The first
step in understanding your Medicare
rights is to first know what Medicare is and what it is not. Medicare
eligibility is not based on income level or financial need. Medicare is
a federal health insurance program targeted to three groups of people:
·
Seniors 65
years of age and older;
·
Certain
disabled individuals under the age of 65;
·
Anyone with
permanent kidney failure.
In order to
be eligible for Medicare, generally a person or his/her spouse must have
worked for at least 10 years in Medicare-covered employment and must be
a citizen or permanent resident of the United States.
Medicare
does not cover 100% of all medical expenses. There are usually
deductibles and co-payments much like any private insurance program and
limits to certain services. Medicare does not cover long-term care
services, so often people will purchase supplemental insurance to pay
for what Medicare does not cover.
Medicare has
two parts:
·
Part A (Hospital Insurance) Part A helps pay for services in
Medicare-certified hospitals, skilled nursing facilities, hospice, and
some home healthcare agencies. Most people do not have to pay an
enrollment fee for Part A if they meet the above qualifications.
·
Part B (Medical Insurance)
Part B insurance covers, after a $100 annual deductible, 80% of charges
of most covered outpatient services such as doctor's appointments,
outpatient surgical services and supplies, and durable medical
equipment. For those who choose to enroll in Medicare Part B, the cost
is $78.20 a month, which can be automatically taken out of one's social
security, railroad retirement, or civil service retirement payment.
Medicare Rights
For help with your Medicare rights, call the
Florida PRO, Florida Medical
Quality Assurance, Inc. (Medicare review for the Federal Government)
1-800-844-0795
www.fmqai.com
·
You have the
right to receive all the hospital care that is necessary for the proper
diagnosis and treatment of your illness or injury. According to federal
law, your discharge date must be determined solely by your medical needs
and not by Medicare payments.
·
You have the
right to be fully informed about decisions affecting your Medicare
coverage and payment for your hospital stay and for any post-hospital
services.
·
You have the
right to request a review by a Medicare Peer Review Organization (PRO)
of any written Notice of Noncoverage that you receive from the hospital
or HMO stating that Medicare will no longer pay for your hospital care.
·
You have the
right to question or place a complaint about the quality of care you
have received as either a Medicare recipient or a member of a Medicare
HMO.
For
additional information about Medicare visit Medicare:The
Official U.S. Government Site for Medicare Information. http://www.medicare.gov/
