All About Medicare 2001

by Stenken, Joseph F.

• ISBN13: 9780872182776
• ISBN10: 0872182770
• Edition: Revised
• Format: Paperback
• Copyright: 2001-03-01
• Publisher: Natl Underwriter Co

Table of Contents

Introduction	1	(1)
Medicare Defined	1	(1)
Administration of Medicare	2	(1)
Hospital Insurance Protection	3	(1)
Medical Insurance Protection	4	(1)
Providers of Services and Supplies	5	(1)
Hospital Insurance	6	(1)
Medical Insurance	7	(1)
Home Health Coverage	8	(1)
Limit on Benefits	9	(1)
Availability of Benefits	10	(1)
Medicare Card	11	(1)
Care Not Covered by Medicare	12	(1)
Peer Review Organizations	13	(1)
Fraud and Abuse	14	(1)
Fraud and Abuse Hotline	15	(1)
Fee-for-Service System Versus Medicare-Choice	16	(1)
HOSPITAL INSURANCE PART A:	17	(46)
Eligibility	17	(10)
Who Is Eligible	1	(1)
End-Stage Renal Disease	2	(1)
Government Employees	3	(1)
Medicare as Secondary Payer	4	(1)
Persons Who Do Not Qualify for Social Security	5	(1)
Special Enrollment Premium	6	(21)
Administration	27	(3)
Health Care Financing Administration	7	(1)
Prospective Payment System	8	(1)
Compulsory Nature of Plan	9	(21)
Financing Hospital Insurance	30	(1)
Hospital Insurance Tax	10	(21)
Benefits	31	(1)
Generally	11	(21)
Qualified Medicare Beneficiaries	32	(2)
Medicare Costs Paid by State	12	(1)
How to Qualify	13	(1)
Income Above Poverty Level	14	(1)
Applying for Assistance	15	(19)
Inpatient Hospital Services	34	(12)
Services Covered	16	(1)
Managed Care Plans	17	(1)
Health Maintenance Organizations	18	(1)
Care in Psychiatric Hospital	19	(1)
Religious Nonmedical Health Care Institutions	20	(1)
Selecting a Hospital	21	(1)
Certification by Doctor	22	(1)
Hospital Agreement with Medicare	23	(23)
Hospice Care	46	(3)
Hospice Care Defined	24	(1)
How Hospice Care is Covered	25	(1)
Hospice Benefit Period	26	(1)
Cost to Patient	27	(1)
Respite Care	28	(21)
Skilled Nursing Facility Care	49	(6)
Definition	29	(1)
Services Covered	30	(1)
Cost to Patient	31	(1)
When Payment is Made	32	(23)
Home Health Care	55	(5)
When Services Are Covered	33	(1)
Conditions for Coverage	34	(1)
Services Covered by Medicare	35	(1)
How Medicare Pays the Cost	36	(24)
General Information	60	(3)
Outpatient Hospital Services	37	(1)
Financial Need	38	(1)
Increases in Deductible and Coinsurance Amounts	39	(1)
Living Will and Durable Power of Attorney	40	(23)
MEDICAL INSURANCE PART B:	63	(32)
Eligibility	63	(4)
Who Is Eligible	1	(1)
How to Enroll	2	(1)
Failure to Enroll During Automatic Enrollment Period	3	(1)
Federal-State Agreement	4	(1)
Special Enrollment Period for Certain Disabled Workers	5	(1)
Terminating Coverage	6	(61)
Financing Medical Insurance	67	(8)
How Program is Financed	7	(1)
Qualified Medicare Beneficiary	8	(1)
How Premiums are Paid	9	(1)
Determining ``Approved Charges''	10	(1)
How Payments are Made	11	(1)
Medicare-Participating Doctors	12	(1)
Medicare Supplier	13	(1)
Cost Paid By Patient	14	(1)
How Patient Finds Out How Much Medicare Will Pay	15	(60)
Benefits	75	(17)
Doctors' Services	16	(1)
Outpatient Hospital Services	17	(1)
Outpatient Physical Therapy and Speech Pathology Services	18	(1)
Partial Hospitalization Services	19	(1)
Certified Nurse-Midwife Services	20	(1)
Dental Work	21	(1)
Medical Equipment	22	(1)
Ambulance Service	23	(1)
Outpatient Treatment of Mental Illness	24	(1)
Vaccines	25	(1)
Antigens	26	(1)
Liver Transplant	27	(1)
Comprehensive Outpatient Rehabilitation Facility	28	(1)
Home Health Services	29	(1)
Independent Clinical Laboratory Services	30	(1)
Screening Pap Smears	31	(1)
Breast Cancer Screening	32	(1)
Prostate Screening	33	(1)
Colorectal Screening	34	(1)
Diabetes Benefits	35	(1)
Bone Mass Measurements	36	(1)
Osteoporosis	37	(1)
Eyeglasses	38	(1)
Nurse Practitioners	39	(1)
Lung and Heart-Lung Transplants	40	(1)
Immunosuppressive Drugs	41	(1)
Ambulatory Surgical Services	42	(1)
Rural Health Clinic Services	43	(1)
Telehealth Services	44	(1)
Federally Qualified Health Center Services	45	(1)
