This Health Insurance Section Discusses:

• Basic Medicare• Medicare Advantage• Medicare Supplement Insurance (Medigap)• Medicare Savings Plan• Medicaid• Long Term Care Insurance• Oregon Health Plan

Senior Health Insurance Benefits Assistance (SHIBA)

Trained SHIBA volunteers provide free information and assistance on Medicare benefits and limitations; evaluation of Medicare supplemental insurance and long term care policies; assistance with billing problems; referrals for legal assistance with Medicare. Assistance is available in Crook, Deschutes and Jefferson Counties. Call for an appointment:

Central Oregon Council On Aging(COCOA)/SHIBA 541-678-5483

877-704-4567 (Toll Free)

Medicare

Medicare is a Federal health insurance program for people 65 years or older, people receiving SSDI income who are under 65, and people of any age who have permanent kidney failure. Medicare insurance has four parts: Part A-Hospitalization, Part B-Physician/Outpatient Medical, Part C-Medicare Advantage, and Part D-Prescription Drug Plans.

Medicare Customer Representative

800-633-4227

www.medicare.gov

Applying for Medicare:

To apply for Medicare contact the Social Security Administration General Information and Services Department.

Social Security Administration

336 SW Cyber Dr., Suite 100 Bend, OR 97702

877-405-0302 (Local)

800-772-1213 (National)

800-325-0778 (TTY)

Go to the Security office three months prior to your 65th birth month for Medicare benefits.

Provides free pamphlets about Social Security benefits, Medicare, and Supplemental Security Income (SSI). The Medicare and You Handbook can be an invaluable tool for use in answering questions. Hours: M, T, TH, F 9am-3 pm,W 9am – Noon

Reporting Medicare Fraud:

Senior Medicare Patrol

Report suspicious billing errors or other questionable activities you observe. If you are in doubt as to whether an activity may be fraudulent, do not hesitate to call. Fraud is a major cost to our Government and to your taxes. Call either:

Senior Medicare Patrol (cont’d)

Oregon Medicare & MedicareFraud Hotline

1-800-447-8477

Local Senior Medicare Patrol (SMP) at COCOA

541-678-5483

877-704-4567

The Medicare and You Handbook

Explains benefit periods, deductible charges, and the various procedures. This is a tool to help you understand Medicare. To obtain a copy, contact Medicare:

1-800-MEDICARE (1-800-633-4227)

www.medicare.gov

Oregon Guide to Medigap,Medicare Advantage, and Prescription Drug Plans

The Oregon Department of Business and Consumer Services publishes an annual Oregon SHIBA Guide which describes Medicare parts A through D, as well as the details for Medicare Advantage and MEDIGAP Insurance plans available by county. To download a copy of the SHIBA guide go to:

www.oregon.gov/dcbs/insurance/SHIBA/Pages/shiba.aspx

Or call COCOA SHIBA Helpline to speak with a SHIBA counselor who can furnish a copy of the guide upon your request.

541-678-5483

• Part A: Hospital Insurance

Medicare hospital insurance helps pay for: inpatient hospital care in a hospital participating in Medicare; time-limited, medically necessary inpatient care in a skilled nursing facility; home health care; and hospice care. However, each has limitations and may require co-payments. Medicare DOES NOT pay for care that is primarily custodial.

• Part B: Medical Insurance

Medicare medical insurance helps pay for: doctor’s services, outpatient care, diagnostic testing, durable medical equipment, ambulance services, home health care and other health services and supplies which are not covered by Medicare Part A Hospital Insurance.

Part B DOES NOT cover routine physical examinations, dental services, routine foot care, eye or hearing examinations.

Certain oral anti-cancer drugs now are covered. Check with the doctor or pharmacist. Eyeglasses are NOT covered unless needed after a cataract operation.

Home-delivered meals, homemaker services, and private duty nursing are NOT covered by the Part B Medical Insurance.

• Filing Claims: Part A & Part B

Medicare recipients do not send bills for care received from a doctor, participating hospital, skilled nursing facility, home health agency or hospice. Medicare is billed directly for these services. Medicare sends beneficiaries a notice of each payment made on his or her behalf.

• Appeal Rights: Part B

If a recipient is dissatisfied with a Medicare decision, they may appeal. The time is limited. For assistance or information on the process of appeal, contact your nearest Senior Health Insurance Benefits Assistance (SHIBA) representative.

• Care Outside of the United States

Medicare generally does not pay for hospital or medical services outside of the United States (Puerto Rico, The U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands are considered part of the United States). If you are planning to travel outside the United States, consider purchasing special short-term health insurance for foreign travel, if available. Check with your Medicare Supplement or with your Managed Care organization to see what kind of foreign coverage they supply.

