MedicareSupplement

Summary of Benefits | Prescription Drug Plan Comparison | Medicare Advantage Plan Comparison | Medicare Supplement Plans outlines A-J | Medicare Supplement FAQ's | Medicare Supplement Rates | Medicare Prescription Drug Plan - Part D

F.A.Q.

Summary of Questions

Up to date Information compiled at Thacker Agency.Com for your convenience from the Official Medicare.Gov website

1.What are the Medicare premiums and coinsurance rates for 2005?
2. Information from Medtronic on a possible battery issue with some ICDs and CRT-Ds
3. Are all people with Medicare eligible to get the "Welcome to Medicare" physical
4. How much does the "Welcome to Medicare" physical exam cost?
5. What cancer screening does Medicare currently cover?
6. What services are included in the "Welcome to Medicare" physical exam?
7. What is the new diabetes screening?
8. What are the new cardiovascular screenings?
9. How often does Medicare cover the new cardiovascular screenings?
10. How often is the new diabetes screening covered by Medicare?
11. How are the new Medicare drug plans that are starting in 2006 different from the
12. What happens to my Medicare-approved drug discount card when I sign up for a Med
13. Can I still use any credits left on my Medicare-approved drug discount card afte
14. If I qualify, can I still get $600 credit on my Medicare-approved drug discount
15. What is the new Together Rx Access Card program and who can get one?
16. What are Medicare prescription drug plans?
17. Information about the Flu Medicines Demonstration
18. When can I join a Medicare prescription drug plan?
19. When will I get more information about choosing a Medicare Prescription Drug Pla
20. What if I have prescription drug coverage from an employer or union?
21. What if I already have prescription drug coverage from a Medigap (Supplemental I
22. Do Medicare prescription drug plans work with all types of Medicare health plans
23. Does the Medicare-approved drug discount card program vary if I live in Puerto R
24. How do I get a new Medicare card if my card is lost, stolen, or damaged?
25. How can I get my name and address changed?
26. I've heard that I might be able to get a $600 credit to help pay for my prescrip
27. If I get a flu shot from a doctor or provider who doesn't bill Medicare, what sh
28. I think my doctor or provider charged too much for my flu shot. What should I d
29. Where can I get a flu shot?
30. What does it mean that the sponsor provides discounts on the top 100 drugs and t
31. How much will Medicare pay (For the Flu shot)?
32. Who should get a flu shot this season?
33. What can I do if my regular doctor or provider doesn't have flu shots available?
34. If I can't get the flu shot, can I take FluMist instead?
35. What other steps can I take to prevent the flu?
36. Is there going to be a shortage of flu vaccines for this flu season?
37. Why is there a shortage of the flu shot for this season?
38. What can I do if my Medicare Advantage Plan doesn't have flu shots available?
39. Will getting a flu shot help keep me from getting sick?
40. What is the Medicare Replacement Drug Demonstration?
41. Why doesn't my Medicare-approved drug discount card provide discounts on every d
42. Why is Vioxx no longer on your drug list?
43. How do I go about choosing a Medicare-approved drug discount card?
44. I am on Medicaid spenddown. Am I eligible for a Medicare-approved drug discount
45. What can I do if I am denied the $600 credit that goes along with the Medicare-a
46. What can I do if I am denied enrollment into a Medicare-approved drug discount c
47. When will enrollment in a Medicare-approved drug discount card become effective?
48. When can I change Medicare-approved drug discount cards?
49. How do I use the $600 credit from Medicare to help pay for prescriptions?
50. Can I get the $600 credit without getting a Medicare-approved drug discount card
51. How do I get a Medicare-approved drug discount card and the $600 credit if I liv
52. How do I find out if the pharmacy that provides my drugs has contracted with one
53. For which drugs can the $600 be applied?
54. Can I choose whichever Medicare-approved drug discount card I want even though I
55. If I choose a Medicare-approved drug discount card, do I have to use the pharmac
56. Can I get a discount and the $600 credit?
57. What if I have a Medicare-approved drug discount card already, but it isn't one
58. Can I use my card at an assisted living facility?
59. If I live in a nursing home, can I get a Medicare-approved drug discount card an
60. Why are there three special drug discount cards for people who live in nursing h
61. What if I have one of the three special Medicare-approved drug discount cards fo
62. How do I know how much of the $600 credit I have left?
63. How can I find out the prices of different prescription drugs at my nursing home
64. Can I use the $600 credit while Medicare is paying for my stay in the nursing ho
65. What if I have one of the special drug discount cards for nursing homes and my n
66. Will the availability of the $600 credit or discount prices prevent or delay an
67. How much will I save on my medicines if I join a Medicare-approved drug discount
68. When does Medicare begin paying for my prescription drug costs? How does it wor
69. Who can get a Medicare-approved drug discount card?
70. My income is very limited. It will be hard for me to pay the premiums and deduct
71. What is Medicare Advantage and how does it work with Medicare + Choice plans?
72. I have a Medigap plan that covers prescription drugs. Can I keep that plan and
73. I already have a prescription drug discount card, but it's not Medicare-approved
74. I am in a Medicare managed care plan. Can I get a Medicare-approved drug discou
75. I am disabled and have Medicare and Medicaid. Can I get a Medicare-approved dru
76. I have Medicare and a Medigap policy. Can I get a Medicare-approved drug discou
77. Does the cost go up if I enroll in a Medicare-approved drug discount card after
78. Do I have to join a Medicare-approved drug discount card?
79. Where can I go for the latest, official information about changes in Medicare?
80. Are people with Medicare going to have to pay different premiums for Part B in t
81. I have a Medigap plan that covers prescription drugs. Can I keep that plan and
82. Does the new law make any changes to Medigap supplement policies?
83. Does the new law change the coverage I have for therapy services?
84. Does the new law add any preventive benefits that will help me stay healthy?
85. Will the new law change what Medicare pays my doctors?
86. I don't live near a big city, and sometimes it's hard to get health care. Does
87. How will Medigap plans change with the 2003 Medicare Modernization Act?
88. Will I get Medicare at age 65 if I'm not yet eligible for Social Security?
89. What types of services are covered under Medicare?
90. Who is eligible for Medicare?
91. When should I get my flu shot?
92. How do I enroll in Medicare?
93. What is the new Electronic Medicare Summary Notice (E-MSN)?
94. How do I find a Medicare-approved home health agency?
95. Does Medicare pay for prescription drugs?
96. Can I delay Medicare Part B enrollment without paying higher premiums?
97. Are my spouse and dependent children eligible to get Medicare coverage?
98. What if I'm over 65 and didn't enroll in Part B during my Initial Enrollment Per
99. Important information you need to know regarding Medicare prescription drug and
100. I have more than one insurance. How do I know who pays first?
101. I want to add Part B to my Medicare. When can I do that?
102. Whom do I contact when there is a change in my other health insurance?
103. I have employer group health insurance. Can I drop Part B and add it later?
104. What is Medicare Easy Pay and how do I sign up?
105. Should I sign up for Medicare Part B if I am (or my spouse is) still working?
106. What is the current Medicare coverage for LTC, nursing home care, and SNF care?
107. Why is Social Security still taking money each month for Part B when I joined a
108. Should I sign up for Medicare Part B?
109. I can't afford my Medicare premiums. What can I do?
110. What is a Medicare deductible?
111. What is Medicaid and who does it cover?
112. What is Medicare?
113. What medical supplies and equipment does Medicare Part B cover?
114. Does Medicare cover dental services?
115. What is a Medicare Advantage plan?
116. Should I sign up for Medicare Part A and B if I am still working?
117. How do I get help with my health care costs?
118. Does Medicare cover glaucoma screening?
119. If I retire at age 62 will I be eligible for Medicare at that time?
120. Is the Medicare Part B deductible something new?
121. Who is eligible to get Medicare covered home health care and what services are c
122. How do I submit a Medicare claim (bill)?
123. What diabetic supplies and services does Medicare cover?
124. Do you get Medicare if you are getting Social Security disability benefits?
125. Does Medicare cover chiropractic services?
126. How do I find out more about TRICARE for Life for military retirees?
127. Will Medicare pay for my flu shot every year?
128. Will the Original Medicare Plan offer to pay for my prescription drugs?
129. Does the Original Medicare Plan pay for care in a nursing home?
130. Guide for entering the quantity for non-oral and liquid medications.
131. Why doesn't Medicare pay for dental care, hearing aids, and eyeglasses?
132. Is Medicare saying that all Medicare beneficiaries should be tested for anthrax?
133. Does Medicare cover me when I travel outside of the United States?
134. When does Medicare cover ambulance trips?
135. Is the E-MSN available in my state?
136. Why isn't the drug I'm taking listed in your Drug Assistance Program tool?
137. What if I do not have Medicare Part A -- should I sign up for Medicare Part B?
138. Does a spouse, age 62, receive Medicare when his/her aged 65 husband/wife does?
139. Will my non-working spouse, who turns 65 before me, get Medicare at age 65?
140. I am a retired Federal employee with FEHBP. Do I need to enroll in Part B?
141. What is included in the Durable Medical Equipment category?
142. I received a notice (bill) for my Medicare premiums. Why?
143. I am disabled and have Medicare Part A only. Can I get Part B when I turn 65?
144. Which oral anti cancer drugs are covered under the Original Medicare plan?
145. Can I get the flu even if I get the flu vaccine this year?
146. Why should I get a flu shot?
147. Why do I need to get a flu shot every year?
148. Are Medicare-approved drug discount cards available now? Someone contacted me t
149. How Does Medicare Decide if a Service is Covered?
150. Do I have to pay for Medicare Part A (Hospital Insurance)?
151. Will my secondary insurance cover my deductible and/or 20% coinsurance?
152. Should I notify Medicare when my spouse and I are no longer working?
153. How do I file a claim with my secondary insurance after Medicare processes....
154. Why am I getting notices asking if Medicare is my primary insurance?
155. What is "assignment" in the Original Medicare Plan and why is it important?
156. How can Medicaid help people with low incomes?
157. Why aren't all of my Medicare claims forwarded to my secondary insurer?
158. I live outside the U.S. I do not have Part B. If I get Part B, will I pay more?
159. I am retired and on Medicare. If I go back to work, will it affect my Medicare?
160. Does Medicare pay for an ambulance trip from one hospital to another?
161. Should my doctor submit claims to Medicare if it is my secondary insurance?
162. What supplies require a certificate of medical necessity (CMN)?
163. Are there any programs for medications you can buy without a prescription?
164. Who is eligible to get benefits under TRICARE for Life (TFL)?
165. How do I find out if I have Medicare Part A and B?
166. Will Medicare pay for an ambulance once a patient has been to the ER?
167. Does the Original Medicare Plan cover mental health care?
168. How do Medicare Advantage plans work?
169. Will Medicare pay for ambulance services from home to the doctor's office?
170. What is Durable Medical Equipment (DME)?
171. Where can I find Medicare provider enrollment information?
172. What is a Certificate of Medical Necessity?
173. Please explain how the Medicare Part B deductible is applied?
174. Who can help me if I have questions about my doctor bills and claims?
175. What is a benefit period and how does the Medicare Part A deductible work?
176. Who can help me if I have questions about health plans and long term care?
177. When can I get Medicare if I am under age 65 and have Lou Gehrig's disease?
178. What is an Advance Beneficiary Notice (ABN)?
179. What is a DMERC?
180. Why did I receive an EOB from my secondary insurance and nothing from Medicare?
181. Why aren't all Medicare participating healthcare professionals included...?
182. Where can I find a list of all physicians that participate in Medicare?
183. Will Medicare pay for ambulance service to go to the doctor's office?
184. Can I pay for a service myself, even if Medicare covers it?
185. Where can I find a list of all physicians that participate in Medicare?
186. Why doesn't Nursing Home Compare contain the most recent inspection results?
187. I now have TRICARE for Life, do I need to keep my other supplemental insurance?
188. How do I report the death of a beneficiary?
189. What should I consider when locating a nursing home?
190. Does Medicare cover treatment for macular degeneration?
191. Who are Long Term Care Ombudsmen?
192. What will Medicare cover for bone mass measurement?
193. How do I leave a Medicare Advantage plan?
194. I disagree with Medicare not paying for the ambulance. What should I do?
195. Medicare is forwarding my claims to two secondary insurance plans...
196. Why did I get a Medicare Summary Notice? What is it for if it is not a bill?
197. Do I need a prescription to get a supply?
198. I am a U.S. citizen living outside the country. How do I apply for Medicare?
199. Why didn't Medicare pay for my bone mass measurement?
200. I received a bill for my Medicare premiums. Where do I send my payment?
201. How can I receive additional assistance or more information about my options?
202. What do I do if Medicare is not paying for an item or service that I feel should
203. If my doctor submits a claim too late and it is denied, am I still responsible?
204. How can I arrange to have my parent's Medicare statements mailed to me??
205. I dropped a Medigap policy to join this Medicare Advantage plan for the first ti
206. Will Medicare pay for cardiac rehabilitation if I have a valve replacement?
207. What does $0 mean under Non-Covered Charges of my MSN?
208. I understand that there are new benefits available to Uniformed Services retiree
209. What is included in the Prosthetic and Orthotic category?
210. What if I refuse to sign an ABN but I want the service or item anyway?
211. What is a Supply?
212. Who must follow the Health Insurance Portability and Accountability Act of 1996
213. What about nursing home availability?
214. Where can I get help with my home health care questions?
215. How do I get on or off the automatic crossover file and how long will it take?
216. What is Medicare's policy regarding screening mammograms?
217. I received an ABN that was not on the standard gov't form. Is it legitimate?
218. Who do I contact if I suspect an act of fraud?
219. I disagree with a claims decision; how do I request an appeal?
220. What kinds of services can I receive from a dietician or nutritionist?
221. How do I pay for Supplies?
222. Are there any other steps a person with Medicare can take to try to get a Local
223. When I am liable for payment because I signed an ABN, how much can I be charged?
224. Medicare paid for the services I received after an accident, and then I received
225. What is a "capped" item?
226. How do I get my information corrected in Medicare.gov's Participating Physician Directory?
227. Is accreditation the same thing as Medicare or Medicaid certification?
228. What is assignment and why is it important when choosing a power wheelchair or s
229. What does the Health Insurance Portability and Accountability Act of 1996 (HIPAA
230. How do I order multiple copies of Medicare publications?
231. Patient Survival: What affects patient survival?
232. Am I protected from having to pay if I did not receive an ABN?
233. How does receiving an Advance Beneficiary Notice (ABN) help me?
234. Why aren't all Medicare participating healthcare professionals included in the P
235. What does Medicare pay for a power wheelchair or scooter?
236. I am a Federal employee. How do I enroll in Medicare?
237. Does my doctor have to tell me beforehand if he/she does not accept assignment?
238. If I receive an Advance Beneficiary Notice (ABN), what are my options?
239. Does Medicare cover my costs if I am in a clinical trial?
240. Can I choose any home health agency if I am in a Medicare Advantage Plan?
241. What is Medicare.gov?
242. How can I get a copy of my personal health information?
243. What is the Participating Physician Directory?
244. I live outside of the U.S., how do I contact the Social Security Administration
245. Can I legally get prescription drugs from Canada?
246. What should I do if I get the flu?
247. What determines which home health agencies will be included in the search result
248. Can I rent a power wheelchair or scooter and then buy it?
249. Patient Survival: How rates are calculated?
250. Can I rent a supply then purchase it?
251. Does Medicare cover power wheelchair and scooter accessories?
252. Where does the information in the Participating Physician Directory originate?
253. What is a �Private Contract�?
254. I paid my doctor more than I owe, how do I get my money back?
255. Where can I get information about the availability of mediation as an option to
256. What do I pay for a power wheelchair or scooter?
257. Does the Medicare-approved drug discount card program vary if I live in the U.S.
258. What is the Notice of Medicare Privacy Practices?
259. Will Medicare pay for my Pneumococcal shot?
260. What should I do if my doctor orders a test and the supplier gives me an ABN?
261. Is a power wheelchair or scooter supplier supposed to waive my coinsurance or Pa
262. What is a participating physician?
263. If I receive an ABN, does that mean I should not accept the service or item?
264. Who pays for repairs and general maintenance of my power wheelchair or scooter?
265. How do I get added to the Participating Physician Directory?
266. How do I get my information corrected in your Participating Physician Directory?
267. What can I do so that my spouse and I only receive one copy of the Handbook?
268. Do ABNs mean that less and less is being covered by Medicare?
269. How can I file a complaint with the Secretary of Health and Human Services?
270. Where can I find a list of participating suppliers in my area?
271. Anemia: What is Epogen®?
272. Patient Survival: expected patient survival?
273. How do I become a participating physician?
274. How is the privacy of my medical records protected?
275. What information must be included in an ABN for a Part B service or item?
276. Dialysis Adequacy: Guidelines.
277. On an ABN what does I will be �personally & fully responsible" for payment mean?
278. Are Health Care Providers required to file with Medicare?
279. Do you have tips for how to best view this site?
280. In Home Health Compare, what is risk adjustment?
281. Why are my bills for outpatient services higher than they were before Aug 2000?
282. What are Health Savings Accounts (HSAs)?
283. Patient Survival: As Expected?
284. How can I get my personal health information held by Medicare corrected if I thi
285. Dialysis Adequacy: Importance of URR of 65 or more.
286. Can I rent a power wheelchair or scooter?
287. How can I get a listing of those who have received my personal health informatio
288. Why did Medicare pay for interpreting a test while I was in the hospital?
289. How does Medicare use my personal information?
290. How can I get a paper copy of the Notice of Medicare Privacy Practices?
291. How often is the Participating Physician Directory updated?
292. Dialysis Adequacy: What is Urea?
293. I think my health care provider may have violated my privacy rights. How can I
294. Anemia: Kidney disease and low blood count.
295. Patient Survival: Worse than expected?
296. Anemia: What is anemia?
297. Dialysis Adequacy: How often should I be tested?
298. What rule or policy provides the process for appealing Local Coverage Decisions
299. How often is the data on Home Health Compare updated?
300. How do you collect health plan quality information?
301. Dialysis Adequacy: Other ways to measure?
302. How does Medicare protect my personal information?
303. What if I want to change home health agencies?
304. Who will hear the Local Coverage Decision (LCD) and National Coverage Decision (
305. What is the Screen Reader Version?
306. I am getting Medicaid or State Children's Health Insurance Program benefits. Ho
307. How can I ask Medicare to limit how my personal health information is used or gi
308. What are the timeframes for filing an Local Coverage Decision (LCD) Appeal?
309. Where do I go to file a complaint about a physician?
310. How was the satisfaction information collected?
311. Can a person with Medicare request a formal review of an Local Coverage Decision
312. Anemia: What is K/DOQI?
313. Dialysis Adequacy: What is URR?
314. Patient Survival: Better than Expected?
315. Anemia: What is hemoglobin?
316. Anemia: What is hematocrit?
317. Dialysis Adequacy: How are results affected?
318. I think Medicare may have violated my privacy rights. How can I file a complain
319. Why does Medicare need my personal health information?
320. Do you collect quality information for the Original Medicare Plan?
321. How do I update the demographic information for my agency on Home Health Compare
322. Does the Medicare-approved drug discount card program vary if I live in American
323. I am enrolled in a Medicare Advantage plan. How does this affect my privacy rig
324. Does the Medicare-approved drug discount card program vary if I live in Commonwe
325. Can more than one person file a complaint?
326. Can I use any Medicare-approved drug discount card and the $600 credit if I'm an
327. Anemia: What is a hormone?
328. Anemia: calculated hematocrit/hemoglobin.
329. I am a physician planning to relocate outside the US for a few years. How do I
330. Does the Medicare-approved drug discount card program vary if I live in Guam?
331. How can I report fraud, waste, and abuse to the Inspector General's Hotline abou
332. Why are preventive services important?
333. What is an I/T/U pharmacy?
334. When should I call the Inspector General's Hotline on waste, fraud, and abuse?
335. Why should I get a special Medicare-approved drug discount card to use at an I/T
336. What information do I need to provide when submitting a complaint to the Office
337. What happens when I report fraud to the Inspector General's Hotline?
338. Do I have to identify myself if I report fraud to the Inspector General?
339. My Medicare Summary Notice shows a charge for a service that I did not receive.
340. If I am an American Indian or Alaska native, will my special Medicare-approved d
341. What is the mission of the Office of the Inspector General Hotline ?
342. How do I report identity theft?
343. How do I report disability fraud?
344. What if I am an American Indian or Alaska native and have a Medicare-approved dr
345. Is there any help for American Indians or Alaska natives to fill out the enrollm
346. What if I am an American Indian or Alaska native and my I/T/U clinic doesn't hav
347. What if I am an American Indian or Alaska native and my I/T/U pharmacy doesn't c

