|
|
Center for Medicare Advocacy www.medicareadvocacy.org
This private, non-profit organization provides education, advocacy, and
legal assistance to help elders and people with disabilities obtain necessary
healthcare. The focus is on the needs of Medicare beneficiaries, people
with chronic conditions, and those in need of long-term care. The
center has long experience addressing Medicare home health care problem
situations. For assistance with a Medicare or healthcare problem, call
the Center toll free in Conn. at 1-800-262-4414 or 1-860-456-7790
(outside of Conn.), or in Washington, D.C. at 1-202-293-5760
Centers for Medicare & Medicaid
Services (CMS) www.medicare.gov,
www.cms.hhs.gov
(CMS's Medicare consumer information websites) The two websites are
linked in their information efforts. This Federal agency oversees
Medicare, Medigap, Managed Care (HMOs, PPOs, etc.), Prescription Drug Coverage and
Medicaid (administered by the states). Search on Medicare.gov for
information in your area on Medigap policies,
prescription drug plans, Medicare managed care health plans, suppliers
of medical equipment, participating physicians, nursing homes and
hospitals. Call nationwide 1-800- MEDICARE for Medicare and health
plans information. The following
is a sampling of available booklets and you can find more information
on either of above websites:
*Medicare & You 2008 #10050-Summary of Medicare benefits, rights
and protections; Medicare Hospice Benefits #02154-An explanation of
Medicare's hospice care coverage; Medicare Coverage of Skilled Nursing
Facility Care #10153-Benefits and rights; Medicare and Your Mental
Health Benefits #10184-Also eligibility and payments; Medicare and Home
Health Care #10969- An explanation of coverage; Your Guide to the
Outpatient Prospective Payment System#02118-New paying method; Medicare
and Other Health Benefits: Your Guide to Who Pays First#02179; Medicare
Savings for Qualified Beneficiaries#02184-Help in paying Medicare
out-of-pocket expenses for some low-income persons; Do You Need Help to
Pay Health Care Costs?#10118-Where you can get help; Does Your Doctor
or Supplier Accept Assignment?#10134-Assignment can save money; *2008
Guide To Health Insurance For People With Medicare#02110-information on
choosing a Medigap policy to supplement the
original Medicare Plan; *Your Medicare Beneits#10116-Your Health Care
Coverage in the Original Medicare Plan; Worksheet for Comparing
Medicare Health Plans#10113; Understanding Your Medicare
Choices#10120-Description of health plan options; Guide to Choosing a
Nursing Home#02174-How to choose a nursing home; Choosing a
Doctor#10180-Help Medicare beneficiaries choose a doctor for quality
care; Choosing Treatments#10182-Help beneficiaries make treatment
choices for quality care; Medigap Policies
and Protection#10139-Coverage and your rights to buy policy; Women with
Medicare: Visiting Your Doctor for a Pap Test, Pelvic Exam and Clinical
Breast Exam#02248-What is covered, how often and who pays; Where To Get
Your Medicare Questiions#02246-A good searching tool; Medicare Coverage
of Durable Medical Equipment#11045-Which durable equipment is covered
and where to get help; Guide to Medicare’s Preventive
Services#10110-Learn which preventive services are covered by Medicare;
Medicare Coverage of Diabetes Supplies and Services#11022-Explains the
supplies and services that Medicare covers; Medicare Coverage of Ambulance
Services#11021-Explains coverage, payment, rights and protections:
Choosing Long-term Care#02223-Helps you understand long-term options;
Your Medicare Rights and Protection#10112-Lists your rights and
protections in Medicare health plans; Your Guide to Prescription Drug
Coverage#11109-How it works, Extra Help Available and More
#Publication Number *Important Basic Information
Department
of Health and Human Services Office of the Inspector General Call 1-800-447-8477 about reporting fraud and abuse in any
federal health care program.
