Table Of Content

CENTERS FOR MEDICARE MEDICAID SERVICES & ^ c MMeeddiicare OU 2010 This is the official government handbook with important information about the following: * What's new * 2010 Medicare costs * What Medicare covers SfcRVICi* * Health and prescription drug plans * Your Medicare rights PUBS RA * Health information technology 412 .3 Y68 2010 1 Want to Save? Extra Help is available! More than 2 million people qualify to get Extra Help paying their Medicare prescription drug costs, but don't know it. Don't miss out on a chance to save. See pages 78-81 to learn more. Choose to get future handbooks electronically. Save tax dollars and help the environment by & signing up to access your future "Medicare You" handbooks electronically (also called the eHandbook). Visit www.MyMedicare.gov to request future eHandbooks, including the 201 version. We'll email you next October when the new eHandbook is available. The email will include a link to the handbook on www.medicare.gov. You won't get a copy ofyour handbook in the mail if you choose to get it electronically. Did your household get more than one copy of "Medicares You?" This may happen ifthere is a slight difference in how your or your spouse's address is entered in Social Security's mailing system. Ifyou would like to get only one copy in the future, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048. Blvd. . :;.->! 7jd\o Welcome to Medicare & You 201 I am honored and excited to introduce this handbook—your best and official source ofanswers to your Medicare questions. At the U.S. Department ofHealth and Human Services, we are doing more than ever to carry Medicare into the future. Every day brings new commitment to advance the goals ofhealth reform by reducing costs, offering choices, and making sure you have access to quality, affordable health care. Your good health is our top priority. On February 17, 2009, President Obama signed the American Recovery and Reinvestment Act. This law targets two areas, among many, to ensure the health and well-being ofthe Nation: 1. Strengthening preventive care and wellness to enable Americans to live longer, healthier lives. 2. Investing in health information technology to improve the quality ofhealth care and reduce medical errors. There are some things that you can do to help these efforts: Take advantage ofMedicares preventive services. Use the checklist on page 40, and ask your doctor or other health care provider what preventive services you need. Learn about the technology available to help improve your health care. Look on page 127 to learn more about health information technology. This handbook also includes other important facts and changes you will need for 2010. For the latest information about changes to Medicare, visit www.medicare.gov or call 1-800-MEDICARE TTY (1-800-633-4227). users should call 1-877-486-2048. Yours in good health, IjL^L Kathleen Sebelius Secretary U.S. Department ofHealth and Human Services How to Use This Handbook Please keep this handbook for future reference. Information was correct when it was printed. Call 1-800-MEDICARE (1-800-633-4227), or visit www.medicare.gov to get the most TTY current information. users should call 1-877-486-2048. Find WhatYou Need Table of List oftopic Pages 5-6 Contents areas by section Alphabetical list Index Pages 7-10 oftopics List oftopics Mini Tables of Pages 15, 41, 77, within each Contents 85,99,105,115 section Blue words in the text are Blue Words explained in the Pages 111-114 in the Text "Definitions" section © Highlights Throughout important handbook information * Highlights preventive Pages 26-38, 40 services & "Medicare You" isn't a legal document. Official Medicare Program legal guidance is contained in the relevant statutes, regulations, and rulings. 53 foTTHiTE 4 How to Use This Handbook — 7 Index A Quick Way to Find WhatYou Need 11 What's New and Important in 2010 12 Medicare Basics 12 What Is Medicare? 1 YourMedicareCoverageChoices 14 Whereto GetYourMedicareQuestionsAnswered — 1 Section 1 Medicare Part A and Part B (What's Covered) 19 PartA-Covered Services 25 PartB-Covered Services 39 What's NOTCovered by PartAand Part B? 40 PreventiveServicesChecklist — 41 Section 2 Your Medicare Choices 42 Decide HowtoGetYourMedicare 44 ThingstoConsiderWhen Choosing orChangingYourCoverage 45 Original Medicare 50 MedicareAdvantage Plans (likean HMOorPPO) (PartC) 58 When CanYouJoin, Switch, or Dropa MedicareAdvantage Plan? 60 OtherMedicare Health Plans 62 Medicare Prescription Drug Coverage (Part D) 63 When CanYouJoin, Switch, orDropa Medicare Drug Plan? Continued *=> 11 43 What's new? What's covered? Coverage choices Contents (continued) 73 Who Pays FirstWhenYou HaveOtherInsurance? 74 Medigap (MedicareSupplement Insurance) Policies — 77 Section 3 Programs for People with Limited Income and Resources 78 Extra Help PayingforMedicare Prescription Drug Coverage (Part D) 82 Medicaid 83 MedicareSavings Programs (Helpwith MedicareCosts) — 85 Section 4 Protecting Yourselfand Medicare 86 YourMedicare Rights 86 What Isan Appeal? 92 How Medicare UsesYourPersonal Information 94 ProtectYourselffrom Fraudand IdentityTheft 96 ProtectYourselfand Medicarefrom Billing Fraud — 99 Section 5 Planning Ahead — 105 Section 6 For More Information (Phone,Websites, Publications) — 111 Section 7 Definitions — 115 Section 8 Find and Compare Medicare Health and Prescription Drug Plans in Your Area 123 2010 Medicare Costs 127 Using Computers to ManageYour Health Information _ ^ Need help _ Fraud and Ott 94 / 4.0 with costs? identity theft Medicare costs I niiR: NOTE: The page number shown in bold provides the most detailed information. C (continued) Abdominal AorticAneurysm 26,40 Coinsurance 19-20, 26-39,43,45,52,65-66, 74,78, 83,111,124-125 Acupuncture 39 Advance Beneficiary Notice 89 Colonoscopy 26,28,40 Advance Directives 103-104 Colorectal CancerScreenings 28,40 ALS (AmyotrophicLateral Sclerosis) 17,22 Community-Based Programs 101 AmbulanceServices 26,38 Consolidated Omnibus Budget Reconciliation Act (COBRA) 22,24,71 AmbulatorySurgical Center 26,28 Contract(private) 48 Anxiety(seeMental Health Care) 33 Appeal 86-91,106-107 Coordination ofBenefits 14, 73 Artificial Limbs 35 Copayment 19-20,26-39,54,65-66, 74-75,78, 111, 124-125 Assignment 25,46-47 CosmeticSurgery 39 B Costs 16,21, 25-38,44-47,54,65-66,74,78-83, Balance Exam 31 123-126 Barium Enema 28,40 Coverage Determination (Part D) 90-91 BenefitPeriod 111,124 CoverageGap 65-66,78 Bills 46,73,89,96,107 Covered Services (PartAand PartB) 19-20,26-38,40, Blood 19,26,124-125 124-125 Bluewords 4,111-114 Creditable Prescription Drug Coverage 49,62,67, Bone MassMeasurement(Bone Density) 27,40 71-72,112 Braces (arm/leg/back/neck) 35 Custodial Care 20,100,112 Breast Exam 34,40 