WHAT IS MEDICARE?[1] Medicare is a national health insurance program run by the federal government. Since it is a federal program, Medicare does not differ much from state to state. Medicare is similar to private health insurance in that it pays for some of the cost of your medical care, but often you have to pay some too. WHO IS ELIGIBLE FOR MEDICARE?[2] Medicare is generally for U.S. citizens or people lawfully present in the U.S. who are:
WHEN AND HOW CAN I ENROLL IN MEDICARE? Medicare Parts A and B Some people are automatically enrolled in Medicare Parts A and B (you can read more about the different Parts of Medicare below). If: [3]
If you are automatically enrolled, you have a chance to decline or delay the enrollment for Part B, which usually requires you to pay a monthly premium. You can do this by following the instructions that come with your Medicare card and sending the card back.[4] Some people have to sign up to get Medicare Part A and/or Part B, if they want them (you can read more about the different Parts of Medicare below). You have to sign up for Medicare Part A and/or Part B if:[5]
Initial Enrollment Period[6] If you are not automatically enrolled, your Initial Enrollment Period is your first opportunity to sign up for Medicare Parts A and B. This is a seven-month period starting 3 months before the month you turn 65 and ending three months after the month you turn 65. You should sign up within the first three months of your Initial Enrollment Period if you want your coverage to start the first day of your birthday month (if you sign up later, your coverage might be delayed). General Enrollment Period[7] If you were not automatically enrolled, and you did not sign up during your Initial Enrollment Period, you can sign up during the general enrollment period, which starts every year on January 1 and ends on March 31. Your coverage will then begin on July 1 of that year. When you enroll after your Initial Enrollment Period, you may have to pay higher premiums. Special Enrollment Period[8] If you were not automatically enrolled, and you did not sign up during your Initial Enrollment period because you were covered under a group health plan based on your or a family member’s current employment, you can sign up during a Special Enrollment Period. The Special Enrollment Period is anytime you are still covered by the group health plan, or during the eight-month period starting the month after the employment ends or the coverage ends (whichever happens first). Usually you don’t pay a late enrollment penalty if you sign up during a Special Enrollment Period. COBRA coverage and retiree health plans won’t qualify you for a Special Enrollment Period because they aren’t considered coverage based on current employment. Should I Enroll in Part B? This depends on your specific circumstances. If you have health coverage through your own or a spouse or family member’s employer or union, you should talk to the employer or union benefits administrator to find out how coverage works with Medicare. Sometimes it can be better to delay signing up for Part B. You can sign up later during a Special Enrollment Period (see Special Enrollment Period above). If you have Part A and TRICARE (a health care program for active-duty and retired uniformed services members and their families), you might have to have Part B to keep your TRICARE coverage. Medicare Advantage (Medicare Part C)[9] You can join, switch, or drop a Medicare Advantage Plan as follows:
Medicare Part D[10] If you don’t join a Medicare drug plan when you are first eligible, you will probably have to pay a late enrollment penalty if you join a plan later, unless you have other creditable prescription drug coverage (coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage) or you get Extra Help (a Medicare program that helps people with limited income and resources pay Medicare Part D Prescription Drug Plan costs). You can join, switch, or drop a Medicare Part D Prescription Drug Plan as follows:
Should I Enroll in a Part D Plan? This depends on your specific circumstances. Here are just a few things to think about:
WHAT DOES MEDICARE COVER? Medicare is broken up into four separate parts: Medicare Part A, Medicare Part B, Medicare Advantage (Medicare Part C), and Medicare Part D. Each of these parts is discussed in detail below. Medicare Part A[11] Medicare Part A is sometimes called “hospital insurance” because it pays for care in the hospital. Part A generally covers several types of health care, although keep in mind that you must meet certain requirements before each type of care will be covered by Medicare. These types of health care are:
You can find more detailed information about Medicare coverage of skilled nursing facility/nursing home care, hospice, and home health care under the topic on Long-Term Care. Hospital Care[12] For Medicare coverage purposes, coverage for “hospital care” includes the care you get when you are an inpatient in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, and long-term care hospitals, as well as inpatient care as part of a qualifying clinical research study and mental health care. You are eligible for Medicare-covered hospital care if:
When you are eligible for Medicare-covered hospital care, the following services are covered:
Even if you meet the eligibility requirements listed above, Medicare will not pay for 100% of your hospital care.
Medicare Part B[15] Medicare Part B covers many of the things that you typically think of health insurance as covering. Some examples are:
Specific coverage rules depend on a number of factors, including your Medicare plan and your specific conditions. Medicare will cover 100% of most preventative services if you get the services from a health care provider who accepts assignment. “Assignment” is an agreement by the provider to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and to not bill you for any more than the Medicare deductible and coinsurance. However, you may have to pay a deductible and/or coinsurance for some preventative services. Examples of things not covered by Medicare Part B (or by Medicare Part A) include[16]:
Medicare Advantage (Medicare Part C) A Medicare Advantage plan is a type of “Medicare health plan,” and it is an alternative way to get your benefits for Medicare Parts A and B (which are referred to as “Original Medicare”). This means that can have either Medicare Parts A and B (Original Medicare), or a Medicare Advantage plan. A Medicare Advantage plan is sponsored by a private company that contracts with Medicare to provide you with all of your Part A and Part B benefits. There are several different types of Medicare Advantage plans, including[17]:
Special Needs Plans are a type of Medicare Advantage plan that provide focused and specialized health care for specific groups of people. These plans are only for people who live in nursing homes or other institutions or need nursing care at home; people who are eligible for both Medicare and Medicaid; or people with specific chronic or disabling conditions, like diabetes, dementia, chronic heart failure, End-Stage Renal Disease, or HIV/AIDS.[18] All Medicare Advantage plans are required to cover almost all of the benefits that are covered under Medicare Parts A and B. (The exceptions are hospice care and some care in qualifying clinical research studies. Original Medicare will cover hospice care and some costs for clinical research studies even if you have a Medicare Advantage Plan.)[19] Medicare Advantage Plans can also choose to offer additional coverage. Some Medicare Advantage plans offer extra coverage for things like vision, hearing, dental, and/or health and wellness programs. Many plans also include prescription drug coverage (Medicare Part D). If your plan includes drug coverage, you cannot also have a Medicare Part D prescription drug plan (if you sign up for a Part D plan, you’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare). If your plan does not offer prescription drug coverage, you can join a Medicare Prescription Drug Plan.[20] Medigap policies can’t work with Medicare Advantage Plans. You can’t use a Medigap policy to pay for your Medicare Advantage Plan copayments, deductibles, or premiums. If you already have a Medigap policy and join a Medicare Advantage Plan, you may want to drop your Medigap policy. But keep in mind that if you cancel the policy and then leave the Medicare Advantage Plan, it might be difficult or impossible for you to get the same Medigap policy back or sign up for any Medigap policy at all.[21] Different Medicare Advantage Plans work differently, so you should take the time to carefully research a plan before deciding to join it. You can search for Medicare Advantage Plans and other Medicare health plans available in your area here. Each Medicare Advantage Plan has a specific service area, and you must live in a plan’s service area to be able to join that plan. Different plans can have different rules for how you get services (like for example whether you have to go to providers that belong to the plan for non-urgent care).[22] Sometimes joining a Medicare Advantage Plan can cause you to lose any employer or union coverage that you have, so you should make sure to talk to your employer, union, or other benefits administrator before joining a Medicare Advantage plan.[23] If you have end-stage renal disease, you will usually get your health care through Original Medicare and can only join a Medicare Advantage plan in certain situations. You can learn more about these situations here. [24] Medicare Part D Medicare Part D provides coverage for prescription drugs for people with certain types of Medicare. If you have Original Medicare (Medicare Parts A and B), you can get a Medicare Part D plan. Part D works a little bit differently than Parts A and B: you get Medicare prescription drug coverage by joining a plan run by a private company approved by Medicare. These plans are called Medicare Prescription Drug Plans (sometimes simply called “PDPs”). The cost of each plan and the drugs it covers vary from plan to plan.[25] Usually prescription drugs that you get in an outpatient setting like an emergency room aren’t covered by Medicare Part B. Your Medicare Prescription Drug Plan might cover these drugs under certain circumstances, but you will probably have to pay out-of-pocket for them and submit a claim to your drug plan.[26] Medicare Prescription Drug Plans may have certain coverage rules, although if you or the provider prescribing a drug for you think that a rule should be waived, you can ask for an exception. These rules might include[27]:
If you have a Medicare Advantage Plan and your plan includes drug coverage, you cannot also have a Medicare Part D prescription drug plan. If you sign up for a Part D plan, you will be disenrolled from your Medicare Advantage Plan and returned to Original Medicare. If your Medicare Advantage plan does not offer prescription drug coverage, you can join a Medicare Prescription Drug Plan.[28] You must live in a Medicare Prescription Drug Plan’s service area to join that plan. You can search for Medicare Prescription Drug Plans available in your area here. Supplemental Insurance: Medigap and Other Insurance Because Original Medicare (Parts A and B) does not pay for all of someone’s health care costs, some people have some kind of supplemental insurance to cover some of the things that Original Medicare won’t. Here are some examples of things that Original Medicare does not pay for but supplemental insurance might pay for part or all of:
There are two main kinds of supplemental insurance: Medigap policies, and other kinds of insurance or coverage. It may not make sense to join a Medigap plan if you have some other kind of insurance or coverage, although this depends on the other insurance or coverage that you have. Medigap What is Medigap? Medigap, also called Medicare supplement insurance, is a type of insurance that you can buy from a private company to help pay some of the costs that Original Medicare will not cover. You must have Medicare Parts A and B to get a Medigap policy.[29] There are eleven different standard Medigap policies that you can buy in Michigan, which are labeled A, B, C, D, F, high-deductible F, G, K, L, M, and N. The cost of a policy and the services it covers vary from policy to policy. Medigap policies do not cover long-term care, vision or dental care, hearing aids, eyeglasses, or private-duty nursing.[30] You can see a chart identifying what each of the eleven standard Medigap policies covers here. There are many different companies that sell Medigap plans, but every company must sell the exact same standard benefits of each plan. For example, Plan G sold by Company X must have the same benefits as Plan G sold by Company Y.[31] You can see a list of the companies that are authorized by the state of Michigan to write Medicare Supplement insurance in Michigan here. How Much Do Medigap Policies Cost? Even though a plan has to have the exact same standard benefits regardless of the company selling it, companies often charge different amounts for the same standard plan. For example, Plan G sold by Company X may be more expensive than Plan G sold by Company Y, even though the plans are exactly the same.[32] The cost of a plan can differ for many reasons, including how old you were when you bought the plan, your current age, whether you are a smoker, the number of people in the plan, whether the company uses medical underwriting, and whether the company offers discounts (for example, if you are a woman, married, a non-smoker, and/or pay your premiums using electronic funds transfer). If you are looking for a Medigap policy, you may want to shop around, considering factors like the cost of the policy, how often the company’s premiums for the plan change and by how much, if the premium will change as you get older, and how long the wait is for pre-existing conditions (if you did not have health insurance as good as Medigap in the months before you wanted to buy a Medigap policy, you may have to wait up to six months to be covered for certain health conditions).[33] When Can I Buy a Medigap Policy? It is illegal for a company to sell you a Medigap policy if the company knows you have Medicaid (except in certain situations) or if the company knows you are in a Medicare Advantage Plan (unless your coverage under that plan will end before the effective date of the Medigap policy).[34] You are first eligible to buy a Medigap policy during your six-month Medigap open enrollment period, which automatically starts on the first day of the month in which you are both 65 or older and enrolled in Medicare Part B. During these six months, you can buy any Medigap policy sold in Michigan, even if you have health problems, for the same price as people with good health.[35] However, in Michigan, in addition to the six-month open enrollment period, there are a few companies that must offer Plan A and Plan C to people with Medicare who are under age 65. These companies are allowed to charge people under age 65 more for those plans, except Blue Cross Blue Shield of Michigan (which can’t charge more because someone is under 65).