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20 North Shore Towers Courier n January 2017 MEDICARE CORNER ORIGINAL MEDICARE 2017 NOTE: If you have retiree health coverage your costs sharing may be different. Check with your Human Rights Coordinator and/or Benefits Administrator regarding your cost sharing. COST SHARING ORGINAL MEDICARE What is Original Medicare? Original Medicare is Part A and Part B. It is the single payer insurance managed by the Federal Government. Medicare pays 80% of what it approves. Generally, people enrolled in Original Medicare are also enrolled in a Medigap/Supplemental Insurance plan. These plans usually pay 20% coinsurance of what Medicare approves. NOTE: You will be required to enroll in a stand-alone Prescription Drug Plan (PDP). For more information about Supplemental/Medigap Insurance see section #6 pages 81-84 in the “Medicare and You 2017” handbook. HOW DOES ORIGINAL MEDICARE WORK? • For most people Part A is free (See pages 27 -28 for information regarding Part A cost sharing and eligibility). • You pay an Annual Part B Deductible. The Part B Deductible for 2017 is $183. • You pay a monthly Part B premium based on your modified adjusted gross income filed with IRS from two years ago. If your income exceeds a certain amount you will pay an Income Related Monthly Adjusted Amount (IRMAA) for both Part B and D. • You can usually choose any doctor, health care provider or hospital that accepts Medicare. • If the doctor, health care provider or supplier accepts Medicare in full your cost sharing will in general be covered by your supplemental/ Medigap insurance. • If the doctor, health care provider or supplier does not accept Medicare Assignment in full you may be charged more than what Medicare approves. These doctors and health care providers are referred to as Non-Participating Providers. They can charge what is called the “limiting charge.” The Federal Maximum Limiting charge is 15% above what Medicare approves. • Doctors, hospitals, and other health care providers accepting Medicare in full are required to file claims to Medicare for covered services and supplies. • Non-Participating doctors, health care providers and suppliers may ask for payment in full at time of service. Call 1-800-MEDICARE (1-800- 633-4277) to find out if you have been charged the right amount . • Doctors or health care providers who do not participate in Medicare are referred to as “Opt-Out.” They and you have a written contract that you will be responsible for payment in full. MEDICARE SUMMARY NOTICE Understanding and carefully reviewing the Medicare Summary Notice (MSN) helps to prevent fraud. MSN’s are mailed every three months. You may choose to get the MSN electronically by enrolling on line with “MyMedicare.gov.” MSN’S LIST THE FOLLOWING INFORMATION: • Notice of Part B Deductible paid to provider • Service providers and billing code • If you do not recognize the name of a provider or doctor, call 1-800-Medicare (1-800-633-4227) • Service approved • Check the dates for service—if you did not receive service from that provider or doctor on the date listed call 1-800-Medicare (1-800-633-4227) • Amount Provider charged (The amount charged by the health care provider may be less than what Medicare approves) • Medicare amount approved • Amount Medicare paid (This amount equals 80% of what Medicare approved) • Maximum you may be billed • If you do not have a private insurer such as Medigap/Supplemental you are responsible to pay this amount to the provider • See Notes Column for Explanations of Claims • Your right to appeal and the date that Medicare must receive your notice of appeal • If you need help filing an appeal call 1-800-MEDICARE (1-800-633-4227) HEALTH PLAN PAYMENT SUMMARY If you are enrolled in a private plan, such as a Supplemental Plan/ Medigap Insurance, you will receive a “Health Plan Payment Summary.” The Health Plan Payment Summary will list the following: SUMMARY OF CLAIMS • Amount billed—amount that the health care provider billed • Amount allowed—the maximum amount the plan pays under your plan • Medicare payment—the amount that Medicare paid • What the plan paid—this is the amount that the private insurance plan paid • How to appeal a decision • Deductible • Your remaining deductible for the private insurance plan NEXT MEDICARE CORNER: Medicare Advantage Plans (Part C) 20 NORTH SHORE TOWERS COURIER ¢ December 2016


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