D C Deductible 19-20,25-39,43,45,52,54,65-66, 74-75,78,83,112,124-125 CardiovascularScreenings 27,40 Definitions 111-114 Cataract 30 Demonstrations/PilotPrograms 13,61,113 CatastrophicCoverage 66 Children's Health Insurance Program 84 Dental Careand Dentures 39, 50,84 DepartmentofDefense 14 ChiropracticServices 27 Claims 45-47,87,106-107 DepartmentofHealth and Human Services (Officeof InspectorGeneral) 14,96-97 Clinical LaboratoryServices 27, 125 DepartmentofVeteransAffairs 14,67, 72 Clinical Research Studies 20,27 Depression (seeMental Health Care) 33 COBRA 22,24,71 Diabetes 29-31,33,40,57 8 Index NOTE: The page number shown in bold provides the most detailed information. D (continued) Dialysis (Kidney Dialysis) 12, 18,32,52-53,55,57, Gap (Coverage) 65-66,78 107-108 General EnrollmentPeriod 18,22-23 Discrimination 86,97 GlaucomaTest 31,40 Disenroll 52,59,114 H Drug Plan 43-44,49,62-72,78-81, 90-91, 121, 126 Health Care Proxy 103-104 Drugs (outpatient) 35,69,124 Health InformationTechnology(Health IT) 127 Drugs (prescription) 12, 35,44-49,55-57,62-72, Health MaintenanceOrganization (HMO) 43,50,55 78-82,90-91,115,124 HearingAids 31,39 DurableMedical Equipment(likewalkers) 19,30,32, Helpwith Costs 49,54,78-84 35,47,124-125 Hepatitis BShot 31,40 E Home HealthCare 16, 19,32,82,89, 107-108, EKGs 30,36,40 124-125 Eldercare Locator 101-102 HospiceCare 16,19,50,124 Electronic Handbook insidefrontcover Hospital Care (InpatientCoverage) 16,20,30, 124 ElectronicHealth Record 44,127 EmergencyRoom Services 20,30,69, 106 I IdentityTheft 94-95,97 EmployerGroup Health Plan Coverage 24,43-45,49, Immunizations 25,31,34-35,40,69 52-53,60,63,67,71,73,80,100 End-StageRenal Disease (ESRD) 12, 18,22-23,32, Indian Health Service 44,52, 72 51-53,73 Institution 57-58,63,79,81,112 Enroll 17-18, 21-24,58-59,63-64,75,79-80 J Equipment(likewalkers) 19,30, 32,35,47, 124-125 Join ESRD NetworkOrganization 53 Medicare Drug Plan 43,62-72,79-80,90-91, 115, Exception (PartD) 69,90-91 126 Extra Help (Help Paying Medicare DrugCosts) 49,62, Medicare Health Plan 52,58-61 78-81,112 K Eye Exam 30,31 KidneyDialysis 12, 18,32,52-53,55,57, 107-108 Eyeglasses 30 KidneyTransplant 12,18,33,37,53 F L Fecal OccultBloodTest 28,40 Late EnrollmentPenalty Federal Employee Health Benefits Program 14, 24,72 PartA 18 Federally-Qualified Health CenterServices 31,36 PartB 21-24 FlexibleSigmoidoscopy 26,28,40 PartD 67,78,126 Flu Shot 31,40 Lifetime Reserve Days 112, 124 Foot Exam 31 Limited Income 49,54,78-84, 106 Formulary 44,65,69,78 LivingWill 103 Fraud 94-97 Index NOTE: The page number shown in bold provides the most detailed information. L (continued) Long-TermCare 20,39,61,82, 100-102 OccupationalTherapy 19,32-33, 125 Low-IncomeSubsidy (LIS) 49, 62,78-81, 112 OfficeforCivil Rights 14,93,97 M OfficeofInspectorGeneral 14,96-97 Mammogram 32,40,55,57 OfficeofPersonnel Management 14,72, 100 Ombudsman (Medicare Beneficiary) 98 Medicaid 57-58,61,63,73,79,81-82, 101 Online 2,59,64,80,95,107,127 Medical Equipment 19,30, 32,35,47, 124-125 Original Medicare 13,43,45-49,74-75,87-89, Medical NutritionTherapy 33,40 92-93,124-125 Medical SavingsAccount(MSA) Plans 56,58,62 OrthoticItems 35 Medically Necessary 21,25,30,69, 100, 113 Outpatient Hospital Services 33-34, 125 Medicare Oxygen 30,106 PartA 16-20,43,123-124 PartB 21-38,43,123,125 P PartC 43,50-59,126 PapTest 34,40,55,57 PartD 43-44,49,62-72, 