Listed below is some general information concerning Medicare, Products and Protocol, we hope you find the information helpful.
- What is Medicare?
- How do I get a new Medicare card if my card is lost, stolen, or damaged?
- How can I get my name and address changed?
- How do I report the death of a beneficiary?
- What is “assignment” in the Original Medicare Plan and why is it important?
- Why is assignment important when choosing a power wheelchair or scooter supplier?
- Is a power wheelchair or scooter supplier supposed to waive my coinsurance or Part B deductible?
- What is a Medicare deductible?
- What is Durable Medical Equipment?
- What is included in the DME Category?
- Do I need a prescription to get a supply?
- What is a Certificate of Medical Necessity?
- What supplies require a certificate of medical necessity (CMN)?
- What is a “capped rental” item?
- What are some “capped rental” products?
Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities, and people with end-stage renal disease (ESRD). Medicare has two parts — Part A, which is hospital insurance, and Part B, which is medical insurance.
You can now request a replacement red, white, and blue Medicare card online on Social Security’s web site. Your card will be mailed within 30 days to the address SSA has on record. This service can be accessed during the following hours:
Monday-Friday: 5 a.m. until 1 a.m.
Saturday : 5 a.m. until 11 p.m.
Sunday : 8 a.m. until 10 p.m.
Holidays : 5 a.m. until 11 p.m.
To make an online request, you will need the following information:
Your last (exact) payment amount or the month and year you last received a payment if you have received benefits in the last 12 months.
Your name as it appears on your most recent Social Security card
Your Social Security Number
Your Date of Birth
Your phone number in case we need to contact you about your request
Your e-mail address (optional)
You may also need:
Your Place of Birth
Your Mother’s Maiden Name (to help identify you)
This new service can be accessed via the Social Security Administration website. If you prefer, or if you are unable to use the online request to obtain a replacement Medicare card, call Social Security’s toll-free number, 1-800-772-1213. Their representatives there will be glad to help you. You can also visit a local social security office. For the office closest to you try their Field Office Locator.
You may report a change of name or address by calling the Social Security Administration at 1-800-772-1213 or by visiting your local field office. Addresses and directions to the Social Security field offices may be obtained from the Social Security Office Locator. You can get more information on changing your name on Social Security’s web site. If you get benefits from the Railroad Retirement Board, call your local RRB office, or call 1-800-808-0772.
A family member or other person responsible for the beneficiary’s affairs should do the following:
Promptly notify Social Security of the beneficiary’s death by calling SSA toll-free at 1-800-772-1213.
If monthly benefits were being paid via direct deposit, notify the bank or other financial institution of the beneficiary’s death. Request that any funds received for the month of death and later be returned to Social Security as soon as possible.
If benefits were being paid by check, DO NOT CASH any checks received for the month in which the beneficiary died or thereafter. Return the checks to Social Security as soon as possible.
A one-time payment of $255 is payable to the surviving spouse if he or she was living with the beneficiary at the time of death, OR if living apart, was receiving Social Security benefits on the beneficiary’s earnings record. If there is no surviving spouse, the payment is made to a child who was eligible for benefits on the beneficiary’s earnings record in the month of death.
Assignment is an agreement between Medicare and doctors, other health care providers, and suppliers of health care equipment and supplies (like wheelchairs, oxygen, braces, and ostomy supplies).
Doctors and suppliers who agree to accept assignment accept the Medicare-approved amount as payment in full for Part B services and supplies.
You pay the coinsurance and deductible amounts. In some cases (such as if you have both Medicare and Medicaid), your health care providers and suppliers must accept assignment.
If assignment is not accepted, charges are often higher. This means you may pay more. In addition, you may have to pay the entire charge at the time of service. Medicare will then send you its share of the charge.
There is a limit on the amount your doctors and providers can bill you. The highest amount of money you can be charged for a covered service by doctors and other health care providers who don?t accept assignment is called the limiting charge. The limit is 15% over Medicare?s approved amount. The limiting charge only applies to certain services and does not apply to supplies or equipment.
Assignment is an agreement between Medicare and doctors, other health care providers, and suppliers of health care equipment and supplies (like wheelchairs, oxygen, braces, and ostomy supplies). Doctors, providers, and suppliers who agree to accept assignment accept the Medicare-approved amount as full payment. You pay the coinsurance (usually 20 percent of the approved amount) and deductible amounts. Using a power wheelchair or scooter supplier that accepts Medicare assignment can save you money.
If your power wheelchair or scooter supplier doesn?t accept assignment, there is no limit to what they can charge. You may have to pay the entire bill (your share and Medicare?s share) at the time you get your power wheelchair or scooter. Always ask a supplier if they are enrolled in Medicare. Suppliers who are enrolled in Medicare must accept assignment. If they aren?t enrolled in Medicare, Medicare won’t pay your claim.
The Medicare Part B deductible is the amount you must pay for health care before Medicare begins to pay. The coinsurance is the percent of the Medicare-approved amount that you have to pay after you pay the Part B deductible. In the Original Medicare Plan, the Medicare Part B coinsurance is generally 20 percent of the Medicare-approved amount for the item.
Medicare law requires a supplier of durable medical equipment, such as power wheelchairs and scooters, to bill Medicare for the supplier?s actual charge. Medicare pays 80 percent of the lesser of the supplier?s actual charge or the fee schedule amount, and you pay the remaining 20 percent. It is unlawful for a supplier to routinely waive the Medicare Part B coinsurance and deductible, because that results in Medicare paying 100 percent of the supplier’s actual charge.
Note: If your power wheelchair or scooter supplier routinely waives Medicare copayments and deductibles, you should report these actions to the appropriate Durable Medical Equipment Regional Carrier (DMERC) or by contacting the Inspector General’s Hotline at 1-800-HHS-TIPS.
A deductible is the amount you must pay each year before Medicare begins paying its portion of your medical bill. There are deductibles for both the Part A (Hospital Insurance) and Part B (doctor services) portions of Medicare. Your deductible is taken out of your claims when Medicare receives them. Medicare will not start paying on your claims until you have met your annual deductible. The Medicare Part A deductible for 2005 is $912.00 per benefit period. The Medicare Part B deductible for 2005 is $110.00. If you have any questions on the status of your deductible please contact 1-800-MEDICARE (1-800-633-4227).