[36] Are There Any Restrictions on When I Can Have a Medigap Policy? Medigap policies are to cover gaps in Original Medicare (Parts A and B), so Medigap policies can’t work with Medicare Advantage Plans. You can’t use a Medigap policy to pay for your Medicare Advantage Plan copayments, deductibles, or premiums. If you already have a Medigap policy and join a Medicare Advantage Plan, you may want to drop your Medigap policy. But keep in mind that if you cancel the policy and then leave the Medicare Advantage Plan, it might be difficult or impossible for you to get the same Medigap policy back or sign up for any Medigap policy at all.[37] You also cannot have both a Medigap policy with prescription drug coverage and a Medicare Part D Prescription Drug plan. Medigap policies sold after January 1, 2006, are not allowed to include prescription drug coverage. If your Medigap policy covers prescription drugs, and you join a Medicare Part D Prescription Drug Plan, you have to tell your Medigap insurance company so they can remove the prescription drug coverage from your policy and adjust your premium. However, once the drug coverage is removed, you can’t get it back.[38] If you have a Medigap policy with prescription drug coverage but you want to join a Medicare Part D Prescription Drug plan, it is important to figure out if your Medigap policy included “creditable prescription drug coverage.” Creditable prescription drug coverage is coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage. If your Medigap policy included creditable prescription drug coverage, you can join a Medicare Part D Prescription Drug Plan between October 15 and December 7 (unless you lose your Medigap policy, in which case you can join at the time you lose your Medigap policy). If your Medigap policy did not include credible prescription drug coverage, you will probably pay a higher premium than if you joined when you were first eligible, and each month that you wait to join a Medicare Part D Prescription Drug Plan will make your late enrollment penalty higher.[39] How Does My Medigap Policy Work Once I’ve Bought It? Sometimes companies are allowed to have up to a six-month waiting period before your coverage will start, or up to a six-month waiting period before the policy will cover your pre-existing conditions.[40] When you buy a Medigap policy, by law you get a 30-day “free look” or “trial period.” If you change your mind within 30 days of the day your policy started, you can cancel your policy and get a refund.[41] Generally once you have a Medigap policy, it is “guaranteed renewable.” This means that, as long as you pay your premium, the company cannot cancel your Medigap policy, even if you have health problems.[42] Usually your Medigap insurance company pays your health care providers directly, but depending on the company and your provider(s), you may have to send claims to your Medigap insurance company and pay your provider(s) yourself.[43] If you have a Medigap policy and decide to cancel it, you should be careful about the timing. Depending on your coverage and when you drop the policy, you may have to pay a late enrollment penalty if you choose to join a Medicare Part D Prescription Drug Plan.[44] Where Can I Go To Learn More About Medigap Policies? For more information about Medigap policies, see the following resources:
To find Medigap policies in your area, see:
Other Insurance or Coverage[45] Some people use a variety of other insurances or coverages to pay for care that Medicare does not cover. Depending on the insurance or coverage you have, it may not make sense to also join a Medigap plan. Examples of these other insurances or coverages include:
HOW MUCH DOES MEDICARE COST, AND HOW MUCH WILL I HAVE TO PAY FOR HEALTH CARE? Medicare Part A[46] If you or your spouse paid Medicare taxes while working, usually you don’t have to pay any monthly premium for Medicare Part A. If you aren’t eligible for “premium-free Part A,” you may be able to buy Part A, which costs up to $426 per month as of 2014. Usually if you buy Part A, you must also have Part B and pay monthly premiums for both. You may be able to buy Part A if:
If you buy Part A, you will get a bill for your premium. (Unlike your Part B premium, it won’t automatically be deducted from any benefits checks you might get.) In addition to your premium, you may have to pay copayments, coinsurance, or deductibles when you get services covered by Part A. You can find more detailed information about how much you may be required to pay for inpatient hospital care above. You can find more detailed information about how much you may be required to pay for skilled nursing facility/nursing home care, hospice, and home health care under the topic on Long-Term Care. Medicare Part B[47] You have to pay a Part B premium each month. You can find the amount of the premium for 2019 here. If you get Social Security benefits, (or Railroad Retirement Board or Office of Personnel Management benefits) your Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments, you will get a bill for your premium. In addition to your premium, you may have to pay copayments, coinsurance, or deductibles when you get services covered by Part B. You may have a Part B deductible (which is $147 in 2014). Usually after your deductible is met, and if your health care provider accepts assignment, you have to pay 20% of the Medicare-approved amount of the service. “Assignment” is an agreement by the provider to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and to not bill you for any more than the Medicare deductible and coinsurance. The “Medicare-approved amount” in Original Medicare (Medicare Parts A and B) is the amount a doctor or supplier that accepts assignment can be paid. Medicare Advantage (Part C) Most people who have a Medicare Advantage Plan pay their Part B premium and an additional monthly premium for the Medicare Advantage Plan.[48] Different plans can charge different out-of-pocket costs (for example, premiums, coinsurances, and deductibles). Plans establish these amounts each year and can only change what you pay the plan once a year, on January 1. Your out-of-pocket costs in a Medicare Advantage Plan depend on a lot of different factors, such as:[49]
Medicare Advantage Plans have a yearly cap on how much you pay for Medicare Part A and Part B services. This cap can be different for different Medicare Advantage Plans, and it can change each year.[50] Every fall, your plan should send you an Evidence of Coverage (EOC) that provides lots of information, including information about what your plan covers and how much you pay. They should also send you an Annual Notice of Change (ANOC) that explains any changes in coverage, costs, or service area that will be effective starting January 1.[51] Medicare Advantage Plans can choose not to cover services that are not “medically necessary” under Medicare. You may have to pay all the costs of a service that the plan says isn’t medically necessary. However, you can appeal the plan’s decision that a service isn’t medically necessary, or you can ask for a written advance coverage decision from the plan before you get the service to make sure it is medically necessary and will be covered.[52] If you use a health care provider that doesn’t belong to your Medicare Advantage Plan, your services might not be covered or you might have to pay more.[53] Medicare Part D[54] Most Medicare Part D Prescription Drug Plans charge a monthly premium. This premium differs from plan to plan. You can have this monthly fee deducted from your Social Security (or Railroad Retirement Board) check, or you can be billed directly for it. Some Medicare Part D plans have a yearly deductible. Most Medicare Part D plans have copayments or coinsurance, which differ from plan to plan. Your actual Medicare Part D Prescription Drug Plan costs depend on a lot of different factors, such as:
Most Medicare Part D Prescription Drug Plans have different “tiers” for their drugs, and drugs in different tiers have different costs. Usually a drug in a lower tier costs less than a drug in a higher tier. Most Medicare Part D Prescription
Drug Plans have a coverage gap that is often called the “donut hole.” If you and your plan together spend a certain amount of money for covered prescription drugs, you will then enter the donut hole, where you have to pay a higher percentage for your medications. In 2014, the amount you have to pay when you’re in the donut hole is 47.5% of your plan’s cost for covered brand-name drugs and 72% of the plan’s cost for covered generic drugs. Once you’ve
spent enough money on covered drugs, you will be out of the donut hole. Things like your deductible, coinsurance, copayments, payments you make in the coverage gap, and discounts you get on covered brand-name drugs in the coverage gap will all count towards you getting out of the donut hole. Once you’re out of the donut hole, you will automatically get “catastrophic coverage,” where you only pay a small coinsurance or copayment for covered drugs for the rest of the year. If you
get Extra Help, you won’t have some of these costs. The “donut hole” will close in 2020. Until then, there will be more and more coverage each year for drugs in the donut hole. Some plans might also offer additional coverage in the donut hole, (like for generic drugs) but they might charge a higher monthly premium. It might be helpful to think of the costs you will have to pay for a Medicare Part D Prescription Drug Plan in four phases:
WHAT IF I CAN'T AFFORD MEDICARE? Medicaid[55] If you qualify for both Medicare and Medicaid, you are called a “dual eligible.” If you have Medicare and full Medicaid coverage:
If you are eligible for both Medicare and Medicaid (“dually eligible”), you may be eligible to participate in MI Health Link. This is a program of integrated care for dual eligibles. You can read more about this in the Topic on Integrated Care for Dual Eligibles. Medicare Savings Programs[56] If you have limited income and resources and meet certain conditions, you may be able to take advantage of the Medicare Savings Program (also called the Medicare Buy-In Program in Michigan) and get help from the state of Michigan to pay your Medicare costs. In Michigan, you can be classified in one of three categories for the Medicare Savings Program, and how you are classified determines what help you will get from Medicaid.