IPRO (Quality Improvement
Organization) www.ipro.org
In New York, IPRO is responsible for reviewing complaints about the
quality of care in the following types of medical facilities as well as
help to appeal your discharge from the hospital:
Complaints of
Care
In all
hospitals, licensed community health centers and clinics, call 1-800-804-5447,
Monday-Friday, 8:30 a.m. – 4:45 p.m. excluding holidays
In home care
service agency, call 1-800-628-5972, Monday-Friday, 10:00 a.m. - 4:00
p.m. excluding holidays
In adult care
and assisted living, call 1-866-893-6772, Monday-Friday, 8:30 a.m.
– 4:45 p.m. excluding holidays
In nursing
home, call 1-888-201-4563, Monday-Friday, 8:30 a.m. – 4:45 p.m.
excluding holidays
Appeal your
Discharge (Request a notice of non-coverage and make the call to
IPRO as soon as possible after you receive it)
From traditional Medicare hospital
stay, call 1-800-446-2447, Monday-Friday, 8:30 a.m. – 4:30 p.m.
to appeal your discharge from the hospital
From home health agency, skilled
nursing facility, a hospice or a CORF (comprehensive outpatient
rehabilitation facility) –all part of the traditional Medicare
program, call 1-800-833-0356, 8:30 a. m. – 4:30 p.m., seven days
a week to appeal the decision to discontinue services. You should get the notice at least
two days before the services are scheduled to end
From Medicaid hospital stay, call
1-800-648-4776 to appeal your discharge from the hospital. In the case of a Medicaid hospital
stay, you may get a discharge notice instead of a notice of
non-coverage
From Medicare Advantage Plan
hospital stay, call 1-800-446-2447, Monday-Friday, 8:30 a.m. –
4:30 p.m. to appeal your discharge from the hospital. You should get a Notice of Discharge
and Medicare Appeal Rights instead of a notice of non-coverage
From skilled nursing facility,
home health agency or comprehensive outpatient rehabilitation facility
– all part of a Medicare Advantage Plan, call 1-888-696-9561,
8:30 a.m. – 4:30 p.m., seven days a week to appeal the decision
to discontinue services.
From private insurance or self-pay
hospital stay, call 1-800-648-4776 to appeal your discharge from
the hospital. In the case of a
private insurance or self-pay hospital stay, you may get a discharge
notice instead of a notice of non-coverage.
There is
education literature such as: “HMO Report Card-Annual compilation
of access, service and quality data for all commercial managed care
plans in New York State”, “Healthy Seniors
Newsletter-featuring timely information about Medicare and
Health-related topics” and “IPRO Electronic Newsletters-previous
issues and subscribe facility to future electronic issues.”
Medicare Rights Center www.medicarerights.org
Do you need individual counseling?
Call the consumer hotline at 1-800-333-4114 between 9 a.m. and 6
p.m. You can also find answers
on the MRC website’s free virtual counseling tool,
“Medicare Interactive.”
The website has newly updated information on Medicare drug
coverage as well as the drug plan appeals process; also “Dear
Marci”-a weekly e-newsletter and other Medicare policy and news
updates to keep you in the loop about health care benefits, rights and
options.
National Association of Insurance Commissioners www.naic.org
Call 1-816-783-8300 for booklet A Shopper's Guide to Long-Term Care
Insurance. This informative
(been around a long time) booklet is not listed in the index of
publications but it is available – well worth reading.
National Government Services (Medicare Contractor) www.ngsmedicare.com
Part A claims in NY, CT, DE, MA 1-800-Medicare (1-800-633-4227)
Part B claims in NY and NJ 1-800-Medicare (1-800-633-4227) Look up a
local coverage determination (LCD) – from foot care to colonoscopy, download a form (patent request for
medical payment, for example), subscribe to mailing lists on various
topics – Medicare Monthly Review changes in local determination
policies, Part A and Part B training courses, and much more.