Other Benefits	46	(1)
Services Covered With No Cost Sharing	47	(45)
Medicare Coverage of Blood	92	(1)
How Medicare Helps Pay Cost of Blood	48	(44)
Private Contracts	92	(3)
Private Contracts with Physicians	49	(46)
MEDICARE+CHOICE PART C:	95	(14)
Definition	95	(3)
Medicare+Choice Defined	1	(1)
Health Maintenance Organization	2	(1)
Private Fee-For-Service Plan	3	(1)
Medical Savings Account Plan	4	(1)
Special Rules for Medical Savings Accounts	5	(1)
Provider-Sponsored Organization	6	(1)
Religious Fraternal Benefit Society Plan	7	(91)
Eligibility, Election, and Enrollment	98	(2)
Enrollment Process	8	(1)
Enrollment Periods	9	(1)
Beneficiary Information	10	(90)
Benefits and Beneficiary Protections	100	(4)
Basic Benefits	11	(1)
Standards of Protection	12	(1)
Antidiscrimination Rules	13	(1)
Disclosure to Enrollees	14	(1)
Access to Services	15	(1)
Quality Assurance Program	16	(1)
Grievances	17	(1)
Provider Participation Rules	18	(1)
Billing Limits	19	(85)
Premiums	104	(1)
Proposed Premiums	20	(1)
Other Premium Rules	21	(84)
Payments to Medicare+Choice Organizations	105	(1)
Medicare Payments	22	(83)
Contracts with Medicare+Choice Organizations	105	(2)
Contracts with Health Care Financing Administration	23	(84)
Medigap Insurance Program	107	(2)
Medigap Insurance Rules	24	(1)
Special Protections	25	(84)
MEDIGAP INSURANCE	109	(14)
Defined	1	(1)
Open Enrollment Period	2	(1)
Medigap Insurance for Medicaid Recipients	3	(1)
Federal Standards for Medigap Insurance	4	(1)
Additional Benefits	5	(1)
Twelve Standard Policies	6	(1)
Medicare SELECT Policies	7	(1)
Choosing the Right Policy	8	(1)
Medicare+Choice Program	9	(1)
Rules for Selling Medigap Insurance	10	(1)
Shopping for Medigap Insurance	11	(112)
HOW TO SUBMIT CLAIMS AND APPEALS	123	(10)
Claims Procedure	123	(3)
Hospital Insurance Services	1	(1)
How to Submit Medical Insurance Claims	2	(1)
Itemized Bills	3	(1)
Death of Person Filing Claim	4	(1)
Time Limit for Filing Claim	5	(1)
Where to Send Claims	6	(1)
Prompt Payment	7	(119)
Appeals Procedure	126	(7)
Right to Appeal Decision on Claim	8	(1)
How to Appeal Medical Insurance Claim Decision	9	(1)
Review by Medicare Carrier	10	(1)
Hearing with Medicare Carrier	11	(1)
How to Appeal Hospital Insurance Claim Decision	12	(1)
How to Appeal All Other Hospital Insurance Claims	13	(1)
How to Appeal HMO Decisions	14	(1)
Protection if Organization Ceases To Provide Benefits	15	(118)
MEDICAID	133	(22)
Overview	133	(2)
Medicaid Defined	1	(1)
Expenses Paid by Federal Government	2	(1)
Medicaid Beneficiaries	3	(132)
Medicaid Eligibility	135	(4)
Groups Covered by States	4	(1)
SSI States	5	(1)
Optional Coverage	6	(133)
Medicaid Services	139	(2)
Basic Services	7	(1)
AIDS	8	(1)
Optional Services	9	(132)
Payment Under Medicaid	141	(2)
How Providers are Paid	10	(1)
Amount and Duration of Services	11	(1)
Medicare Coverage	12	(131)
Long-Term Care	143	(1)
Medicaid Coverage	13	(131)
Exempt Income and Resources	144	(1)
Income and Resources Recipient Can Keep	14	(131)
Spousal Improverishment	145	(2)
Income	15	(1)
Resources	16	(1)
Income Eligibility Requirements	17	(1)
Post-eligibility Treatment of Income	18	(129)
Medicaid Transfer Rules	147	(2)
Transfer of Property to Meet Eligibility Requirements	19	(130)
Trusts	149	(3)
Use of Trusts	20	(1)
Exceptions to Trust Rule	21	(131)
Estate Recoveries	152	(1)
State Recovery of Medicaid Expenses	22	(130)
Discrimination	152	(1)
Nursing Homes	23	(130)
Managed Care	153	(2)
Changes to Medicaid Program	24	(131)
APPENDICES	155	(20)
Appendix A - Table of Medicare Benefits	155	(2)
Appendix B - What Medicare Does Not Cover	157	(2)
Appendix C - Example of Medicare Benefits	159	(2)
Appendix D - Medicare Carriers	161	(4)
Appendix E - Medicare Peer Review Organizations (PROs)	165	(4)
Appendix F - Durable Medical Equipment Regional Carriers	169	(4)
Appendix G - Insurance Counseling-General Information	173	(2)
Appendix H - Health Care Financing Administration Regional Offices	175