1. What are the Medicare premiums and coinsurance rates for 2005?

The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2005:

Medicare Premiums for 2005:

Part A: (Hospital Insurance) Premium

• Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
• The Part A premium is $206.00 for people having 30-39 quarters of Medicare-covered employment.
• The Part A premium is $375.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.

Part B: (Medical Insurance) Premium

$78.20 per month.

Medicare Deductible and Coinsurance Amounts for 2005:

Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2005 = $912) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

For each benefit period you pay:

• A total of $912 for a hospital stay of 1-60 days.
• $228 per day for days 61-90 of a hospital stay.
• $456 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
• All costs for each day beyond 150 days

Skilled Nursing Facility Coinsurance

• $114.00 per day for days 21 through 100 each benefit period.

Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)

• $110.00 per year. ( Note : You pay 20% of the Medicare-approved amount for services after you meet the $110.00 deductible.)

Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2005 is available in the September 3, 2004 Health and Human Services press release titled "HHS Announces Medicare Premium, Deductibles for 2005" on the www.hhs.gov website.

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2. Information from Medtronic on a possible battery issue with some implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds) manufactured between April 2001 and December 2003.

On February 10, 2005, Medtronic, the manufacturer of implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy defibrillators (CRT-Ds), began notifying physicians about a problem that may affect the battery in some of the company's implantable devices. There have been no reports of patient injury or death related to this issue. This problem has been identified in a very small number of ICD and CRT-D devices with batteries manufactured between April 2001 and December 2003.