National Heritage Insurance Company is the Durable
Medical Equipment (DME) Medicare Administrative Contractor (MAC) www.medicarehic.com/dme for NY, DE, ME, MA. NH,
PA and RI. The home page states
the following: NHIC will provide its services for Medicare
beneficiaries and Durable Medial Equipment, Prosthetics, Orthotics and Supplies. However, Medicare beneficiaries are
directed to 1-800-Medicare for questions. Nevertheless, the website can be a
good source for current medical policies regarding various benefits.
New York City Department for the
Aging www.nyc.gov/aging
Click on “Benefits Guide for Seniors” for eligibility for
Medicare, Medicare Saving Plan, Medicaid and much more. HIICAP
(Health Insurance Information Counseling and Assistance Program), a program of Department for the Aging, is a counseling service regarding Medicare and related health
insurance issues. Call the NYC help-line 1-212-341-3979 with your
questions, and they can refer you to the counseling site nearest to
you. Request the booklet "A Complete Guide To Health Care Coverage
For Older New Yorkers."
Other organizations in New York City
offering in- person one-on-one Medicaid counseling:
Community Services Society, Aces Program 1-212-614-5310
Monday-
Wednesday, 10:00 a.m. – 4:00 p.m. By appointment
One Stop Senior
Center 1-212-864-7900 Monday-Friday 10:00
a.m. – 2:00 p.m. By
appointment
New York State Department of Health-Office of Medicaid
Management www.health.state.ny.us The website summarizes eligibility
and benefits for Medicaid programs for Medicare beneficiaries. In New York City, contact the Human
Resources Administration by calling 718-557-1399. Residents of the five boroughs of New
York City may call toll free at 1-877-472-8411. Outside New York City you can write,
phone or go to the local
department of social services – simply click
on the link and you will have the
address and phone number. The
New York State Help Line is 1-800-541-2831.
New York State EPIC (Elderly Pharmaceutical Insurance
Coverage Program) www.health.state.ny.us/nysdoh/epic/faq.htm
Call 1-800-332-3742 for information and application for this New York
State sponsored prescription drug plan. New York State residents can
join Epic if they are 65 or older, and have an annual income of $35,000
or less if single, or $50,000 or less if married. In other states similar programs are
known as a SPAP (State Pharmaceutical Assistance Program). It is incumbent on every Medicare
beneficiary residing in a state where there is a SPAP to check it
out. If you are not eligible for
Medicare, it is probably as important, if not more, that you look into
the eligibility rules to ascertain whether you qualify – the SPAP
may turn out to b your best buy in prescription drug coverage.
New York State HIICAP (Health Insurance Information
Counseling and Assistance Program) www.hiicap.state.ny.us
The web site has benefit facts and information about programs of
interest to Medicare beneficiaries.
In New York City, call the NYC Department for the Aging HIICAP
HELP-Line at 1-212-341-3979 for an appointment to meet with a trained
HIICAP Counselor. In other parts
of New York State, call the NYS-HIICAP Toll Free Hot Line
1-800-701-0501.
New York State Insurance Department www.ins.state.ny.us
The website offers information to Medicare beneficiaries regarding Medicare
coverage, Medicare supplement insurance (Medigap)
information including rates tables and important protections for NYS
residents terminated by Medicare HMOs.
Additionally there is offered an orientation on Long Term Care
Insurance and sample annual premiums.
For persons (a few years from Medicare eligibility) inquiring
about private insurance, I am able to give them a list of New York
State approved HMOs (addresses and phone numbers) with premiums, which
I have copied from this website.
You may call 1-800-342-3736 for assistance on Medigap, HMOs and Long Term Care Insurance -- as
well as contacting the department’s Elder Protection Unit which
was established (7/23/97 to provide support and protection for the
elderly in dealing with insurance and related concerns.
New York State Partnership for
Long-Term Care www.nyspltc.org
The following opening statement on the website says it all:
The New York
State Partnership for Long-Term Care is a unique program combining
long-term care insurance and Medicaid Extended Coverage. Its purpose is to help New Yorkers
financially prepare for the possibility of needing nursing home care,
home care or assisted living services some day. The program allows New
Yorkers to protect some or all of their assets (resources) depending on
the insurance plan purchased, if their long-term care needs extend
beyond the period covered by their private insurance policy.
