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Plans Must Follow Rules


Medicare plans and agents must follow certain rules when marketing their plans and getting your enrollment information. They can't ask you for a credit card or banking information over the phone or via email unless you're already a member of that plan. Medicare plans can't enroll you into a plan over the phone unless you call them and ask to enroll, or you've given them permission to contact you.

Call 1-800-MEDICARE to report any plans or agents that:
  • Ask for your personal information over the phone or email
  • Call to enroll you in a plan
  • Use false information to mislead you
You can call the Medicare Drug Integrity Contractor (MEDIC) at 1-877-SAFERX (1-877-772-3379). The MEDIC fights fraud, waste, and abuse in Medicare Advantage (Part C) and Medicare Prescription Drug (Part D) Programs.


Fighting fraud can pay
You may get a reward if you help us fight fraud and meet certain conditions. For more information, visit Medicare.gov, or call 1-800-MEDICARE, TTY users can call 1-877-486-2048.


Investigating fraud takes time
Every tip counts. Medicare takes all reports of suspected fraud seriously. When you report fraud, you may not hear an outcome right away. It takes time to investigate your report and build a case, but rest assured that your information is helping us protect Medicare.


What's the Medicare Beneficiary Ombudsman?
An "ombudsman" is a person who reviews questions, concerns, and challenges with how a program is administered and helps to resolve them when possible. 

There are several resources to get answers to your Medicare questions and get assistance with your Medicare, like Medicare.gov, 1-800-MEDICARE and State Health Insurance Assistance Program (SHIPs). The Medicare Beneficiary Ombudsman works closely with those resources and Medicare to help make sure information and assistance are available for you and work to improve your experience with Medicare.

Visit Medicare.gov for information on how the Medicare Beneficiary Ombudsman can help you.


CMS Accessible Communications
To help ensure people with disabilities have an equal opportunity to participate in our services, activities, programs, and other benefits, we provide communications in accessible formats. 

The Centers for Medicare & Medicaid Services (CMS) provides free auxiliary aids and services, including information in accessible formats like Braille, large print, data/audio files, relay services and TTY communications. If you request information in an accessible format from CMS, you won't be disadvantaged by any additional time necessary to provide it. This means you'll get extra time to take any action if there's a delay in fulfilling your request.

To request Medicare or marketplace information in an accessible format you can:
  • Call us: For Medicare, 1-800-MEDICARE; TTY: 1-877-486-2048
  • Email us: altformatrequest@cms.hhs.gov
  • Send us a fax: 1-844-530-3676
  • Send us a letter:  
               Centers for Medicare & Medicaid Services
               Offices of Hearings and Inquiries (OHI)
               7500 Security Boulevard, Mail Stop S1-13-25
               Baltimore, MD 21244-1850
               Attn: Customer Accessibility Resource Staff

Your request should include your name, phone number, type of information you need (if known), and the mailing address where we should send the materials. We may contact you for additional information.

Note: If you're enrolled in a Medicare Advantage Plan or Medicare Prescription Drug Plan, contact your plan to request its information in an accessible format. For Medicaid, contact your State or local Medicaid office.


Nondiscrimination Notice
The Centers for Medicare & Medicaid Services (CMS) doesn't exclude, deny benefits to, or otherwise discriminate against any person on the basis of race, color, national origin, disability, sex, or age in admission to, participation in, or receipt of the services and benefits under any of its programs and activities, whether carried out by CMS directly or through a contractor or any other entity with which CMS arranges to carry out its programs and activities.

You can contact CMS in any of the ways included in this notice if you have any concerns about getting information in a format that you can use.

You may also file a complaint if you think you've been subjected to discrimination in a CMS program or activity, including experiencing issues with getting information in an accessible format from any Medicare Advantage Plan, Medicare Prescription Drug Plan, State or local Medicaid Office, or Marketplace Qualified Health Plans. 


There are three ways to file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:
          Office for Civil Rights
          The U.S. Department of Health and Human Services
          200 Independence Avenue, SW
          Room 509F, HHH Building
          Washington, D.C. 20201


          




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NCOV -19 and MEDICARE 2020

Medicare Part B , which includes a variety of outpatient services cover medically necessary clinical diagnostic laboratory tests when a doctor or other practitioner orders them. Medically necessary clinical diagnostic laboratory tests are generally not subject to coinsurance or deductible. It will cover medically necessary imaging tests, such as computed tomography (CT) scans, as needed for treatment purposes for lung infections, however not for screening asymptomatic patients. For those imaging tests paid by Part B, beneficiary coinsurance and deductible would apply. If the Part B deductible ($198 in 2020) applies to the Part B services, beneficiaries must pay all costs - up to the approved amount of Medicare until the beneficiary meets the yearly Part B deductible. Once it is met, Medicare pays its share, and beneficiaries typically pay 20% of the approved amount of the service, except laboratory tests. There’s no yearly limit for what a beneficiary pays out-of-pocket tho
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Cardiovascular Disease Risk Reduction

Cardiovascular disease generally refers to conditions that can lead to a heart attack or stroke. Cardiovascular disease risk reduction visits can help detect and prevent this disease. How to know if I am Eligible? Medicare   Part B  covers an annual cardiovascular disease risk reduction visit with your primary care  provider . You do not need to show any signs or symptoms of cardiovascular disease to qualify for screening, but you must be considered competent and alert when counseling is provided.  During the screening, your provider may; Encourage aspirin use if the benefits outweigh the risks You are a man  of age 45-79 Or a woman of age 55-79 Screen for high blood pressure if you are age 18+ Provide behavioral counseling and tips to encourage a healthy diet Note: Men under 45 and women under 55 are not encouraged to use aspirin as a tool to reduce cardiovascular disease. How much will it cost? If you are eligible,  Original Medicare  will cover your cardiovascular disease risk red
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Lifetime Reserve Days

There are  90 days of  inpatient  hospital care coverage on Original Medicare for each  benefit period , In addition, you also have an additional 60 days of coverag e , called LIFETIME RESERVE DAYS .   These Lifetime Reserved Days  can be used only ONCE, and you will pay a  coinsurance  for each of it. To have a better understanding of it, let’s imagine an individual who had a 120-day  Medicare -covered inpatient stay, this means that they used 30 lifetime reserve days. After they have been out of the hospital for 60 days in a row, they will be eligible for another 90 days of hospital coverage because they will be in a new  benefit period . However, if they need  inpatient care  beyond the benefit period maximum, they will only have 30 of their 60 lifetime reserve days remaining. The above example illustrates that lifetime reserve days do not have to be applied to the same hospital stay. If you need to stay in the hospital twice for 120 days each time during different benefit
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