The Health Care Financing Administration, the Social Security Administration and Medicare.
Patient privacy rules have changed, and you have more access to your own medical records and more control over how your personal health information is used by your health care provider or your health plan. This rule became fully effective on April 14, 2003.
If you have any questions about this privacy rule, look at the National Statndards to Protect the Privacy of Personal Health Information, on the web.
If you are in a Medicare-managed care plan or a Medicare Private Fee-for-Service plan, you also have the right to timely access to your medical records.
Abuse involves actions that are inconsistent with accepted, sound medical, business or fiscal practices. Abuse directly or indirectly results in unnecessary costs to the program through improper payments. The real difference between fraud and abuse is the person's intent. Both have the same impact: they steal valuable resources from the Medicare Trust Fund that would otherwise be used to provide care to Medicare beneficiaries.
Part A is paid for by a portion of Social Security tax. It helps pay for inpatient hospital care, skilled nursing care, hospice care and other services.
Part B is paid for by the monthly premiums of people enrolled and by general funds from the U.S. Treasury. It helps pay for doctors' fees, outpatient hospital visits, and other medical services and supplies that are not covered by Part A.
Part C (Medicare Advantage) plans allow you to choose to receive all of your health care services through a provider organization. These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee. You must have both Parts A and B to enroll in Part C.
Part D (prescription drug coverage) is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare. Unlike Part B in which you are automatically enrolled and must opt out if you do not want it, with Part D you have to opt in by filling out a form and enrolling in an approved plan.
If You Are Under 65
Before age 65, you are eligible for Medicare hospital insurance if you:
Aliens who are 65 or older and aren't eligible for hospital insurance must be lawfully admitted permanent residents and must live in the United States for five years before they can enroll for medical insurance.
Medicaid is an assistance program. Medical bills are paid from federal, state and local tax funds. It serves low-income people of every age. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state. It is run by state and local governments according to federal guidelines
There are some exceptions. In rare cases, Medicare can pay for inpatient hospital services that you get in Canada or Mexico. Medicare can pay only if:
Normal or other Medicare coverage criteria also applies to the services you get in foreign settings.
Some Medicare Advantage plans may provide worldwide coverage benefits for health care needs when you travel outside the United States. You should check with your Medicare Advantage plan prior to traveling outside of the United States regarding worldwide coverage benefits.
Medigap policies C, D, E, F, G, H, I, and J provide Foreign Travel Emergency health care coverage when you travel outside the United States.
Only give personal information when you have made the contact. For example, you call or visit the websites of plans that are approved by Medicare; call or visit people in the community who work with Medicare, like your State Health Insurance Assistance Program or the Social Security Administration; or call 1-800-MEDICARE or visit www.medicare.gov on the web. People who are really working with Medicare won't try to enroll you into a drug plan over the telephone unless you call them, or unless you are already in a Medicare Advantage Plan or other Medicare Health Plan, and they call to ask if you would like to add prescription drug coverage to the coverage you already have.
Call 1-800-MEDICARE if you aren't sure if a plan is approved by Medicare. Plans are allowed to mail information and to call you. They aren't allowed to sell plans door-to-door.
If you think someone is misusing your personal information, call:
Your costs will vary depending on which plan you choose. Your plan must, at a minimum, provide a standard level of coverage as shown below. Some plans offer more coverage and/or vary the standard level of coverage by charging copayments based on drug tiers or lowering the deductible in exchange for higher out-pocket-costs later on.
Standard Coverage (the minimum coverage drug plans must provide)
Effective January 1, 2008, for covered drugs you will pay:
After you pay the $275 yearly deductible, here's how the costs work: