News Alert

The Senior Health Insurance Assistance Program (SHIP) Needs volunteers to help people with Medicare learn about the many available benefits:

ü Medicare & Medigap

We are recruiting volunteers to assist people with Medicare, do community outreach, provide educational programs, provide individual counseling and give general program support !!

The Senior Health Insurance Assistance Program (SHIP) funded by the Maryland Department on Aging with a grant from the Center for Medicare and Medicaid Services (CMS) and Montgomery County , provides free information, educational programs, individual assistance and counseling about Medicare, supplements to Medicare (Medigap Plans), Medicare Advantage Plans (Managed Care Plans), Prescription Drug Programs, Income saving programs (QMB/SLMB), Maryland Health Insurance Plans, Federal Health Insurance Plans, Employer Health Insurance Plans, and Long Term Care Insurance. The SHIP program provides advocacy on Medicare Fraud and Abuse and billing issues.

There are more than 110,000 people with Medicare in Montgomery County, including those who are aged 65 and older, and those who are disabled. Our outreach is to this population, their family members and caregivers, as well as to our aging network partners. One third of our senior citizens over the age of 65 live alone and need special assistance and advocacy with health insurance programs and options.

The SHIP Program provides educational programs, seminars, and trainings to community groups, church groups, clubs, neighborhood associations, and our aging network partners. SHIP updates and supplies printed information, comparison charts and tables outlining health insurance options and maintains a web site (www.medicarehlep.org) in several languages, as a 24 hour answering machine and tries to respond to messages in a timely manner. Trained volunteers meet on an individual basis with seniors, the disabled, their family members and caregivers on a walk-in or scheduled basis in county libraries, senior centers, senior communities, and HOC buildings to provide objective information, help solve individual insurance problems, assist with Medicaid and Medicare forms, insurance claims, and act as advocates in making appeals.

MEDICARE 2008 FACT SHEET

PART A MEDICARE BENEFITS

1. INPATIENT HOSPITAL CARE

Benefits are paid on the basis of “benefit periods”. A benefit period begins the first day you are hospitalized and ends when you have been out of a hospital or skilled nursing facility for 60 consecutive days. If you enter a hospital again after 60 days, a new benefit period begins.

In 2008, a Medicare beneficiary is responsible for a deductible of $1,024 for the first day of each benefit period, after which Medicare pays for up to 60 days of full hospital care. For days 61-90, the beneficiary is responsible for $256 per day (co-payment). In addition, a beneficiary has 60 lifetime reserve days, and would be responsible for a co-payment of $512 per day for days 91-150. There is no Medicare coverage for days 150 - 365.

2. SKILLED NURSING FACILITY (SNF) CARE

After a hospital stay of at least 3 consecutive days, Medicare covers 100 days of skilled nursing or rehabilitative care in a SNF, provided the SNF is approved by Medicare and your treatment is connected with the illness that caused you to be hospitalized. You must need skilled nursing care or skilled rehabilitative care on a daily basis. Days 1-20 are paid in full by Medicare. The beneficiary is responsible for a $128 per day co-pay for days 21-100 in a skilled nursing facility. NO CUSTODIAL OR INTERMEDIATE NURSING HOME CARE IS PROVIDED.

3. HOSPICE CARE

Medicare pays for a maximum of 210 days of care for terminally ill patients in a Medicare approved hospice program, through two 90-day periods and one 30-day period. There are no deductibles or co-payments, except for covered prescription drugs and inpatient respite care. Individuals must choose hospice care.

Medicare provides for full payment of intermittent part-time skilled care from registered nurses, therapists, and home health aides from a Medicare approved home health agency. Intermittent part-time care is generally defined as daily care for 5 days a week up to 2 or 3 weeks. In exceptional cases, longer care may be provided. In order to be eligible, a beneficiary must meet all the following criteria:

If you require skilled services (nursing, physical therapy, or speech therapy), you may also receive occupational therapy, social work services, and home health aide services if your physician determines you need them. Prior hospitalization is not required to receive home health services under Medicare.

1. PHYSICIAN SERVICES (INPATIENT AND OUTPATIENT), OUTPATIENT SERVICES, AND DURABLE MEDICAL EQUIPMENT AND SUPPLIES.

co- payment for Medicare-approved charges and services. Medicare pays 80% of the Medicare-approved charge. A beneficiary is responsible for all costs above Medicare-approved charges (“excess charge”). Physicians who do not accept assignment of a Medicare claim are limited as to the amount they can charge Medicare beneficiaries for covered services.

The Limiting Charge is 115% of the fee schedule amount for non-participating physicians. NOTE: Medicare-covered services, such as mental health services, physical and occupational therapy, and certain services rendered by special practitioners have special payment rules.

Medicare pays the full-approved charge for flu shots and pneumococcal vaccine and its administration. Neither the annual Part B deductible nor the 20%

co-payment apply to these services. Medicare may cover certain oral anti-cancer, asthma, and ophthalmologic drugs subject to the Part B premium and 20% co-payment rules. Medicare helps pay for Hepatitis B vaccine and its administration, furnished to beneficiaries considered to be at high or intermediate risk of contracting the disease. Medicare also pays for immunosuppressive drugs post transplant if the transplant was Medicare-approved (certain time guidelines do exist).

New Medicare prescription drug coverage is available to everyone with Medicare. The drug plans are offered by insurance companies and other private companies approved by Medicare. Drug plans will vary in monthly premiums, list of covered drugs, deductibles and co-pays, and pharmacies accepting the plan. It is important to review the list of drugs you take and review the plans every year. You may change plans during the

ü Medicare & Medigap

MEDICARE 2008 FACT SHEET

PART A MEDICARE BENEFITS

IMPORTANT RELATED SUBJECTS