 (home health)	866-854-1876 (hospice)

Medicare 2006: Part B

Part B (Medical Insurance) helps pay for doctors, outpatient hospital care and some medical services that Part A does not cover. Part B is voluntary and has a monthly premium ($88.50 per month in 2006). It is deductible from your Social Security, Railroad Retirement or Civil Service Retirement.

Medicare (Part B): Medical Insurance-Covered Services Per Calendar Year
Service	Benefit	Medicare Pays⁽²⁾	You Pay⁽²⁾
Medical Expenses Physician's services, inpatient and outpatient medical surgical services and supplies, physical occupational, and speech therapy, diagnostic tests, and durable medical equipment.	Unlimited if medically necessary	80% of approved amount (after $124 deductible). Reduced to 50% for most outpatient mental health services	$124 deductible ⁽⁵⁾ plus 20% of balance of approved amount. Limited charges about approved amounts ⁽⁶⁾.
Clinical Laboratory Services Blood tests, urinalysis, etc.	Unlimited if medically necessary	Full Cost.	Nothing.
Home Healthcare (If you don't have Part A) Intermittent skilled care, home health aide service, durable medical equipment	Visits limited to medical necessity	Full Cost. 100% of approve amts. 80% of approved amt. For durable medical equip.	Nothing for services. 20% of approved amts. of durable medical equipment
Outpatient Hospital Services	Unlimited as medically necessary	80% of approved amount (after $100 deductible).	Subject to deductible plus 20% of balance of approved amounts.
Blood As an outpatient or as part of a Part B covered service	Blood	80% of approved amount (after $100 deductible and starting at 4th pint).	First 3 pints plus 20% of approved amount after the deductible.
(5) Once you have had $124 of expenses for covered services the Part B deductible does not apply to any further services you receive the rest of the year. (6) You pay for charges higher than the amount approved by Medicare unless the doctor or supplier agrees to accept Medicare's approved amount as the total charge for services rendered.

Nebraska's Part B Carriers (as of May 2006)

Coverage and claims for physicians and medical services:
Blue Cross/Blue Shield of Kansas
www.bcbsk.com
800-633-4227
Coverage and claims for medical equipment and supplies:
CIGNA (Connecticut General Life Insurance Company)
www.cignamedicare.com
800-633-4227

Medicare C

Medicare Part C, formerly known as Medicare+Choice, is now known as Medicare Advantage. Medicare Advantage is a plan obtained through a private health insurance company that offers expanded benefits depending on the type of policy purchased.

To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You pay the Medicare Part B premium ($88.50/month in 2006) and possibly an additional premium for the added benefits offered in the Medicare Advantage Plan.

Medicare D

Medicare Part D is a new voluntary prescription drug benefit as of January 1, 2006 that offers prescription drug insurance and some other health coverage for those eligible. They are stand-alone drug plans offered by insurance and other private companies.

Those enrolled in Medicare Part A or Part B are eligible for a Medicare Part D Prescription Drug Plan (PDP) that offers only prescription drug coverage. Those enrolled in a Medicare Advantage Plan (Part C) are eligible for a Medicare Advantage Prescription Drug Plan (MA-PD) that offers both prescription drug and other health coverage.

There are 42 PDP options and 11 MA-PD options to choose from in Nebraska as of May 2006. Things to consider when deciding on a prescription drug plan that best benefits you include:

Drugs covered by that plan

Available pharmacies with that plan

Annual deductibles

Monthly premiums

Monthly cost share

Possible future needs

Comparisons of prescription drug plans can be found on the Medicare website at www.medicare.gov. You can determine availability and cost by conducting either a personalized plan search or a generalized plan search.

Enrollment is open each year from November 15th-December 31st for coverage beginning January 1st of the following year. For those who choose not to enroll originally when eligible, a late penalty fee of 1% of the premium per month not enrolled may be assessed. When you turn 65, you are eligible to enroll immediately regardless of the time of year.

If you have limited income or resources, you may qualify for extra help paying your drug plan costs.

Medicare Supplemental Insurance

You may purchase one of ten standard Supplemental Insurance Policies (Medigap or Medicare Select) for extra benefits. Some policies may help pay Medicare's co-insurance amounts and deductibles.

Medigap is a Medicare supplemental insurance policy that is sold by private insurance companies to fill the gaps in the Medicare Original Part A and Part B Plan coverages. There are ten standardized policies ranging from Plan A, offering basic benefits, through Plan J, offering the most benefits. These plans are standardized among insurance companies and they only work with the original Medicare Plan. Purchasing a Medigap plan allows you to go to any doctor or hospital that accepts Medicare.

Medicare Select is a type of Medigap policy that may require you to use doctors and hospitals within the carrier's network in order for you to be eligible for full benefits.

For more information on Medicare Supplemental Insurance Policies, obtain a copy of A Guide to Health Insurance for People with Medicare at:

www.medicare.gov
1-800-MEDICARE (1-800-633-4227)
1-877-486-2048 (TTY/TDD)

Care Consultants for the Aging does not recommend or endorse any of the services or facilities that are named or advertised in the Handbook. As always, we encourage you to investigate any product or service that is being considered.

Although every effort has been made to assure the accuracy of this information, we apologize in advance for any services, products, or organizations that may have been omitted or any errors noted within. We welcome corrections and additions. Please e-mail us at ccainc1@yahoo.com or call us at 402-398-1848 with any suggestions. Thanks!