Devices manufactured during this time period include the following models:

Model 7230 Marquis� VR

Model 7274 Marquis� DR

Model 7232 Maximo� VR

Model 7278 Maximo� DR

Model 7277 InSync Marquis�

Model 7289 InSync II Marquis�

Model 7279 InSync III Marquis�

Model 7285 InSync III Protect� (no devices implanted in the United States)

This potential issue does not affect individuals with other models of Medtronic devices or these devices with batteries manufactured after December 2003. If your device is not included in this list, your device is not affected by this situation.

If you believe you may have one of Medtronic's devices, please call your doctor who follows the performance of your device. Your doctor is in the best position to assess your care needs.

If you have other questions or concerns, please call the Medtronic patient toll-free line at 1-888-775-2702.

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3. Are all people with Medicare eligible to get the �Welcome to Medicare� physical exam?

No. In order to be eligible to get the �Welcome to Medicare� physical exam, your Medicare Part B coverage must have been effective on or after January 1, 2005. Also, you must get the �Welcome to Medicare� physical exam within the first six months you have Part B coverage.

Additional information can be found in Medicare.gov's publication titled, Guide to Medicare's Preventive Services .

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4. How much does the �Welcome to Medicare� physical exam cost?

You pay 20% of the Medicare-approved amount after you meet the yearly Part B deductible ($110 for 2005). Since this may be your first Medicare-covered service, you may meet your entire Part B deductible at this visit.

Additional information on preventive services can be found in Medicare.gov's publication titled, Guide to Medicare's Preventive Services .

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5. What cancer screening does Medicare currently cover?

Medicare covers the full-range of colorectal cancer tests, annual mammogram tests for women over 40, a pap test and pelvic exam once every 24 months and annual prostate exams for men over 50.

Additional information on preventive services can be found in Medicare.gov's publication titled, Guide to Medicare's Preventive Services .

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6. What services are included in the �Welcome to Medicare� physical exam?

The �Welcome to Medicare� physical exam will include a thorough review of your health, education and counseling about the preventive services you need, like certain screenings and shots, and referrals for other care if you need it. The �Welcome to Medicare� physical exam is a great way to get up-to-date on important screenings and shots and to talk with your doctor about your family medical history and how to stay healthy.

During the exam, your doctor will record your medical history and check your blood pressure, weight and height. Your doctor will also give you a vision test and an Electrocardiogram (EKG). Depending on your general health and medical history, further tests may be ordered if necessary. You will also get a written plan (like a checklist) when you leave letting you know which screenings and other preventive services you should get.

Additional information on preventive services can be found in Medicare.gov's publication titled, Guide to Medicare's Preventive Services .

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7. What is the new diabetes screening?

Diabetes is a medical condition in which your body doesn't make enough insulin or has a reduced response to insulin. Diabetes causes your blood sugar to be too high because insulin is needed to use sugar properly. A high blood sugar level is not good for your health.

As of January 1, 2005, Medicare began covering tests to check for diabetes. These tests are available if you have any of the following risk factors: high blood pressure, high cholesterol, obesity, or a history of high blood sugar. Other risk factors may also qualify you for these tests. Talk with your doctor for more information.

Additional information on preventive services can be found in Medicare.gov's publication titled, Guide to Medicare's Preventive Services .

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8. What are the new cardiovascular screenings?

As of January 1, 2005, Medicare began covering cardiovascular screening tests. These tests check your cholesterol and other blood fat (lipid) levels. High cholesterol can increase your risk for heart disease and stroke. These tests will tell you if you have high cholesterol and can help you find cardiovascular problems in the early stages.

Additional information on preventive services can be found in Medicare.gov's publication titled, Guide to Medicare's Preventive Services .

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9. How often does Medicare cover the new cardiovascular screenings?

Medicare will cover these cardiovascular screening tests once every five years. You don't have to pay a deductible or co-payment for these tests.

Additional information on preventive services can be found in Medicare.gov's publication titled, Guide to Medicare's Preventive Services .

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10. How often is the new diabetes screening covered by Medicare?

Based on the results of your diabetes screening tests, you may be eligible for up to two diabetes screenings every year. You don't have to pay a deductible or co-payment for these tests.

Additional information on preventive services can be found in Medicare.gov's publication titled, Guide to Medicare's Preventive Services .

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11 .How are the new Medicare drug plans that are starting in 2006 different from the Medicare-approved drug discount cards that are already available?

Medicare prescription drug plans are a new type of insurance that can give you prescription drug coverage from Medicare. These plans work like other insurance you may already have. If you join one of these plans, you will pay a monthly premium, and you will have to pay a copayment or coinsurance for each prescription you fill. You will first be able to sign up for one of these new plans beginning November 15, 2005.

The Medicare-approved drug discount cards that became available in May 2004 are a way for you to get a discount on your prescriptions at the pharmacy. They work like other grocery store or pharmacy discount cards you may have. You can sign up for one of these cards only until December 31, 2005. They were offered as a transition step to help people with Medicare save money on prescription drug costs until Medicare prescription drug plans became available.

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12. What happens to my Medicare-approved drug discount card when I sign up for a Medicare prescription drug plan?

You can use your Medicare-approved drug discount card until May 15, 2006 or until you join a Medicare prescription drug plan, whichever is first. Once you have a Medicare prescription drug plan, you can't use your Medicare-approved drug discount card. You will get coverage for prescription drugs through the Medicare prescription drug plan instead of saving with the discount card.

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13. Can I still use any credits left on my Medicare-approved drug discount card after December 31, 2005?

Yes. You can continue to use your Medicare-approved drug discount card and your credit until May 15, 2006 or until you join a Medicare prescription drug plan, whichever is first. After you join a Medicare prescription drug plan, you can't use your Medicare-approved drug discount card. You also can't use any of the credit you have left.

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14. If I qualify, can I still get $600 credit on my Medicare-approved drug discount card in 2005? Does it matter when I enroll?

If you apply for the $600 credit for the first time during 2005, the company must receive your completed enrollment form in the beginning part of the year. If you apply later, you won't get the full $600 credit from Medicare. The chart below shows how much you will get depending on when in 2005 you join:

Please visit the Prescription Drug and Other Assistance Programs section of www.medicare.gov for additional information about the Medicare-approved drug discount card program.

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15. What is the new Together Rx Access Card program and who can get one?

Ten pharmaceutical companies have come together to launch the new Together Rx Access Card* program; Abbott, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, members of the Johnson & Johnson Family of Companies, Novartis, Pfizer, Sanofi-Aventis Group, Takeda, and TAP Pharmaceutical Products Inc. This new program is available now to the approximately 36 million uninsured Americans. Discounted savings is available on more than 275 brand name drugs, as well as to a wide range of generic drugs directly at the local pharmacy. Enrolled individuals can use this card at any one of the many participating pharmacies available nationwide.

To be eligible, you must:

• be a legal U.S. resident,
• under 65 years of age, not otherwise eligible for Medicare,
• without public or private prescription drug insurance, and
• with incomes up to $30,000 per year for a single person ($40,000 per year for couples)

This program will be expanded in February 2005 to individuals residing in Puerto Rico that meet the eligibility requirements listed above.

For more information on the new Together Rx Access Card program and how to enroll, please visit their website at www.TogetherRxAccess.com or call their toll free number 1-800-444-4106.

*Please Note: The new Together Rx Access Card should not be confused with the existing Together Rx Card that is offered by many of the same companies and is available to people with Medicare. For more information on the Together Rx Card, please visit their website at www.togetherrx.com .

Although these programs are beneficial and provide assistance to those in need, they are NOT endorsed or funded by the Medicare program.

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16. What are Medicare prescription drug plans?

Beginning January 1, 2006, new Medicare prescription drug plans will be available to people with Medicare. Insurance companies and other private companies will work with Medicare to offer these drug plans. They will negotiate discounts on drug prices. These plans are different from the Medicare-approved drug discount cards, which phase out by May 15, 2006, or when your enrollment in a Medicare prescription drug plan takes effect, if earlier.

Medicare prescription drug plans provide insurance coverage for prescription drugs. Like other insurance, if you join you will pay a monthly premium (generally around $35 in 2006) and pay a share of the cost of your prescriptions. Costs will vary depending on the drug plan you choose.

Drug plans may vary in what prescription drugs are covered, how much you have to pay, and which pharmacies you can use. All drug plans will have to provide at least a standard level of coverage, which Medicarewill set. However, some plans might offer more coverage and additional drugs for a higher monthly premium. When you join a drug plan, it is important for you to choose one that meets your prescription drug needs.

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17. Information about the Flu Medicines Demonstration

Medicare announced a demonstration project that may help pay for antiviral flu treatments for people with Medicare. If you have Medicare Part B and do not have drug coverage, you will be able to get up to two prescriptions filled during the demonstration period. If you have met your Part B deductible, Medicare will pay 80 percent of the cost of the drug up to the Medicare allowed payment. You must use a Medicare participating pharmacy.

If you have a Medicare-Approved Drug Discount Card, you will pay 20% of the card sponsor's cost for the drugs, or , 20% of the Medicare allowed payment, whichever is lower.

If you are in a Medicare Advantage plan, you can also participate in this demonstration. Please fill your prescription(s) at your plan participating pharmacy.

If you are currently in the hospital and have Medicare Part A, the antiviral flu drugs will also be covered.

This demonstration project will last until May 31, 2005. In the United States, four antiviral medications (amantadine, rimantadine, oseltamivir, and zanamivir) are approved for treatment of flu. Detailed information about each medication, including dosage and approved persons for use, may be found at
http://www.cdc.gov/flu/professionals/treatment .

Information about how to file a claim can be found by viewing our FAQ titled, " How do I submit a Medicare claim (bill)? "

If you think you have the flu, or think that you may have been exposed to flu, please contact your doctor as soon as possible. Additional information about the flu can be found in the Stay Healthy section of Medicare.gov's website.

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18. When can I join a Medicare prescription drug plan?

If you currently have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance), you can join a Medicare prescription drug plan between November 15, 2005, and May 15, 2006. If you join by December 31, 2005, your Medicare prescription drug plan coverage will begin on January 1, 2006. If you join after that, your coverage will be effective the first day of the month after the month you join. In general, you can join or change plans once each year between November 15 and December 31.

Even if you don't use a lot of prescription drugs now, you still should consider joining a plan. If you don't join a plan by May 15, 2006, and you don't have a drug plan that covers as much or more than a Medicare prescription drug plan, you will have to pay more each month (a surcharge) to join later.

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19. When will I get more information about choosing a Medicare Prescription Drug Plan?

Throughout 2005, Medicare will provide you more information about Medicare prescription drug plans, including how to choose and join a drug plan that best meets your needs. In the fall of 2005, the �Medicare & You 2006� handbook will list the Medicare prescription drug plans available in your area, and you will be able to get personalized information at this website.
In mid-2005, SSA will send people with certain incomes information about how to apply for extra help paying their prescription drug costs.

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20. What if I have prescription drug coverage from an employer or union?

If you have prescription drug coverage from an employer or union, you will get a notice from your employer or union that tells you if your plan covers as much or more than a Medicare prescription drug plan.

