
INDEX


 (this is cover 3)

                OTHER PUBLICATIONS ABOUT MEDICARE
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
You Can Order This Publication From the Government Printing
Office:
Guide to Health Insurance for People with Medicare 
     Discusses what Medicare pays and does not pay, types of 
private health insurance to supplement Medicare and hints   on
shopping for private health insurance. (HCFA-02110)
Send $x.xx to the U.S. Government Printing Office, Superintendent
of Documents, Washington, DC, 20402.  
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
These Publications Can Be Ordered Free of Charge: 

Thinking of Having Surgery? (553T)
     Explains the importance of getting a second opinion for
non-emergency surgery, Medicare coverage of costs, and gives a
toll-free number for locating a specialists in your area.
(HCFA-02114)

Medicare and Prepayment Plans (515W)
     Describes the health services available to beneficiaries rom
Medicare-certified HMOs and CMPs. (HCFA-02143)

Medicare and Employer Health Plans (609T)
     Explains the law which requires employers to offer employees
     age 65 and older the same health insurance plan they offer 
their younger employees. (HCFA-02150)

Hospice Benefits Under Medicare (513W)
     Describes the scope of medical and support services    
available to Medicare beneficiaries with terminal illnesses. 
(HCFA-02154)

Medicare Coverage of Kidney Dialysis and Kidney Transplant
Services: A Supplement to Your Medicare Handbook (611T)
     Describes Medicare benefits for people with chronic kidney 
disease. (HCFA-10128)

To order a copy of one or more of these free publications, fill
out and mail the order form at the bottom of the page to:

                   Consumer Information Center
                          Department 59
                        Pueblo, CO  81009

Supplies may be limited.  Allow 6 to 8 weeks for delivery.
- - - - - - - - - - - - - - - - -cut and mail- - - - - - - - - -
Please send me a copy of each free booklet checked below:

         Thinking of Having Surgery? (553T)
         Medicare and Prepayment Plans (515W)
         Medicare and Employer Health Plans (609T)
         Hospice Benefits Under Medicare (513W)
         Medicare Coverage of Kidney Dialysis and Kidney
          Transplant Services (611T)


          Name                                                   
          Address                                                
          City                        State         Zip          

Address lists 
  Medicare carriers, 30-34 
  Peer Review Organizations and Quality Review 
      Organizations, 35-38 
Ambulance services 
  conditions, 15 
  foreign hospital, 8 
Ambulatory surgical services, 14 
Annual deductible amount, 11, 23 
Antigens, 16 
Appeal rights, 18 
Appealing claims decisions 
  by carriers, 19-20 
  by intermediaries, 19 
  by Peer Review Organizations, 19 
  by prepaid health care organizations, 3, 20 
  by providers of services, 19 
Appliances. See Medical appliances 
Application process, 2 
Approved charges, 18 
Assignment payment method, 16-17 
 
Benefit periods 
  examples, 6 
  hospice care, 10 
  hospital, 6 
  skilled nursing facility, 9 
Black lung benefits, 24 
Blood 
  deductible amount, 11-12 
  hemophilia clotting factors, 16 
  home health care, transfusions, 10 
  hospital inpatient, transfusions, 7 
  payment for, 7-8, 16 
  skilled nursing facility, transfusions, 9 
 
Care not covered, 20 
Chiropractors, services covered, 12 
Christian Science sanatorium, 8 
Claim number, 4 
Claims 
  benefits explanation notice, 17-18 
  claim number, 4 
  deceased beneficiary, 24-25 
  foreign hospital care, 8 
  insurance other than Medicare, 23-24 
  intermediaries and carriers role, 2 
  Railroad Retirement system, 25 
  submission, for home health care, 10 
  submission process, 22-25 
  time limit, 25 
CMPs. See Prepaid health care organizations 
Coinsurance, 6, 12 
Competitive medical plans (CMPs). See Prepaid health care 
    organizations 
Complaints 
  fraud and abuse hot line, 5 
  Medigap fraud, 4-5 
  review process, 2-3 
Comprehensive Outpatient Rehabilitation Facility (CORF), 
    14-15 
Cosmetic surgery, 12 
Counseling, 11 
Custodial care, 5, 9, 20 
 