78-81, 90-91, 121, 126 PartA 16-20,43,123-124 MedicareAdvantage Plans (likean HMOorPPO)43, PartB 21-38,39,43,123,125 50-59,87 PartC 43,50-59,126 MedicareAuthorizationto Disclose Personal Health PartD 43-44,49,62-72,78-81,90-91, 121, 126 Information 106 PaymentOptions (premium) 70, 123 Medicare BeneficiaryOmbudsman 98 Pelvic Exam 34,40,55,57 MedicareCard (lost) 14,17 Penalty MedicareCostPlan 60 PartA 18 Medicare Plans 115-122 PartB 21-24 Medicare Prescription DrugCoverage 43-44,49, PartD 67,78,126 62-72,78-81,90-91,121,126 Personal Health Record 127 Medicare Prescription Drug Plans (PDP) 43-44,49, Physical Exam 26,30,34,40 62-72,78-81,90-91,121,126 PhysicalTherapy 19-20,32-34,125 MedicareSavings Programs 79,83 Physician Assistant 33 MedicareSELECT 74-75 Pilot/Demonstration Programs 13,61, 113 MedicareSummary Notice (MSN) 46,87,92,96-97 Pneumococcal Shot 35,40 Medigap (MedicareSupplement Insurance) 23-24,43, PowerofAttorney 103 45,48,52,59,71,74-76 Preferred ProviderOrganization (PPO) Plan 43,50,55 Mental Health Care 20,33,57, 124-125 Premium 16-18,21,43-45,49-50,54,60,65-67,70, N 75,78-79,83,92,96,113,123 Non-doctor 33 Prescription Drugs 12, 35,44-49,55-57,62-72, Nurse Practitioner 33 78-82,90-91,115,124 Nursing Home 57-58,79,81-82, 100-101, 104, 108 PreventiveServices 25-36,40, 106-107 NutritionTherapyServices 33,40 PrimaryCare Doctor 45,55-57,113-114 10 Index NOTE: The page number shown in bold provides the most detailed information. P (continued) S (continued) PrivacyNotice 92-93 State Health InsuranceAssistance Program (SHIP) 14, PrivateContract 48 42, 107-108, backcover Private Fee-for-Service (PFFS) Plans 56,62 StateMedical Assistance (Medicaid) Office 61,80, 82-83,101,106 ProgramsofAll-InclusiveCareforthe Elderly (PACE) 61, 82,101 State PharmacyAssistance Program (SPAP) 82 ProstateScreening (PSATest) 35,40 SubstanceAbuse 33 Proxy(Health Care) 103-104 Supplemental Policy (seeMedigap) 23-24,43,45, 48,52,59,71,74-76 Publications 109 Supplemental SecurityIncome (SSI) 79,84 Q Supplies (medical) 19-20,25,29-36,46-47,86, QualityofCare 14,44,61,105,107-108,127 96,106 Quality ImprovementOrganization (QI0) 14,88, 105, 114 Surgical Dressing Services 36 R T Railroad RetirementBoard (RRB) 14, 17-18,21-23,46, Telehealth 36 106,123 Tests 27-29,31-36 Referral 26, 30, 34,44-45,50-51,55-57, 114 Tiers (drugformulary) 69,90 Religious Nonmedical Health Care Institution 16 TransplantServices 37 Replacing a MedicareCard 14,17 Travel 38,44,74 Retiree Health Insurance 24,43-45,49,52-53,67, TRICARE 14,24,67,72-73 71-73,80,100 TTY 14,106,114 Rights 86-93,97-98 Rural Health Clinic 35-36 U Union 24,43-45,49,52-53,60,63,67, 71,73, 80, S 100 Second Surgical Opinions 35 Urgently-Needed Care 38,48,50,55,57,59 ServiceArea 44,52,55,58,59,63-64, 114 V ShinglesVaccine 69 Shots (vaccinations) 25, 31,34-35,40,69 Vaccinations (shots) 25,31, 34-35,40,69 Veterans'Benefits (VA) 14,67,72 Sigmoidoscopy 26,28,40 Vision 30-31,50 Skilled Nursing Facility (SNF) Care 16,20,36, 100, 111, W 114,124 Smoking Cessation 36,40 Walkers 30,106 SMP (SeniorMedicare Patrol) Program 95 Welcometo Medicare Physical Exam 26,30,34,40 Social Security 14, 16-18, 21-23, 70,80-81,84, 94, 123 Wheelchairs 30,106 Special EnrollmentPeriod 18,22-24,63,71 www.medicare.gov 107 Special Needs Plan (SNP) 53,57,120 www.MyMedicare.gov 2,40,46,87, 107 Speech-language Pathology 19,32-33,36, 125 X-ray 32,34,36