• keep your current drug plan. If you join a Medicare prescription drug plan later your monthly premium won't be higher (no surcharge), or
• drop your current drug plan and join a Medicare prescription drug plan, but you may not be able to get your employer or union drug plan back.

• keep your current drug plan and join a Medicare prescription drug plan to give you more complete prescription drug coverage, or
• just keep your current drug plan. But, if you join a Medicare prescription drug plan later, you will have to pay more for the monthly premium (a surcharge), or
• drop your current drug plan and join a Medicare prescription drug plan, but you may not be able to get your employer or union drug plan back.

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21. What if I already have prescription drug coverage from a Medigap (Supplemental Insurance) Policy?

If you have a Medigap policy with drug coverage, you will get a detailed notice from your insurance company telling you whether or not your policy covers as much or more than a Medicare prescription drug plan.This notice will explain your rights and choices.

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22. Do Medicare prescription drug plans work with all types of Medicare health plans?

Yes. There will be Medicare prescription drug plans that add coverage to the Original Medicare Plan. These plans will be offered by insurance companies and other private companies.

There will also be other drug plans that are a part of Medicare Advantage Plans (like HMOs), in some areas.

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23. Does the Medicare-approved drug discount card program vary if I live in Puerto Rico?

Each U.S. territory has its own program to provide lower-income Medicare beneficiaries with additional assistance in paying for their prescription drugs. If you are a resident of one of the territories, you are not eligible for the $600 credit that goes along with the Medicare-approved drug discount card.

If you are a Medicare beneficiary who lives in Puerto Rico and your monthly income is no more than $931 as a single person or no more than $1,249 for a married couple, then you may be eligible for the MediMed program. If you qualify, you will receive a credit of $150.00 each quarter to help with the cost of your prescription drugs. You do not qualify for the MediMed program if you are already enrolled in Medicaid, the health insurance plan of the Commonwealth of Puerto Rico (Reforma) or a private program that pays for prescription drugs. The MediMed Program in Puerto Rico can be contacted toll-free by calling 1-877-725-4300.

If you wish to apply for this program, you should ask for an appointment at your local Medicaid Office. When you go in for your appointment, you should bring a photo ID, your Medicare card, evidence of your home address, and evidence of your income. (Your Medicaid office will tell you what documents you need to bring for proof of income.)

Please visit the Prescription Drug and Other Assistance Programs section of www.medicare.gov for additional information about the Medicare-approved drug discount card program.

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24. How do I get a new Medicare card if my card is lost, stolen, or damaged?

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:

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 .

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25. How can I get my name and address changed?

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.

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26. I've heard that I might be able to get a $600 credit to help pay for my prescription drugs. How does that work?

If your annual gross income is below a certain level, Medicare may pay your enrollment fee for the Medicare-approved drug discount card and provide up to a $600 credit on your card toward your prescription drugs. You can use the $600 credit toward most prescriptions, even those not on the discount drug list. If you get the $600 credit to help you pay for your prescriptions, you will still have to pay a percentage of the cost for each prescription.

You may be able to get the $600 credit to help pay for your prescriptions if:

• you have Medicare Part A and/or Part B, and
• your annual income in 2005 is no more than $12,919 ($1077/month) if you are single, or no more than $17,320 ($1444/month) if you are married (this includes your income and your spouse's income).

You can't get the $600 credit if you already have outpatient prescription drug coverage from any of the following:

• Medicaid
• TRICARE for Life (military health insurance)
• Employer group health plan or other health insurance coverage including a few Medicare Managed Care Plans (other than a Medicare Advantage plan or Medigap policy)
• FEHBP (health insurance for Federal employees or retirees)

Even if you don't qualify for the $600 credit, you may be able to save money on your prescriptions with a Medicare-approved drug discount card.

If you and your spouse both qualify for the credit, you will each get the credit and won't have to pay your annual enrollment fee.

Income limits in Alaska are $16,133 ($1,345/month) if you are single and $21,641 ($1,804/month) if you are married.
Income limits in Hawaii are $14,864 ($1,239/month) if you are single and $19,926 ($1,661/month) if you are married.

The following sources of income should be included when calculating your gross income for your $600 credit enrollment form:

• Employee compensation (salary, wages, tips, bonuses, awards, etc.)
• Unemployment compensation
• Pensions and annuities
• Social Security benefits (including Social Security Equivalent portion of RR Retirement)
• Railroad Retirement benefits
• Veterans Affairs (VA) benefits
• Military and government disability pensions � armed forces, Public Health Service (PHS), National Oceanic and Atmospheric Administration (NOAA), Foreign Service (based on date pension began, combat-related pension, etc.)
• Individual Retirement Account (IRA) distributions
• Interest (savings accounts, checking accounts, etc.)
• Ordinary dividends (stocks, bonds, etc.)
• Refunds, credits, or offsets of state and local income taxes
• Alimony received
• Business income
• Capital gains
• Farm income
• Rental real estate, royalties, partnerships, trusts, etc.
• Other gains (sale or exchange of business property)
• Other income (lottery winnings, awards, prizes, raffles, etc.)

The following sources of income should not be included when calculating your income for $600 credit enrollment form:

• Inheritances and gifts (taxed to estate or giver if not under limits for exemption)
• Interest on state and local government obligations (e.g., bonds)
• Workers compensation payments
• Federal Employees Compensation Act payments
• Supplemental Security Income (SSI) benefits
• Income from national senior service corps programs
• Public welfare and other public assistance benefits
• Proceeds from sale of a home
• Lump sum life insurance benefits paid upon death of insured
• Life insurance benefits paid in installments
• Accelerated life insurance death benefit payments (e.g., viatical settlements, terminal illness, chronic illness)
• Medical Savings Accounts (MSA) withdrawals for medical expenses
• Payments from long-term care insurance policies (subject to limitation)
• Accident or health insurance policy benefits
• Accident compensatory damages
• Child support payments received
• Most foster care provider payments received
• Disaster Relief grants
• Disability payments as the result of a terrorist attack

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27. If I get a flu shot from a doctor or provider who doesn't bill Medicare, what should I do?

If you get your flu shot from a doctor or provider who doesn't bill Medicare, you will have to send Medicare a special form and receipt. You can get a receipt from the doctor or provider who gives you the flu shot. Make sure the receipt has the following information on it: the doctor or provider's name, the address, service provided (�flu shot�), the date you got the flu shot, and the amount you paid. To get this form and to find out where to send it, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

You can also click here to get a copy of this form. Please send your completed form to your local Medicare Carrier at the address listed below. For further assistance, please contact 1-800-MEDICARE (1-800-633-4227).

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28. I think my doctor or provider charged too much for my flu shot. What should I do?

If you think your doctor or provider charged an unfair amount for your flu shot, go to the Attorneys General Contact List on the website of the National Association of Attorneys General. This list contains contact information for each state's Attorney General. State Attorneys General take enforcement action against companies conducting unlawful business practices involving consumers.

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29. Where can I get a flu shot?

Contact your local health department or ask your regular doctor or provider about places that might be offering flu shots.

You can call 1-800-MEDICARE (1-800-633-4227) to get the phone number for your state health department. You can also find the number to your state health department by visiting the Helpful Contacts section of Medicare.gov's website. Once in the Helpful Contacts section, simply click on "Organization", and then select "State Health Departments" and your state from the drop down boxes. Once you have done this, press the "View Results" button at the bottom of the page, which will take you to the number to your state health department.

State health departments throughout the United States are trying to make sure that as many high-risk people as possible will eventually be able to get the flu shot. If you can't find a place that is offering flu shots now, keep trying. Some flu shot clinics and doctors' offices might get a supply later.

You may also be able to find a flu shot by using the Flu Shot Locator on Medicare.gov's website for the American Lung Association.

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30. What does it mean that the sponsor provides discounts on the top 100 drugs and they have an open or a closed formulary?

Currently all 66 of the general Medicare-approved drug discount card sponsors provide discounts on the top 100 drugs used by people over 65 years.* Please refer to the table below for a list of the top 100 drugs.

An open or a closed formulary indicates the likelihood that a particular Medicare-approved drug discount card sponsor will provide a discount on a larger list of drugs. A formulary is simply the list of drugs discounted by a particular Medicare-approved drug discount card sponsor. Currently the range of openness of formularies across all 66 general Medicare-approved drug discount card sponsors ranges from 64% to 94%. This simply means that the sponsor(s) with the 94% open formulary may be more likely to provide a discount on any new drugs that may be prescribed for you compare to the sponsor(s) with the 64% open formulary.

This information might be important for you if you need different prescription drugs in the future. If your prescriptions change or you need additional prescriptions, the drug card sponsors with a higher percentage will be more likely to discount the drugs you may need.

Note : As of September 30, 2004, this list was reduced to include only 99 drugs. Vioxx was removed from the list because it was withdrawn from the market by the manufacturer.

* This list was derived from data collected by Scott-Levin/Verispan and includes data s is based on the top retail dollar drugs from the 2003 Scott Levin/Verispan data. The Scott-Levin/Verispan data include data on prescriptions filled for the 12-month period ending May 31, 2003 based on Source Prescription Audit (SPA) and Physician Drug & Diagnosis Audit (PDDA) data. The rationale for using this data was based on the fact that it is the most recent data set that is currently available, and includes those drugs where most expenditures were being made by individuals 65 and older. Two drugs that were in the original top 100 list were removed since they are statutorily excluded under the Medicare-approved drug discount card program, the number 101 and 102 drug respectively were added to the list represented above.

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31. How much will Medicare pay? (For the Flu Shot)

Medicare will pay about $18 for your flu shot if you go to a doctor or provider who doesn't participate in Medicare. This amount varies by State and could be less than a doctor or provider charges you.

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32. Who should get a flu shot this season?

The number of flu shots available is limited for this season, so the Centers for Disease Control and Prevention is recommending that certain people be given priority for getting the flu shot. People in the following groups should get a flu shot this season:

• People 65 or older
• Anyone with a chronic condition such as heart or lung disease
• Nursing home and long-term care residents
• Pregnant women
• Health care workers who provide direct patient care
• Babies and toddlers ages 6-23 months
• Children on aspirin therapy
• Anyone who cares for or lives with babies younger than 6 months

These are people who are at high risk for serious flu complications or are in contact with people at high risk for serious flu complications.

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33. What can I do if my regular doctor or provider doesn't have flu shots available?

You can go to any licensed doctor or provider to get a flu shot. If you go to a doctor or provider who participates in Medicare, you will pay nothing for the shot. You can also go to a doctor or provider who doesn't bill Medicare. You will have to pay for the flu shot and then submit a receipt to Medicare to get all or part of your payment back.

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34. If I can't get the flu shot, can I take FluMist instead?

Most people with Medicare shouldn't take FluMist because it is approved only for people ages 5-49. The only people with Medicare who may take FluMist are healthy disabled persons age 49 or under. You should check with your doctor or other health care provider to see if FluMist is available and if you can take it.

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35. What other steps can I take to prevent the flu?

There are other good health habits that can help prevent the flu. To help prevent the flu:

• avoid close contact with people who are sick. When you are sick, keep your distance from others to protect them from getting sick too.
• stay home when you are sick, if possible. You will help prevent others from catching your illness.
• cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick.
• wash your hands often to help protect yourself from germs.
• avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth.