Call 1-888-697-7582 inside of New York State, or
1-518-473-8083 outside New York State, for information about
partnership long-term care insurance and insurance brochures and
consumer booklets.
Tricare Management Activity www.tricare.osd.mil This office administers amongst many other health
programs, TRICARE for Life (phone # 1-866-773-0404), which provides
Medicare secondary coverage to uniformed service retirees, their family
members and survivors, age 65 and over.
They must have Medicare Part A, be enrolled in Part B and
registered in the Defense Enrollment Eligibility Reporting System
(OEERS) 1-800-538-9552. The office
also administers a pharmacy program (1-877-363-6337) which covers the
above group of eligible persons for prescriptions. Tricare
prescription drug coverage is available to all Tricare
eligible beneficiaries who are enrolled in DEERS. If you decide later to enroll in a
Medicare Part D prescription drug program, you won’t be required
to pay the late enrollment penalty because Tricare
prescription drug coverage is creditable coverage. If you have limited income and
assets, and you qualify for Medicare’s extra help with
prescription drug costs, you may benefit by enrolling in a Medicare
prescription drug plan.
The welcome page invites you to click on tabs-Medical,
Dental, Vision, Prescriptions and Mental Health for general information
– wrong way to go. It
would be preferable to enter your profile to see tailored information
just for you. An example is a
former spouse or dependent parents or parents-in-law, and the
sponsor’s information is active duty service member or retiree,
and you need to enter one of the seven uniformed services.
Pharmaceutical
Research and Manufacturers of America (PhRMA) www.phrma.org, and member companies, together with other organizations
have formed the Partnership for Prescription Assistance. They have created a new interactive
site www.pprx.org, that lets
patients search for prescription drug assistance programs. You have access to the helping
patient web site at the pharma web site. Select your medications from the list
of available prescription drugs, answer 10 simple questions to
determine your eligibility, and you have accessed contact information
and can print out applications to apply for free or discounted drug
programs. You may also call
1-888-4777-2669.
Railroad Retirement Board www.rrb.gov
Railroad retirees should call the automated help line 1-800-808-0772
regarding lost RRB Medicare card, general Medicare information,
unemployment and sickness benefits, railroad retirement annuities and
address and phone numbers of your nearest field office. There are available on the website
benefit information and on line services, beneficiary publications and
news releases. For Part B bills
and services call the Part B Carrier, Palmetto GBA, 1-800-833-4555.
Call the Fiscal Intermediary in your state for Part A bills and
services.
Social Security Administration www.ssa.gov
Look to the website or call 1-800-772-1213 for Medicare eligibility and
enrollment information, lost Medicare card replacement, helping
Medicare beneficiaries understand how they may qualify and apply for
extra help to pay for prescription drugs, SSI eligibility and
enrollment and general Social Security issues including Social Security
disability pensions, social security eligibility, application and
calculation of benefits.
The National Council on the
Aging www.ncoa.org operates an
online service, Benefits Checkup, www.benefitscheckup.org,
which helps people ages 55 and over find programs that may pay for some
of the costs of prescription drugs, health care, utilities and other
essential items or services. You
need to complete a simple questionnaire and will find on the NCOA
website a direct link to benefits checkup.
Veterans Administration www.va.gov
You can call 1-877-222-2387 and/or navigate the website to find out if
you are eligible for health care benefits, how to apply and what it
will cost. I suggest that you
first do the website – it will prompt you to ask more and better
questions. You will find on the
health care index page links to the following Health Care Benefit
topics: Eligibility for Benefits, Apply for Care, Copays,
Charges, Benefits for Family Members, Special
Programs and Vocational Rehabilitation.
On the same page, Information for Patients links can give you
further details of the health care programs. You can also call the New York
Regional office at 1-800-827-1000 for information about all VA benefits
(including health care).
Updated: May 12, 2008
For comments, questions
or feedback, please email to
senhealth@yahoo.com
|