Deductibles 
  annual, 11 
  blood, 11-12 
  hospital insurance (Part A), i, 6 
  medical insurance (Part B), ii, 11-12 
Dentists, services covered, 13 
Diagnosis Related Groups (DRGs), 5 
Diagnostic tests, 7, 15 
Dialysis. See Kidney disease 
Disabled people 
  cancelling or losing Medicare protection, 22 
  eligibility for coverage, 1 
  enrollment process, 2, 21-22 
Doctors 
  participating, 17 
  services covered, 12-13 
Doctors of osteopathy, 12 
DRGs. See Diagnosis Related Groups 
Drugs and biologicals 
  hemophilia clotting factors, 16 
  hepatitis B vaccine, 16 
  home health care, 10 
  hospice care, 11 
  immunosuppressive drugs, 16 
  inpatient, 7 
  pneumococcal vaccine, 16 
  skilled nursing facility, 9 
Durable medical equipment 
  copayment for, 10 
  description, 15-16 
 
Elective surgery, written estimate of costs, 2 
Emergency room services, 14 
Enrollment, Medicare cards, 4 
Enrollment process, 2 
  hospital insurance (Part A), 21-22 
  medical insurance (Part B), 21-22 
Equipment. See Durable medical equipment; Medical appliances 
Explanation of Medicare Benefits, 17-18 
Eye examinations, 13 
 
Financial assistance for low-income beneficiaries, 5 
Foot care, 12-13 
Foreign hospital care, 8 
Form 1490S, 23 
Fraud and abuse hot line numbers, 5 
 
Guide to Health Insurance for People with Medicare, 4 
 
Health maintenance organizations (HMOs). See Prepaid health 
    care organizations 
Hemophilia clotting factors, 16 
Hepatitis B vaccine, 16 
HMOs. See Prepaid health care organizations 
Home health agencies, 9-10 
Home health aides, 10, 11 
Home health care 
  description, 9 
  services covered, 10, 14 
Homemaker services, 10, 11 
Hospice care 
  description, 10 
  and prepaid health care organizations, 3 
  services covered, 11 
Hospital inpatient care, 6-8 
Hospital insurance (Part A) 
  appealing decisions, 19 
  benefit periods, 6, 8, 9, 10 
  buying, 1, 21 
  cancelling or losing protection, 22 
  coinsurance, 6 
  coinsurance payments, list, i 
  coverage, 5-11 
  covered services, list, i 
  deductible, list, i 
  deductible amount, 6 
  description, 1 
  eligibility, 1 
  enrollment process, 2, 21-22 
  noncoverage, notice of, 28-29 
  patient rights, 28 
  premium-free, 1 
  premiums, i 
  prospective payment system, 5 
Hospital outpatient care, 13-14 
Hot line, fraud and abuse, 5 
 
Immunizations, 12, 16 
Immunosuppressive drugs, 16 
An Important Message From Medicare, 2, 19 
Inpatient care 
  blood, payment for, 7-8 
  Christian Science sanatorium, 8 
  conditions for payment, 6 
  foreign hospitals, 8 
  psychiatric, 8 
  reserve days, 7 
  services covered, 7 
Insurance. See also Hospital insurance (Part A); Medical 
    insurance (Part B); Medicare 
  illegal sales practices, penalties and fines, 4-5 
  other than Medicare, claims submission, 23-24 
  supplemental, 4-5 
Intermediaries and carriers 
  appealing decisions by, 19-20 
  description, 2 
 
Kidney disease 
  application filing process for Medicare benefits, 2 
  cancelling or losing Medicare protection, 22 
  coverage booklet, iv 
  dialysis and transplants, 15 
  Medicare as secondary payer, 24 
  and prepaid health care organizations, 3 
 
Laboratory services 
  independent clinical laboratory, 15 
  inpatient, 7 
  portable X-ray, 15 
Limitation of liability, 20-21 
Low-income assistance, 5 
 
Medical appliances 
  hospice care, 11 
  inpatient care, 7 
  skilled nursing facility, 9 
Medical insurance (Part B) 
  appealing decisions, 19-20 
  approved or "reasonable" charges, 18 
  assignment payment method, 16-17 
  benefits explanation notice, 17-18 
  buying, 1, 21 
  cancelling or losing protection, 22 
  claims, 23
  coverage, 11-18 
  covered services, list, ii 
  deductible, list, ii 
  deductible and coinsurance amounts, 11-12 
  description, 1 
  doctors and suppliers, participating, 17 
  eligibility, 1 
  enrollment process, 2, 21 
  premiums, ii 
  providers, participating, 17 
  "reasonable" charges, 18 
Medical supplies 
  description, 16 
  home health care coverage, 10 
  hospice care coverage, 11 
  inpatient coverage, 7 
  skilled nursing facility coverage, 9 
Medicare, Part A. See Hospital insurance (Part A) 
Medicare, Part B. See Medical insurance (Part B) 
Medicare and Employer Health Plans, 24 
Medicare cards, 4 
Medicare Catastrophic Coverage Act, 4 
Medicare Coverage of Kidney Dialysis and Kidney Transplant 
    Services, iv, 15, 22 
Medicare Participating Physician/Supplier Directory, 17 
Medigap insurance. See Supplemental insurance 
Mental illness, outpatient treatment, 18 
 