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36. Is there going to be a shortage of flu vaccines for this flu season?

As you may have heard in the media, it is anticipated that there will be a shortage of flu vaccines for the 2004-2005 flu season. Because of this shortage, the CDC has coordinated with its Advisory Committee for Immunization Practices (ACIP) to issue interim recommendations for influenza vaccination during the 2004�2005 flu season. These interim recommendations were formally updated by ACIP on December 22, 2004.

Priority Groups for Influenza Vaccination

• adults aged 65 years and older ( updated December 22, 2004 to include adults aged 50 - 64 years as long as the vaccine supply in the area can meet the demand);
• added December 22, 2004 - close contacts of people in high-risk groups (as long as the vaccine supply in the area can meet the demand);
• persons aged 2�64 years with underlying chronic medical conditions;
• residents of nursing homes and long-term care facilities;
• health-care workers involved in direct patient care;
• all women who will be pregnant during the influenza season;
• all children aged 6�23 months;
• children aged 6 months�18 years on chronic aspirin therapy;
• out-of-home caregivers and household contacts of children aged less than 6 months.

Other Vaccination Recommendations

• Persons in priority groups identified above should be encouraged to search locally for vaccine if their regular health-care provider does not have vaccine available.
• Intranasally administered, live, attenuated influenza vaccine, if available, should be encouraged for healthy persons who are aged 5�49 years and are not pregnant, including health-care workers (except those who care for severely immunocompromised patients in special care units) and persons caring for children aged less than 6 months.
• Certain children aged less than 9 years require 2 doses of vaccine if they have not previously been vaccinated. All children at high risk for complications from influenza, including those aged 6�23 months, who present for vaccination, should be vaccinated with a first or second dose, depending on vaccination status. However, doses should not be held in reserve to ensure that 2 doses will be available. Instead, available vaccine should be used to vaccinate persons in priority groups on a first-come, first-serve basis.

If you are not included in one of the priority groups above, you may be informed about the urgent vaccine supply situation and asked to forego or defer vaccination. Please contact your health care provider for additional information.

Please check back periodically for updates to our website. The Centers for Disease Control (CDC) also maintains up to date information on the treatment of flu and the availability of the flu vaccine.

To find out where you can get a flu shot in your area, go to the Flu Shot Locator on the American Lung Association's website and enter your zip code.

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37. Why is there a shortage of the flu shot for this season?

One of the companies that make flu shots was not able to have it available for this flu season. This caused the flu shot supply to be short by almost one half of the expected amount.

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38. What can I do if my Medicare Advantage Plan doesn't have flu shots available?

Call your Medicare Advantage Plan and ask if you can get the flu shot from a doctor or provider outside of the plan's network. Ask how the plan will handle payment for the flu shot in this case.

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39. Will getting a flu shot help keep me from getting sick?

If you get a flu shot there is a chance that you may still get the flu, but your symptoms will be less severe. You need a flu shot every year because flu viruses are always changing. The shot is updated each year for the most current flu viruses.

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40. What is the Medicare Replacement Drug Demonstration?

The Medicare Replacement Drug Demonstration (MRDD) is a new demonstration mandated under section 641 of the Medicare Modernization Act. Under this demonstration, Medicare will pay for certain drugs that replace other drugs that are currently covered under Medicare Part B. This includes certain drugs for rheumatoid arthritis, multiple sclerosis, cancer, and other serious diseases. Up until now, some of the drugs that treat these conditions were only covered under Medicare when provided in a doctor's office. A complete list of covered drugs and conditions can be viewed below.

In order to be eligible for this demonstration, you must:

• have both Medicare A & B,
• live in one of the 50 states or the District of Columbia,
• have Medicare as your primary health insurance, and
• have your doctor certify that you need one of the covered drugs for the listed indication.

Because this demonstration is intended to increase access to drug coverage for Medicare beneficiaries, if you already have comprehensive drug coverage through another health insurance such as TriCare, Medicaid, or a retiree policy, then you should not apply. But if you have more limited coverage through a Medicare supplement or Medicare Advantage (Medicare + Choice or Medicare managed care) plan, you may apply.

There is some cost sharing under this demonstration, but the savings are significant and can be over 90% depending upon the cost of the drug. If you are on a limited income, there are even greater savings.

To find out more about this demonstration and how you may apply, go to the The Medicare Replacement Drug Demonstration page on www.cms.hhs.gov. On this page you will find a brochure about the demonstration, frequently asked questions and answers, and an application form. Or, you may call the demonstration customer service center at 1-866-563-5386 (TTY number 1-866-563-5387) anytime between 8 am and 7:30 pm Eastern time, Monday � Friday and one of our customer service representatives will be happy to mail you information, answer any questions you may have, and/or assist you in completing the application form.

DRUGS COVERED UNDER THE MEDICARE REPLACEMENT DRUG DEMONSTRATION

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41. Why doesn't my Medicare-approved drug discount card provide discounts on every drug? Are certain drugs excluded?

Your Medicare-approved drug discount card can help you save on many prescription drugs. You may be able to save even more with generic drugs. While most prescription drugs are covered under the Medicare-approved drug discount card, certain groups of drugs are not covered.

The Medicare law excludes the following nine (9) groups of drugs from being covered under the Medicare-approved drug discount card program:

1. anorexia, weight loss, or weight gain drugs
2. fertility drugs
3. drugs used for cosmetic reasons or hair growth
4. drugs used for the relief of coughs and colds
5. prescription vitamins and minerals, except prenatal vitamins and fluoride preparations
6. nonprescription drugs (over-the-counter drugs)
7. outpatient drugs normally covered when manufacturers require you to buy the associated tests or monitoring services exclusively from them along with those drugs
8. barbiturates (often called sleeping pills)
9. benzodiazepines (known as tranquilizers, sleeping pills, anti-anxiety drugs)

If any of your drugs fall under one of those 9 groups you may not receive a discount on them through the Medicare-approved drug discount card program or use your $600 credit.

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42. Why is Vioxx no longer on your top 100 drug list, or on the Prescription Drug and Other Assistance Programs search tool?

On September 30, 2004, Vioxx, a medication used for pain relief, was removed from the market by the manufacturer, Merck, because of the increased risk for heart disease and stroke. Please contact your physician for additional instructions regarding what actions you should take, and for a replacement prescription.

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43. How do I go about choosing a Medicare-approved drug discount card?

The five steps below can help you choose a Medicare-approved drug discount card.

1. Get information about your current prescription drug coverage. Make a list of the prescriptions you currently take and how much you pay for each drug to see if a discount card may be right for you.
2. Find out which discount cards are available in your state, and get information on each one.
3. Compare each discount card based on what is important to you.
4. Decide if you want a discount card. Choose the one that is best for you. Fill out and send your enrollment form to the company.

For assistance in choosing a Medicare-approved drug discount card, please call 1-800-MEDICARE (1-800-633-4227), or go to the Prescription Drug and Other Assistance Programs section of our Website.

You may also wish to read Medicare.gov's publication titled, Guide to Choosing a Medicare-approved Drug Discount Card , for additional information.

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44. I am on Medicaid spenddown. Am I eligible for a Medicare-approved drug discount card and the $600 credit?

If you have outpatient prescription drug benefits through Medicaid, you will not be eligible for the Medicare-approved drug discount card or $600 credit. However, if you are on Medicaid spenddown , but have not yet met your spenddown requirement, you may qualify for a Medicare-approved drug discount card and a $600 credit to help you pay for your prescription drugs. If you become eligible for Medicaid outpatient drug benefits as a result of meeting the spenddown requirement, you will still be able to use the card and the $600 credit. In this case, Medicaid becomes the primary payer for drugs covered by Medicaid. You can save whatever remains of the $600 credit to use in the future should you lose your Medicaid benefits, or you can use the credit for drugs not covered by Medicaid.

If you move in and out of Medicaid spenddown status each month, your Medicare-approved drug discount card and credit will not be affected.

Please visit the Prescription Drug and Other Assistance Programs section of www.medicare.gov for additional information about the Medicare-approved drug discount card program.

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45. What can I do if I am denied the $600 credit that goes along with the Medicare-approved drug discount card?

When you apply for a Medicare Approved Drug Discount Card and the $600 credit, the sponsor may know that you are not eligible based on your answers to certain questions; for example, if you have Medicaid, TRICARE, FEHBP, or some other insurance such as retiree, or if your income is too high for the $600 credit.

If the Card sponsor accepts your enrollment information, they will submit your application to the Centers for Medicare and Medicaid Services (CMS) for verification. If CMS rejects your application, the Card sponsor will send you a denial letter that states the reason for the rejection.

If you receive a letter from the Card sponsor stating you do not qualify for the Medicare Approved Drug Discount Card and the $600 credit, you can appeal the decision by contacting MAXIMUS Center for Health Dispute Resolution. (MAXIMUS is working under contract for Medicare to handle these appeals.)

To be reconsidered, submit an appeal to MAXIMUS by phone, fax or mail. MAXIMUS will review the information and will then either uphold or overturn the rejection decision. If they overturn the decision (that is you are eligible for both the card and the $600 credit), they will enroll you in the Medicare Approved Drug Discount Card. In most cases, MAXIMUS will perform this process within 30 days of receipt of your appeal. You will be contacted once a final decision has been reached.

If you do not want to be reconsidered for the $600 credit but would still like the Medicare Approved Drug Discount Card, you must reapply for the card.

Center for Health Care Dispute Resolution (CHDR)/MAXIMUS Contact Information:
Toll-free telephone : 1-800-567-0757
Mailing address :
�The Medicare Drug Card Reconsideration Contractor� or �Maximus, The Medicare Drug Card Reconsideration Contractor�
BOWLING GREEN STATION
P.O. BOX 5042
NEW YORK, NY 10274-5042.
FAX : 917-228-8600

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46. What can I do if I am denied enrollment into a Medicare-approved drug discount card?

When the Medicare Approved Drug Discount Card sponsor submits your application for CMS approval, the CMS system will reject your application if you have prescription drug coverage under Medicaid. The sponsor will then send you a denial letter that identifies the reason for rejection.

If you receive a letter from the Card sponsor stating you do not qualify for the Medicare Approved Drug Discount Card, you can appeal the decision by contacting MAXIMUS Center for Health Dispute Resolution. (MAXIMUS is working under contract for Medicare to handle these appeals.)

To be reconsidered, submit an appeal to MAXIMUS by phone, fax or mail. MAXIMUS will review the information and will then either uphold or overturn the rejection decision. If they overturn the decision (that is, they say you are eligible), they will enroll you in the Medicare Approved Drug Discount Card. In most cases, MAXIMUS will perform this process within 30 days of receipt of your appeal. You will be contacted once a final decision has been reached.

Center for Health Care Dispute Resolution (CHDR)/MAXIMUS Contact Information:
Toll-free telephone : 1-800-567-0757
Mailing address :
�The Medicare Drug Card Reconsideration Contractor� or �Maximus, The Medicare Drug Card Reconsideration Contractor�
BOWLING GREEN STATION
P.O. BOX 5042
NEW YORK, NY 10274-5042.
FAX : 917-228-8600

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47. When will enrollment in a Medicare-approved drug discount card become effective?

If you are approved for a Medicare-approved drug discount card (including the $600 credit, if you qualify), you can begin using your card the first day of the month following the month the sponsor receives and approves your completed enrollment form. For example, if you are approved on March 12, 2005 you can begin using your card on April 1, 2005.

If you apply early in the month, you may receive your Medicare-approved drug discount card before the first of the following month. Generally, you must wait to use your discount until the first of the month. If you apply late in the month, you may not receive your card by the first of the month due to mailing time. You must have your card to take advantage of the drug discounts.

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48. When can I change Medicare-approved drug discount cards?

Generally, once you have submitted your enrollment form to the Medicare-approved drug discount card sponsor of your choice you must remain enrolled in that card for the rest of the year.

There are some special circumstances in which you may disenroll from your current card and enroll in another one during the year. These are:

• If you move out of the service area of your current discount card
• If you enter or leave a long-term care facility (like a nursing home)
• If you enroll in or disenroll from a Medicare managed care plan
• If the Medicare-approved drug discount card you are currently enrolled is no longer offered

If you choose to leave the Medicare-approved drug discount card you are enrolled in for any reason other than those listed above, you cannot apply for a new discount card.

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49. How do I use the $600 credit from Medicare to help pay for prescriptions?

If you are approved for the $600 credit from Medicare to help pay for your prescriptions, this amount will be applied to your discount card. Depending on your annual income, you will pay a 5% or 10% coinsurance for your prescription drugs. The pharmacy will then deduct the remainder from your discount card. For example, if your prescription costs $100, and you pay the 10% co-insurance of $10, $90 will be deducted from the balance on your card.

To find out how much of the $600 you have left, you can call the company's toll-free telephone number to get this information. You can also check the statement you get with your prescription or ask the pharmacist.

When you have used all of your $600 credit, you still will be able to use your Medicare-approved drug discount card to save money on your prescriptions. If you don't have other prescription drug coverage, you will have to pay the full discounted price.

If you keep the same Medicare-approved drug discount card you had in 2004, and some of your $600 credit is left, you can use that money this year in 2005. You don't have to reapply for the $600 credit in 2005. You will automatically get another $600 credit for 2005.

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50. Can I get the $600 credit without getting a Medicare-approved drug discount card?

No. You must enroll in a Medicare-approved drug discount card to get the $600 credit.

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51. How do I get a Medicare-approved drug discount card and the $600 credit if I live in a nursing home?

To get a Medicare-approved drug discount card and the $600 credit:

• Find out which pharmacy provides your prescriptions, and ask which Medicare-approved drug discount cards it accepts.
• Call the company that offers the card you want, and ask for enrollment materials.
• Fill out the enrollment form for the card and $600 credit.
• Send the signed enrollment form with this information to the card sponsor.
• The sponsor will send you a letter letting you know if you are eligible. If you are eligible, you will also get your Medicare-approved drug discount card with that letter.

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52.How do I find out if the pharmacy that provides my drugs has contracted with one of the special Medicare approved drug discount cards that serve Medicare nursing home residents?

To find out if the pharmacy in your nursing home works with one of these cards, ask the pharmacy or contact the drug card's customer service staff.

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53. For which drugs can the $600 be applied?

You can use the $600 credit toward most drugs that are filled with a prescription and are approved by the Food and Drug Administration (FDA). However, the credit cannot be used for certain drugs, such as over-the-counter (OTC) drugs, weight-related, fertility, and cosmetic drugs, drugs for symptomatic relief cough or colds, vitamins (except prenatal), barbiturates, benzodiazepines, and certain drugs that Medicare already covers for you under Part B. The card sponsor and your pharmacy will know when to apply the $600 credit.

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54. Can I choose whichever Medicare-approved drug discount card I want even though I live in a nursing home?

Yes. You can choose any Medicare-approved drug discount card offered in your area, including the three special cards for people living in nursing homes. If you are eligible for the $600 credit, you should consider one of the special cards for people living in nursing homes. You can only have one Medicare-approved drug discount card at a time.

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55. If I choose a Medicare-approved drug discount card, do I have to use the pharmacy that my nursing home uses?

Depending on where your nursing home is located, there may be rules that offer you a choice between a pharmacy that specializes in serving people living in nursing homes and a pharmacy that serves the community. Check with your nursing home to find out where you get your medicines. Keep in mind when choosing a pharmacy that Medicare makes sure that the prescriptions you get in your nursing home meet high quality standards.

If you get your medicines from a pharmacy that is set up by your nursing home to serve the people living in your nursing home, and you are eligible for the $600 credit, you should consider one of the special cards for people living in nursing homes. These special cards will use the $600 credit to help pay for your medicines. The $600 credit can't be used while Medicare Part A is paying for your stay in the nursing home.

If you get your medicines from a community pharmacy, you can consider one of the special cards for people living in nursing homes that include your community pharmacy in their pharmacy networks, or you may want to consider other Medicare-approved drug discount cards that include your community pharmacy in their pharmacy networks.

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56. Can I get a discount and the $600 credit?

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57. What if I have a Medicare-approved drug discount card already, but it isn't one of the three cards for people in nursing homes?

If you move into a nursing home, and you qualify for the $600 credit and get drugs through the nursing home's contracted pharmacy, you may need to switch to one of the three special cards to use your $600 credit. Check with the pharmacy that provides your prescriptions in the nursing home to see which Medicare-approved drug card they work with.

You may change cards when you enter or leave a nursing home.

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58. Can I use my card at an assisted living facility?

Check with the card sponsor to see if you can use your Medicare-approved card at the pharmacy that serves your assisted living facility.

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59. If I live in a nursing home, can I get a Medicare-approved drug discount card and the $600 credit?

You can get a Medicare-approved drug discount card if:

• you have Medicare Part A and/or Part B, and
• you don't have outpatient prescription drug benefits through Medicaid.

You also may be able to get the $600 credit to help pay for your prescriptions if:

• you don't have other health insurance with any outpatient prescription drug coverage (except a Medicare Advantage plan or a Medigap policy), and
• your monthly income in 2005 is no more than $1,077 * if you are single, or no more than $1,444 * if you are married (this includes your income and your spouse's income). If your state helps pay your Medicare Part A or Part B premiums you may still qualify even if your income is above these amounts.

* If you live in Alaska or Hawaii, income limits are different.

Note: You can get the $600 credit while Medicare is paying for your nursing home stay. The $600 credit can't be used while Medicare Part A is paying for your stay in a nursing home.

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60. Why are there three special drug discount cards for people who live in nursing homes?

Many people who live in nursing homes get their prescriptions from a pharmacy that specializes in serving people in nursing homes. To make sure the Medicare-approved drug discount card works best for people with Medicare in nursing homes, Medicare created a special type of card to help people who live in nursing homes who are eligible for the $600 credit with the cost of their prescriptions.

The three Medicare-approved drug discount cards for eligible people with Medicare living in a nursing home are:

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61. What if I have one of the three special Medicare-approved drug discount cards for people in nursing homes and I leave a nursing home?

No matter when you leave the nursing home, you will have the opportunity at that time to choose a different Medicare-approved drug discount card. You can choose a card that meets your prescription needs outside of the nursing home.

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62. How do I know how much of the $600 credit I have left?

To find out how much of the $600 you have left, you can call the card sponsor's toll-free telephone number. You can also check the statement you get with your prescription or ask the pharmacist.

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63. How can I find out the prices of different prescription drugs at my nursing home pharmacy?

The price of prescriptions for people with Medicare who live in nursing homes is based on many different factors. If you have a question about your prescription drug costs, talk to your card sponsor or the pharmacy that provides you your prescription drugs.

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64. Can I use the $600 credit while Medicare is paying for my stay in the nursing home?

The $600 credit can't be used while Medicare Part A is paying for your stay in the nursing home.

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65. What if I have one of the special drug discount cards for nursing homes and my nursing home pharmacy won't accept it?

If the pharmacy serving your nursing home won't accept your card, call the card sponsor to complain. If the sponsor doesn't resolve your complaint, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

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66. Will the availability of the $600 credit or discount prices prevent or delay an individual's eligibility for Medicaid under a "spenddown?"

No. Neither the $600 credit nor the discount prices will have a negative impact on the Medicaid eligibility process. The discount and any portion of the $600 credit used for precription drugs will be treated as incurred medical expenses for purposes of Medicaid spenddown, and there will be no delay in the onset of Medicaid eligibility. CMS will issue guidance on how the Medicaid State agencies will calculate the applicant's level of drug spending to apply to "spenddown."

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67. How much will I save on my medicines if I join a Medicare-approved drug discount card ?

For a small or no enrollment fee, you can get a Medicare-approved drug discount card and save on covered brand-name drugs. You can save even more with generic drugs. You may have to pay an annual enrollment fee of no more than $30 to the drug card sponsor.

No matter when you join, the enrollment fee is the same. You can choose to join any time until December 31, 2005, when this program ends.

Some people with low income can get up to a $600 credit from Medicare to go along with this card.

Please visit the Prescription Drug and Other Assistance Programs section of www.medicare.gov for additional information about the Medicare-approved drug discount card program.

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68. When does Medicare begin paying for my prescription drug costs? How does it work?

Prescription Drug Benefits will be added to Medicare in 2006. All people with Medicare will be able to enroll in plans that cover prescription drugs. Plans might vary, but in general, this is how they will work:

• You will choose a prescription drug plan and pay a premium of about $35 a month.
• You will pay the first $250 (called a "deductible").
• Medicare will pay 75% of drug costs between $250 and $2,250 in drug spending. You will pay only 25% of these costs.
• You will pay 100% of drug costs above $2,250 until you reach $3,600 in out-of-pocket spending.
• Medicare will pay about 95% of the costs after you have spent $3,600.

Some prescription drug plans may have additional options to help you pay the out-of pocket costs.

Extra help will be available for people with low incomes and limited assets. Most significantly, people with Medicare in the greatest need, who have incomes below a certain limit won't have to pay the premiums or deductible for prescription drugs. The income limits will be set in 2005. If you qualify, you will only pay a small co-payment for each prescription you need.

Other people with low incomes and limited assets will get help paying the premiums and deductible. The amount they pay for each prescription will be limited.

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69. Who can get a Medicare-approved drug discount card?

Almost everyone with Medicare can choose to join a Medicare-approved drug discount card. It doesn't matter whether you have Original Medicare (Part A and/or Part B), a Medigap policy, a Medicare managed care plan, or another kind of Medicare health plan. The only people who can't enroll in a Medicare-approved drug discount card are those who have outpatient drug coverage through Medicaid.

Please visit the Prescription Drug and Other Assistance Programs section of www.medicare.gov for additional information about the Medicare-approved drug discount card program.

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70. My income is very limited. It will be hard for me to pay the premiums and deductible under the new Medicare prescription drug benefit. Is there any extra help for me?

Extra help will be available for people with low incomes and limited assets. Most significantly, people with Medicare in the greatest need, who have incomes below a certain limit won't have to pay the premiums or deductible for prescription drugs. These income limits will be set in 2005. If you qualify, you will only pay a small co-payment for each prescription you need. Other people with low incomes and limited assets will get help paying the premiums and deductible.

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71. What is Medicare Advantage and how does it work with Medicare + Choice plans?

Medicare Advantage is the new name for Medicare + Choice plans. Medicare Advantage rules and payments are improved to give you more health plan choices. In 2006, Medicare Advantage plan choices will be expanded to include regional preferred provider organization plans (PPOs). Regional PPOs will help ensure that all people with Medicare have multiple choices for Medicare health coverage. PPOs can help you save money by choosing from doctors and providers on a plan's �preferred� list, but usually don't require you to get a referral.

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72. I have a Medigap plan that covers prescription drugs. Can I keep that plan and choose NOT to enroll in Medicare's prescription drug coverage?

If you have a Medigap policy by December 31, 2005 that also covers prescription drugs (plans H, I, or J);

You can keep that policy with the drug coverage, if you don't enroll in Medicare's Prescription Drug Benefit that begins in 2006. If you choose to enroll in a Medicare Prescription Drug Benefit plan, you can keep your current Medigap policy but the drug coverage will be removed from the policy or, for a limited time, you can buy a different Medigap policy that does not cover drugs. You can contact your Medigap insurer to find out more about your options.

If you do not have a Medigap plan H, I, or J by December 31, 2005;

Starting January 1, 2006, there will be a change in Medigap policies that cover prescription drugs. Medigap Plans H, I, and J may still be sold, but without the prescription drug benefit.

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73. I already have a prescription drug discount card, but it's not Medicare-approved. How will the new Medicare-approved drug discount cards work with my card?

If you already have a discount card that is not Medicare-approved, you don't have to give up that card. You can still choose a Medicare-approved drug discount card. You will be able to use both cards. For example, you might use one of your drug discount cards to get the best price for some of your medications and use the second drug discount card to get the best price on the rest of your medications. You should compare the different costs of your prescriptions among all of the drug discount cards that are available; to make sure you are making the best choice.

Please visit the Prescription Drug and Other Assistance Programs section of www.medicare.gov for additional information about the Medicare-approved drug discount card program.

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74. I am in a Medicare managed care plan. Can I get a Medicare-approved drug discount card?

Yes. If you are enrolled in a Medicare managed care plan, and your plan offers a drug discount card to you as a plan member, you can choose to join ONLY this discount card. In addition, if you qualify for the $600 credit to help pay for your prescription drugs, you will receive this credit through your Medicare managed care plan. If you choose not to join the discount card offered by your Medicare managed care plan, you can't choose another Medicare-approved drug discount card.

If your Medicare managed care plan doesn't offer a Medicare-approved drug discount card, or offers a discount card that is open to non-members, you can choose any discount card offered in your state.

Please visit the Prescription Drug and Other Assistance Programs section of www.medicare.gov for additional information about the Medicare-approved drug discount card program

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75. I am disabled and have Medicare and Medicaid. Can I get a Medicare-approved drug discount card?

Almost everyone with Medicare can choose to join a Medicare-approved drug discount card. The only people who can't enroll in a Medicare-approved drug discount card are those who have outpatient drug coverage through Medicaid.

Please visit the Prescription Drug and Other Assistance Programs section of www.medicare.gov for additional information about the Medicare-approved drug discount card program.

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76. I have Medicare and a Medigap policy. Can I get a Medicare-approved drug discount card, and how will it affect my Medigap coverage?

Yes. You can choose to enroll in a Medicare-approved drug discount card even if you have a Medigap policy. You can keep both the discount card and your Medigap policy. If you have drug coverage under your Medigap policy, that drug coverage will not change.

Medigap plans H, I, and J, cover 50% of outpatient prescription drug costs, after you meet a $250 calendar year deductible, and up to the maximum benefit under the policy ($1,250 under plans H and I and $3,000 under plan J). If you use your Medicare-approved drug discount card to buy a prescription drug and a claim with the discounted price is sent to your Medigap insurer, your Medigap policy will pay 50% of the discounted drug price, after you have met your $250 deductible.

If the pharmacy that you go to does not accept both of your cards (Medicare-approved drug discount card and Medigap card), and/or cannot exchange claims information with your Medigap plan, then it will be up to you to submit claims to your Medigap plan.

Please visit the Prescription Drug and Other Assistance Programs section of www.medicare.gov for additional information about the Medicare-approved drug discount card program.

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77. Does the cost go up if I enroll in a Medicare-approved drug discount card after a certain date?

No. There is an annual enrollment fee of no more than $30. No matter when you join, the enrollment fee is the same. There is no penalty or extra charge for joining at a later date. These voluntary cards are being offered until December 31, 2005, when this program ends and the new comprehensive prescription drug benefit begins. You can choose to join any time until December 31, 2005, when this program ends. Medicare's new comprehensive prescription drug benefit begins January 1, 2006.

Please visit the Prescription Drug and Other Assistance Programs section of www.medicare.gov for additional information about the Medicare-approved drug discount card program.

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78. Do I have to join a Medicare-approved drug discount card?

No. The Medicare-approved drug discount cards are voluntary and enrolling is completely your choice. If you don't choose a Medicare-approved drug discount card or turn in an enrollment form, Medicare won't enroll you in a card.

Please visit the Prescription Drug and Other Assistance Programs section of www.medicare.gov for additional information about the Medicare-approved drug discount card program.

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79. Where can I go for the latest, official information about changes in Medicare?

For up-to-date information and answers to your questions, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov on the web.

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80. Are people with Medicare going to have to pay different premiums for Part B in the future?

Yes. People with Medicare whose incomes are more than $80,000 as an individual or $160,000 as a couple, will pay higher Part B premiums than people with lower incomes. This change begins in 2007.

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81. I have a Medigap plan that covers prescription drugs. Can I keep that plan and also choose Medicare's prescription drug coverage?

No. If you choose to enroll in one of Medicare's prescription drug plans, you won't be allowed to renew a Medigap policy that also covers prescription drugs (plans H, I, or J). However, you can choose another Medigap plan that doesn't offer drug coverage. And, you can choose to stay with your current Medigap policy until Medicare's drug coverage starts in 2006.

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82. Does the new law make any changes to Medigap supplement policies?

Yes. Starting in 2006, Medigap supplement policies will include two new kinds of benefit packages that you can choose to buy, to help with out-of pocket costs. No new Medigap policies with drug coverage (plans H, I, and J) will be sold. If you have a Medigap policy with drug coverage, you can choose to renew it. Or, if you choose to join a Medicare prescription drug plan in 2006, you won't be allowed to renew your current Medigap policy.

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83. Does the new law change the coverage I have for therapy services?

Yes. In September 2003, Medicare started certain limits on what it would pay for occupational therapy, physical therapy, and speech-language therapy services. The new law takes away those limits until January 1, 2006. You still pay the regular coinsurance amount, and Medicare pays its share for your covered therapy services.

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84. Does the new law add any preventive benefits that will help me stay healthy?

Yes. As of January 1, 2005, Medicare began covering

• A one-time initial preventive physical exam within 6 months of the day you first enroll in Medicare Part B
• Screening blood tests for early detection of cardiovascular (heart) diseases
• Diabetes screening tests for people with Medicare at risk of getting diabetes

Additional information on preventive services can be found in Medicare.gov's publication titled, Guide to Medicare's Preventive Services .

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85. Will the new law change what Medicare pays my doctors?

Yes, the law increases Medicare's payments to doctors by 1.5%. If the law hadn't passed, Medicare's payments to doctors would have gone down by 4.5%. This could have resulted in fewer doctors seeing Medicare patients.

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86. I don't live near a big city, and sometimes it's hard to get health care. Does this new legislation help people in rural areas?

The new law increased Medicare's payments to rural providers by $25 billion to ensure people with Medicare in rural areas can get the care they need.

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87. How will Medigap plans change with the 2003 Medicare Modernization Act?

In 2006 , Medigap plans will include two new plans to help beneficiaries with out-of pocket costs. No new Medigap policies with drug coverage may be sold.

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88. The retirement age for Social Security is increasing until it reaches age 67. Will I still get Medicare at age 65 if I'm not yet eligible for Social Security retirement benefits?

Although the retirement age is rising, 65 remains as the starting date for Medicare eligibility. You will be eligible to apply for Medicare if you have paid into Social Security for at least 10 years or you are eligible to receive Social Security benefits on your spouse's earnings. If you do not meet these requirements, you can still get Medicare hospital insurance (Part A) by paying a monthly premium if you are a citizen or a lawfully admitted alien who has lived in the U.S. for at least five years.

Also, anyone who is age 65 and a citizen or a lawfully admitted alien with five years of residency in the United States can sign up for Medicare Part B. Medical Insurance and pay a monthly premium.

Be sure to sign up for Medicare about three months before you reach age 65. And remember, you do not have to be retired to enroll in Medicare.

For more information about retirement, visit www.socialsecurity.gov or call 1-800-772-1213 (TTY users should call 1-800-325-0778).

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89. What types of services are covered under Medicare?

Listed below is general information on what is covered under Medicare Parts A and B. We have also included links to publications which contain detailed information on specific types of care (for example, prevention services and hospice care). You may also want to visit the Your Medicare Coverage section of our website for expanded information regarding your current Medicare Part A and Part B coverage under the Original Medicare Plan.

Medicare Part A

Medicare Part A (Hospital Insurance) helps cover your inpatient care in hospitals, critical access hospitals, and skilled nursing facilities. It also covers hospice care and some home health care. You must meet certain conditions.

Medicare Part A Helps Cover Your:

Hospital Stays: Semiprivate room, meals, general nursing, and other hospital services and supplies. This includes care you get in critical access hospitals and inpatient mental health care. This does not include private duty nursing, or a television or telephone in your room. It also does not include a private room, unless medically necessary. Read Medicare and Your Mental Health Benefits for more information on inpatient mental health benefits.

Skilled Nursing Facility Care: Semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies (after a related 3-day hospital stay). Read Medicare Coverage of Skilled Nursing Facility Care for more information.

Home Health Care: Part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services. Please visit the Home Health Compare section of our website for more information.

Hospice Care: Medical and support services from a Medicare-approved hospice for people with a terminal illness, drugs for symptom control and pain relief, and other services not otherwise covered by Medicare. Hospice care is given in your home. However, short-term hospital and inpatient respite care (care given to a hospice patient by another caregiver so that the usual caregiver can rest) are covered when needed. Read Medicare Hospice Benefits for more information.

Blood: Pints of blood you get at a hospital or skilled nursing facility during a covered stay.

Medicare Part B

Medicare Part B (Medical Insurance) helps cover your doctors' services, outpatient hospital care, and some other medical services that Part A does not cover, such as some of the services of physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. You pay the Medicare Part B premium of $58.70 per month in 2003.

Medicare Part B Helps Cover Your:

Medical and Other Services: Doctors' services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also covers second surgical opinions, outpatient mental health care, outpatient physical and occupational therapy, including speech-language therapy. Read Medicare and Your Mental Health Benefits and Getting a Second Opinion Before Surgery for more information.

Clinical Laboratory Services: Blood tests, urinalysis, and more.

Home Health Care: Part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services. Please visit the Home Health Compare section of our website for more information.

Outpatient Hospital Services: Hospital services and supplies received as an outpatient as part of a doctor's care. Read Your Guide to the Outpatient Prospective Payment System for more information.

Blood: Pints of blood you get as an outpatient or as part of a Part B covered service.