• Medicare Advantage Plans (MA)

Private insurance companies can offer more health benefits beyond what original Medicare covers. Medicare Advantage takes the place of Medicare. One of the new health plan choices might be right for you. When choosing a plan, read the marketing materials carefully. Make sure you understand coverage, out-of-pocket costs, and the plan rules. Compare the advantages and disadvantages of your various options.

Call to find out what Medicare Advantage Plan options are available in your area.

Central Oregon Council On Aging/SHIBA

For questions about Medicare contact:

541-678-5483 or

877-704-4567 (Toll Free)

• Medicare Part D: Prescription Drug Program

Provides prescription coverage for those who have Medicare Part A and/or B regardless of income. You may qualify for extra help with premiums, co-pays, and deductibles through the Social Security Administration Limited Income Subsidy Program (LIS). Initial enrollment begins 3 months before enrollee’s birthday month and closes 3 months after enrollee’s birthday month. Private insurance companies offer basic and enhanced plans. Premiums and deductibles vary. To join you must enroll in the Prescription Drug Program, annual enrollment period: which occurs in October 15th – December 7th each year as set by Medicare. There is a penalty of 1 percent of the establishment national premium benchmark for every month the applicant is eligible for coverage but not signed up. To prepare: know your coverage, low income eligibility, and have a list of your current prescriptions.

Supplement Insurance-Medigap

Medicare provides basic protection against the high cost of health care, but it will not pay all medical expenses. For this reason many private insurance companies sell supplement insurance or Medigap policies. Beneficiaries can choose from ten standardized Medicare supplement plans.

Oregon law gives the right to enroll in any of the Medicare supplement plans approved for sale in the State of Oregon to anyone who is within the first six months of enrolling in Medicare Part B, including people with Medicare by reason of disability.

To find out what your options are, you can obtain “The Oregon Guide to Medigap, Medicare Advantage and Prescription Drug Plans” published by Oregon Department of Consumer and Business Services by calling your local COCOA/SHIBA program:

541-678-5483

877-704-4567 (Toll free)

Also available online at

www.oregonshiba.org

Medicaid

The State of Oregon’s Medicaid program provides for health care (medical benefits) and long-term care services for low-income or disabled individuals who meet income and asset requirements, and other specific criteria. The Medicaid program is funded by State and Federal funds. To find out if you qualify, contact the Aging and People with Disabilities Programs office nearest to you. (See below)

Financial Aid Center for Long Term Care

888-870-5467

541-479-2415

www.oregonmedicaidhelp.com

Specializes in assisting Oregon seniors in qualifying for Medicaid, while preserving assets for the spouse and/or family. Provides Medicaid financial counseling via telephone and/or personal appointment.

Medicare Savings Program

This program pays the recipient’s Part B Medicare premiums increasing their monthly Social Security Benefits by the amount of the premiums. Depending on the level of assistance, Medicare Medicare deductibles and co-pays may be covered. A person must be eligible for part A and part B Medicare. Eligibility is based on income and asset limitations.

You must apply to qualify! To get complete information and application for the Medicare Savings Program, contact the Aging and People with Disabilities Programs office nearest to you.

Bend: 541-388-6240

La Pine: 541-536-8919

Madras: 541-475-6773

Prineville: 541-447-4511

Redmond: 541-548-2206

Long Term Care Insurance

People often mistakenly think that Medicare, Medicare Advantage and Medigap pay for custodial care. Medicare, Medicare Advantage and Medigaps pay for “skilled care” in a nursing home, but only if particular requirements are met, and for a limited period of time. Custodial care is not covered by Medicare even if received in a skilled nursing facility.

Many insurance companies sell long-term care insurance as separate policies. For more information call and ask for the Long term Care Booklet.

Oregon Insurance Division Consumer Advocates

888-877-4894

Cover Oregon

The Oregon Health Plan provides medical coverage for low income Oregonians. Persons eligible for Medicare are not eligible for the Oregon Health Plan. Eligibility is based on income and assets. For more information contact the office of Aging and People with Disabilities Programs nearest to you.

Bend: 541-388-6240

La Pine: 541-536-8919

Madras: 541-475-6773

Prineville: 541-447-4511

Redmond: 541-548-2206

For anyone under age 65 medical insurance coverage can be obtained by contacting Cover Oregon.

855-268-3767

www.coveroregon.com

If you are 65 or older and unsure of your Medicare coverage, call the state SHIBA office:

800-722-4134

Quality Improvement Organization (QIO)

QIO’s mission is to improve the effectiveness, efficiency, economy and quality of services delivered to Medicare beneficiaries. Each state has a QIO, a non-governmental, physician-sponsored organization that works with healthcare professionals to evaluate services, information and education. If you have healthcare concerns, call:

800 MEDICARE

(800-633-4227)

www.cms.hhs.gov/qualityimprovementorgs/