In addition to income requirements, there are also other eligibility requirements, like whether you are entitled to Medicare Part A and whether you are eligible for Medical Assistance (MA) in Michigan. Medicaid will not help pay your Medicare costs unless:
Extra Help[57] Extra Help is a Medicare program to help people with limited income and resources pay Medicare prescription drug costs. Extra Help is sometimes called the “low-income subsidy” (LIS). You automatically qualify for Extra Help if you have Medicare and meet any of these conditions:
If you automatically qualify for Extra Help, Medicare will mail you a purple letter. If you get this letter, you don’t have to apply for Extra Help, and if you have any problems, you can use this letter as proof that you qualify. To use Extra Help after you get the purple letter you have to join a Medicare Part D Prescription Drug Plan. If you don’t join a prescription drug plan on your own, Medicare might enroll you in one so that you’ll be able to use the Extra Help. If Medicare does this, you will get a yellow or green letter telling you when your coverage begins. If you don’t want to be in a prescription drug plan, you can call the plan listed in your letter and tell them that you “opt out.” But if you do this, you’ll have to pay a penalty to join later unless you still qualify for Extra Help or you had some other creditable prescription drug coverage (coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage). If you don’t automatically qualify for Extra Help, you can apply for it. You can find more information about qualifications and how to apply here. If you apply for Extra Help and Social Security finds that you qualify, you will get a Notice of Award. If you have any problems you can show this notice as proof that you qualify. If you qualify for Extra Help and join a Medicare drug plan:
If you aren’t already enrolled in a Medicare drug plan and paid for prescriptions since you qualified for Extra Help, you may be able to get back part of what you paid. Keep your receipts, and call Medicare’s Limited Income Newly Eligible Transition (NET) Program at 1-800-783-1307. WHAT RIGHTS DO I HAVE AS A MEDICARE BENEFICIARY? If you have Medicare, regardless of how you get your Medicare, you have the right to[58]:
Depending on the kind of Medicare you have, you also have additional rights. If you have Original Medicare (Medicare Parts A and B), you also have the right to[59]:
If you have a Medicare Advantage Plan (Medicare Part C), you also have the right to[60]:
If you have a Medicare Prescription Drug Plan (Medicare Part D), you also have the right to[61]:
If you are having problems with your rights being violated or denied, you can contact the following people and organizations who might be able to help[62]:
WHAT DO I DO IF MY PROVIDER SAYS MEDICARE WON'T COVER MY SERVICES, OR IF MEDICARE SAYS SOMETHING ISN'T COVERED? Original Medicare (Medicare Parts A and B) Figuring It Out[63] If you have Original Medicare (Medicare Parts A and B), every three months you will be mailed a Medicare Summary Notice (MSN). This Notice:
When you get this Notice, you should:
If you disagree with a decision that Medicare made, you can appeal it. The MSN will have information about your appeal rights. Appeal If you disagree with certain decisions that Medicare or any of your Medicare plans (like your Medicare Advantage Plan or Medicare Prescription Drug Plan) has made, you can file an appeal. If you decide to appeal, you can ask your health care provider for any information that might help your case. You should keep a copy of everything you send to Medicare as part of your appeal. You have a right to appeal if Medicare or any of your Medicare plans:
If you want to, you can appoint a representative to help you with your appeal or file your appeal for you. You can appoint anyone you want to be your representative, including a family member, friend, lawyer, or doctor. Sometimes your doctor might be able to help you challenge decisions by Medicare or any of your Medicare plans without being officially appointed as your representative. There are two ways to appoint a representative. Either way, you need to send the paperwork to the company that handles your bills for Medicare, or if you’ve appealed, with your appeal request.
The appeals process works differently depending on whether you have Original Medicare (Medicare Parts A and B), Medicare Advantage, or a Medicare Part D Prescription Drug Plan. Original Medicare’s (Medicare Parts A and B) Appeal Process The appeal process for Original Medicare has five levels. If you disagree with the decision made at any level of the process, you can generally go on to the next level, or you can stop at any time. Medicare Prescription Drug Plan (Medicare Part D) Figuring It Out[64] If you have a Medicare Part D Prescription Drug Plan, every month that you fill a prescription your drug plan will mail you an Explanation of Benefits (EOB) notice. This notice gives you a summary of your prescription drug claims and your costs. When you get this notice, you should:
RESOURCES General Information about Medicare
Medicare Rights
Medicare Eligibility and Enrollment
Paying for Medicare and Medicare Savings Programs
Original Medicare (Medicare Parts A and B)
Medicare Advantage (Medicare Part C)
Medicare Part D Prescription Drug Plans
Extra Help (Low-Income Subsidy)
Medigap (Medicare Supplement Insurance)
Contesting Adverse Decisions by Medicare
Resources to Contact If You Have Questions About or Problems with Medicare
[13] Your benefit period begins the day you are admitted as an inpatient in a hospital or skilled nursing facility and ends when you have not received any inpatient hospital care or skilled care in a skilled nursing facility for 60 days in a row. [14] Lifetime reserve days are additional days that Medicare will pay for when you’re in a hospital for more than 90 days. You have 60 total reserve days that can be used during your lifetime. [54] Id. at p. 90-93, 96. |