Medicare For The Clueless: The Complete Guide to This Federal Program

by Joan H. Conklin

Overview

Outlines the rules and regulations of what is and is not covered by Medicare, describes how to cope with the system, and provides advice on choosing supplemental coverage.

Product Details

ISBN-13:	9780806523163
Publisher:	Kensington
Publication date:	06/01/2002
Series:	The Clueless Guides Series
Pages:	228
Product dimensions:	5.50(w) x 8.50(h) x 0.52(d)

Table of Contents

	Foreword	xi
	Introduction	xiii
Chapter 1	Getting Started	1
	What Is Medicare?	1
	What Does It Cover?	1
	Who Is Eligible?	2
	How Much Does It Cost?	3
	How Do You Enroll?	4
	Where Do You Enroll?	5
	When Should You Enroll?	5
	Recap	7
	The Medicare Card	9
	Getting Help to Pay Your Health Care Costs: The Medicare Savings Programs	9
Chapter 2	Medicare Part A	13
	Hospital Bills	13
	The Deductible	14
	Benefit Periods	17
	Psychiatric Hospital Restrictions	18
Chapter 3	What You Should Know Before You Enter the Hospital	19
	Medicare Myths	19
	Your Rights as a Medicare patient	19
	Advance Directives	23
	Care in a Foreign Hospital	24
	Paying Hospital Bills	26
Chapter 4	Skilled Nursing Facilities	31
	When Medicare Pays	31
	What Part of the Bills Does Medicare Pay?	32
	Notice of Noncoverage	35
	Looking for a Nursing Home	37
Chapter 5	Home Health Care	38
	When Medicare Pays: The Rules	38
	What Medicare Covers	40
	What Medicare Does Not Cover	40
	Your Rights	41
	Advance Directives	42
	How to Find an Approved Home Health Care Agency	42
	Home Health Care Advance Beneficiary Notice	43
Chapter 6	Hospice Care	46
	Who Is Eligible?	46
	How the Program Works	47
	What Is Covered?	47
	Deductibles and Copayments	48
Chapter 7	Doctors' Bills: The Doctors You Choose Determine How Much You Will Owe	50
	Private Contracts	51
	The "Approved Amount"	52
	Mistakes Are Made	58
	How to Find Doctors Who Accept Assignment	60
	Recap	61
Chapter 8	The "I Didn't Know" Rule	62
	How It Works	63
	Can You Get a Refund?	65
	Advance Beneficiary Notice	67
Chapter 9	Services Not Covered	70
	The Importance of This List	72
	What Is and What Is Not "Routine"	73
Chapter 10	Not for Diabetics Only	75
	Finding the Right Pharmacy or Supplier	77
	Some People Do Their Jobs Better Than Others	80
	For Diabetics Only	82
Chapter 11	Diagnostic Tests	84
	What Is a "Diagnostic Test"?	84
	What Kinds of Diagnostic Tests Are Covered?	85
	What Other Diagnostic Services Are Covered?	85
	Diagnostic Tests in Doctors' Offices and Laboratories	86
	Prohibition on Referrals	86
	Paying Diagnostic Testing Bills	87
Chapter 12	Durable Medical Equipment and Supplies	88
	What Durable Medical Equipment and Supplies Are Covered?	88
	When to Rent and When to Buy	90
	Participating Suppliers	92
Chapter 13	Ambulance Bills	96
	The Rules	96
	Medicare Denial of Ambulance Bills	98
	The New Changes to the Rules	101
Chapter 14	Outpatient Hospital Bills	105
	Services Included	105
	The "New" Outpatient Prospective Payment System	106
	The Budget Reconciliation Act of 1997	107
Chapter 15	The Medicare Part B Deductible	108
	How Do You Know When You Have Met the Deductible?	109
Chapter 16	Paying Part B Bills	112
	What to Do When Medicare Refuses to Pay a Bill	112
	When to Pay Part B Bills	117
	The "Rule of Anastasia" or, "Don't Pay Bills You Don't Have to Pay"	121
Chapter 17	Medicare Part C	124
	Background	124
	Who Is Eligible?	129
	Traditional Medicare versus Medicare + Choice (M+C)	129
	What Happens If "Harry" joins an HMO	130
	What Happens When "Harry" Joins a PSO	131
	What Happens When "Harry" Joins a PFFS	131
	The Pros and Cons of Joining a Medicare + Choice Plan	132
	Shopping for a Medicare + Choice Plan	133
	You've Finished Shopping; It's Time to Make a Decision	137
	The Least You Need to Know When You Join a Medicare + Choice Plan	140
Chapter 18	Appeals	143
	Appealing a Decision in a Medicare + Choice Plan	143
	Appealing a Decision Under Traditional Medicare	145
Chapter 19	Medigap Insurace	149
	It's as Easy as A,B,C	150
	The Ten Standard Medigap Policies	152
	Medicare Select	155
	You Have to Compare Prices	158
	Prescription Drug Coverage	159
	Preexisting Condition Clauses	161
	Shopping for a Medigap Policy	162
	Author's Note	164
Chapter 20	Supplementary Insurance	167
	When You Get Your Supplementary Insurance Through a Former Employer, Does It Do the Job?	167
	Buying a Supplementary Policy to Supplement a Supplementary Policy	171
	Advice for the Brave	174
	Who Pays First?	174
Chapter 21	Tricare for Life	176
	Who Is Eligible?	176
	How Much Does It Cost?	177
	Who Pays First?	177
	How the System--Medicare Plus Tricare--Works	180
Chapter 22	Odds and Ends	183
	Medicare versus Medicaid	183
	Blood Deductible	184
	Prescription Drug Coverage	184
	Did You Know?	187
	Final Words	190
	Organizations	191
	Hospice Organizations	191
	Long-Term Care Ombudsman	195
	Peer Review Organizations	197
	Durable Medical Equipment Regional Carriers	201
	Index	205