Noncoverage 
  notice of, 28-29 
  what Medicare does not cover, 20 
Nurse anesthetists, 13 
Nurse midwives, 13 
Nursing home. See Skilled nursing facility 
 
Occupational therapy. See Therapy 
Optometrists, services covered, 13 
Outpatient hospital care 
  emergency care, nonparticipating hospital, 13 
  overpayments, 13 
  services covered, 14 
Overpayments, 13 
Oxygen equipment. See Durable medical equipment 
 
Part A. See Hospital insurance (Part A) 
Part B. See Medical insurance (Part B) 
Participating doctors and suppliers, 17 
Participating providers, 17 
Patient's Request for Medicare Payment (Form 1490S), 23 
Payments. See also Deductibles 
  assignment payment method, 16-17 
  for blood, 7-8, 16 
  for durable medical equipment, 10 
  inpatient care, conditions, 6 
  limitation of liability, 20-21 
  overpayments, 13 
  prospective payment system, 5 
Peer Review Organizations (PROs). See also Appeal rights 
  address and telephone number list, 35-38 
  appealing decisions, 19 
  complaints review process, 2-3 
  description, 2 
Physical examinations, 12, 14 
Physical therapy. See Therapy 
Physician assistants, 13 
Physicians 
  participating, 17 
  services covered, 12-13 
Pneumococcal vaccine, 16 
Podiatrists, services covered, 12-13 
PPS. See Prospective payment system 
Premium-free eligibility, 1 
Prepaid health care organizations 
  appealing decisions, 20 
  claims, submitting, 18, 23 
  coverage, 3 
Prescription drugs. See Drugs and biologicals 
Private duty nurses, 7, 9 
Private insurance organizations. See Intermediaries and 
    carriers 
PROs. See Peer Review Organizations 
Prospective payment system (PPS), 5 
Prosthetic devices, 16 
Psychiatric care. See also Mental illness 
Psychiatric hospital care, 8 
Psychologists, 13 
 
QROs. See Quality Review Organizations 
Quality of care. See also Appeal rights; Peer Review 
    Organizations; Quality Review Organizations 
  complaints, 2-3 
  fraud and abuse hot line numbers, 5 
Quality Review Organizations (QROs). See also Appeal rights 
  address and telephone list, 35-38 
  description, 3 
 
Radiation therapy, 15 
"Reasonable" charges, 18 
Rehabilitative services. See Therapy 
Relatives, services by, 20 
Reserve days, 7 
Respiratory therapy. See Therapy 
Respite care, 10-11 
Routine physical examinations, 12, 14 
Rural health clinic services, 15 
 
Seat lift chairs. See Durable medical equipment 
Second opinion before surgery, 13 
Secondary payer, 23-24
Services not covered, 20 
Skilled nursing facility 
  inpatient care, 8-9 
  services covered, 9 
Social Security Administration 
  disability eligibility, 1 
  enrollment, cards, premium amounts, questions, iv 
Special enrollment period, 21 
Special practitioners, 13 
Speech pathology, 7, 9-10, 11, 12, 14 
Supplemental insurance, buying, 4 
Supplies. See Medical supplies 
Surgery 
  ambulatory, 14 
  cosmetic, 12 
  elective, 2 
  second opinion, 13 
 
Telephone numbers 
  hot line, fraud and abuse, 5 
  Medicare carriers, 30-34 
  Peer Review Organizations and Quality Review 
      Organizations, 35-38 
  second opinion referral center, 13 
Terminal illness. See Hospice care 
Tests, diagnostic, 7, 15 
Therapy 
  Comprehensive Outpatient Rehabilitation Facility services, 
      14-15 
  doctors' services, coverage, 12 
  home health care, coverage, 9-10 
  hospice care, coverage, 11 
  inpatient, coverage, 7 
  outpatient, coverage, 14 
  radiation, coverage, 15 
  skilled nursing facility, coverage, 9 
Time limit for claims submission, 25 
Toll-free telephone numbers, 5, 13 
 
Vaccines, 12, 16 
Veterans benefits, 24 
 
Wheelchairs. See Durable medical equipment 
Workers' compensation benefits, 24 
 
X-ray services, 12, 15 