Medicare Also Helps Cover:

• Ambulance services (when other transportation would endanger your health).
• Artificial eyes.
• Artificial limbs that are prosthetic devices, and their replacement parts.
• Braces - arm, leg, back, and neck.
• Chiropractic services (limited), for manipulation of the spine to correct a subluxation.
• Emergency care.
• Eyeglasses - one pair of standard frames after cataract surgery with an intraocular lens.
• Immunosuppressive drug therapy for transplant patients as long as you are covered by Medicare (transplant must have been paid for by Medicare).
• Kidney dialysis. Read Medicare Coverage of Kidney Dialysis and Kidney Transplant Services for more information.
• Macular degeneration of the eye ("wet" age-related) treatment, using ocular photodynamic therapy with verteporfin.
• Medical nutrition therapy services for people with diabetes or kidney disease with a doctor's referral.
• Medical supplies - items such as ostomy bags, surgical dressings, splints, casts, and some diabetic supplies.
• Outpatient prescription drugs (very limited). For example, some oral drugs for cancer.
• Preventive services. Read Medicare Preventive Services to Keep You Healthy or Women with Medicare - Visiting Your Doctor for a Pap Test, Pelvic Exam, and Clinical Breast Exam for more information.
• Prosthetic devices, including breast prosthesis after mastectomy.
• Second opinion by a doctor (in some cases). Read Getting a Second Opinion Before Surgery for more information.
• Services of practitioners such as clinical social workers, physician assistants, and nurse practitioners.
• Telemedicine services in some rural areas.
• Therapeutic shoes for people with diabetes (in some cases).
• Transplants - heart, lung, kidney, pancreas, intestine, bone marrow, cornea, and liver (under certain conditions and when performed at approved facilities).
• X-rays, MRIs, CAT scans, EKGs, and some other diagnostic tests.

What is not paid for by Medicare Part A and Part B:

The Original Medicare Plan does not cover everything. Health care costs not covered by Medicare will include, but are not limited to:

• Acupuncture.
• Deductibles, coinsurance, or copayments when you get health care services.
• Dental care and dentures (in most cases).
• Cosmetic surgery.
• Custodial care (help with bathing, dressing, using the bathroom,and eating) at home or in a nursing home.
• Health care you get while traveling outside of the United States (except in limited cases).
• Hearing aids and hearing exams.
• Orthopedic shoes.
• Outpatient prescription drugs (with only a few exceptions).
• Routine foot care (with only a few exceptions).
• Routine eye care and most eyeglasses (see exception above for one pair of standard frames after cataract surgery with an introcular lens).
• Routine or yearly physical exams.
• Screening tests except those listed in Medicare Preventive Services to Keep You Healthy.
• Shots (vaccinations) except those listed in Medicare Preventive Services to Keep You Healthy.

Medicare + Choice plans (like an HMO) may include extra benefits such as prescription drugs, dental care, routine physical and vision services. You can learn more about whether Medicare + Choice plans are available in your area and any extra benefits offered by these plans by visiting the Medicare Personal Plan Finder. Please visit the Your Medicare Coverage section of Medicare.gov's website for expanded information regarding your current Medicare Part A and Part B coverage under the Original Medicare Plan.

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90. Who is eligible for Medicare?

Generally, Medicare is available for people age 65 or older, younger people with disabilities and people with End Stage Renal Disease (permanent kidney failure requiring dialysis or transplant). Medicare has two parts, Part A (Hospital Insurance) and Part B (Medicare Insurance). You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if:

• You are receiving retirement benefits from Social Security or the Railroad Retirement Board.
• You are eligible to receive Social Security or Railroad benefits but you have not yet filed for them.
• You or your spouse had Medicare-covered government employment.

If you (or your spouse) did not pay Medicare taxes while you worked, and you are age 65 or older and a citizen or permanent resident of the United States, you may be able to buy Part A. If you are under age 65, you can get Part A without having to pay premiums if:

• You have been entitled to Social Security or Railroad Retirement Board disability benefits for 24 months. ( Note : If you have Lou Gehrig's disease, your Medicare benefits begin the first month you get disability benefits.)
• You are a kidney dialysis or kidney transplant patient.

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. The monthly Part B premium in 2005 is $78.20. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months.

If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, call the Social Security Administration or visit their web site . The toll-free telephone number is: 1-800-772-1213. The TTY-TDD number for the hearing impaired is 1-800-325-0778. You can also get information about buying Part A as well as Part B if you do not qualify for premium-free Part A. See also FAQ on How to enroll in Medicare .

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91. When should I get my flu shot?

Because flu activity can start as early as December, the best time to get a shot is during September, October and November. But getting the shot after November can still provide protection. A new shot is needed each year. The flu shot can be given at the same time as other shots including the pneumococcal shot. Even if you get your flu shot later than November; you will still benefit from receiving the flu shot since the flu season usually runs from November through April. The Centers for Disease Control (CDC) maintains up to date information on the treatment of flu and the availability of the flu vaccine.

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92. How do I enroll in Medicare?

The Social Security Administration handles Medicare eligibility and enrollment. You can contact the Social Security Administration at 1-800-772-1213 to enroll in Medicare or to ask questions about whether you are eligible. You can also visit their web site at www.socialsecurity.gov .

General information about enrollment in Medicare is provided below. Our other FAQs Who is eligible for Medicare? and Should I sign up for Medicare Part B? may also be helpful to you.

IF YOU ALREADY RECEIVE BENEFITS FROM SOCIAL SECURITY:

If you already get benefits from Social Security or the Railroad Retirement Board, you are automatically entitled to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) starting the first day of the month you turn age 65. You will not need to do anything to enroll. Your Medicare card will be mailed to you about 3 months before your 65th birthday. If your 65th birthday is February 20, 2004, your Medicare effective date would be February 1, 2004. (Note: if your birthday is on the 1st day of any month, Medicare Part A and Part B will be effective the 1st day of the prior month. For example, if your 65th birthday is February 1, 2004, your Medicare effective date would be January 1, 2004.)

IF YOU ARE NOT GETTING SOCIAL SECURITY BENEFITS:

If you are not getting Social Security benefits, you can apply for retirement benefits and Medicare online. If you would like to file for Medicare only, you can apply by calling 1-800-772-1213.

IF YOU ARE UNDER AGE 65 AND DISABLED:

If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security or the Railroad Retirement Board for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You will not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you about 3 months before your Medicare entitlement date. (Note: If you are under age 65 and have Lou Gehrig's disease (ALS), you get your Medicare benefits the first month you get disability benefits from Social Security or the Railroad Retirement Board.) For more information about enrollment, call the Social Security Administration at 1-800-772-1213 or visit their web site . See also Social Security's FAQ: When should I sign up for Medicare benefits? which explains the enrollment process.

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93. What is the Electronic Medicare Summary Notice (E-MSN) and where is it available?

The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that E-MSN service is available to people with Medicare who have claims processed by the Medicare contractor, Palmetto GBA. To see if you are eligible to participate, please see the list below of states that are included. Individuals in the service areas listed below have the opportunity to receive an electronic Medicare Summary Notice (e-MSN) through the Internet.

The electronic Medicare Summary Notice (e-MSN) is a simple and convenient way to obtain a duplicate copy of your MSNs. This duplicate can be viewed and printed right from your own computer at any time just by accessing the Palmetto GBA website. Participants will be able to view and print their E-MSN statement 24 hours a day, 7 days a week. At this time, the e-MSN does not replace the paper Medicare Summary Notice currently mailed on a monthly basis when a claim is processed. This is an optional service and is limited to individuals whose claims are processed by Palmetto GBA. We need to evaluate the benefit of this service before it is made available for all of the Medicare lines of business.

If you do not have a computer you may choose to use a family member's Internet service, or in some towns Internet service is available at the local library. You will be able to view your MSN one day after the original MSN has been printed. Your supplemental insurance company will also accept the copy you print off of the site. We recommend that you use a white piece of paper (8.5 x 11), without lines, to print copies for your supplemental insurance. To register and find out more about this service, please visit the Palmetto GBA website.

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94. How do I find a Medicare-approved home health agency?

You can find a Medicare approved home health agency by:

• Looking at the information in the Home Health Compare section of www.medicare.gov .
• Asking your doctor or hospital discharge planner.
• Using a senior community referral service, or other community agencies that help you with your health care.
• Looking in your telephone directory in the Yellow Pages under "home care" or "home health care." (Look for home health care agencies that are Medicare approved.)

If your doctor decides you need home health care, you have the right to choose the home health agency to give you needed care and services. Your choice should be honored by your doctor, hospital discharge planner or other referring agency. Some hospitals have their own home health agency. You do not have to choose the hospital's agency. You may choose any agency that you feel will meet your medical needs.

If you are in a Medicare Advantage plan, you may have to use a home health agency that belongs to the plan.

It is important to remember that Medicare only pays for home health services that are given by a home health agency that meets Medicare's quality standards and is approved by Medicare. Medicare regularly inspects home health agencies to make sure that these standards are met. Your home health agency must provide you with all the home care you need, both staff and medical supplies. The agency may do this through their own staff, through an arrangement with another agency, or they may hire someone else to meet your needs. This includes nurses, therapists, home health aides, and medical social service counselors.

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95. Does Medicare pay for prescription drugs?

Generally, Original Medicare does not cover prescription drugs. However, Medicare does cover some drugs in certain cases such as immunosuppressive drugs for transplant patients and some oral anti-cancer drugs. Medicare also covers certain prescription drugs used in nebulizers and external infusion pumps.

If you get Medicare covered prescription drugs, make sure your pharmacy or supplier is enrolled in the Medicare Program. If you go to a pharmacy that is not enrolled, Medicare will not pay. You will be responsible for paying the entire bill. Under current law, all Medicare enrolled pharmacies must accept assignment for Medicare covered drugs and biologicals. If you purchase these items from a Medicare-enrolled pharmacy or supplier, you should only pay your 20% co-pay (and any remaining Medicare Part B deductible) when you get your prescription or supplies. Medicare will pay the remaining 80% directly to the pharmacy or supplier after they submit the claim.

Many Medicare Advantage plans cover prescription drugs, up to certain dollar limits (sometimes for an extra cost). Some Medigap policies and states also cover prescription drugs.

The Prescription Drug Assistance Programs Database on www.medicare.gov provides information on programs that offer discounts or free medication to individuals in need including the Medicare-approved prescription drug discount card, State prescription drug assistance programs, programs sponsored by pharmaceutical companies, and disease-specific programs. The Prescription Drug Assistance Database also provides information on prescription drug benefits offered through Medicare managed care plans and Medigap policies.

Starting January 1, 2006, Medicare-approved drug discount cards will begin to phase out, and the new Medicare prescription drug plans will begin.

Medicare will contract with private companies to offer this drug coverage. These companies will most likely offer a variety of options, with different covered prescriptions, and different costs. Medicare prescription drug plans are voluntary. If you want to participate, you must choose a plan offering the coverage that best meets your needs and then enroll. In most cases, there is no automatic enrollment to get a Medicare prescription drug plan.

To enroll, you must have Medicare Part A or Part B. You can first enroll from November 15, 2005 through May 15, 2006. This is called the �initial open enrollment period.�

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96. Can I delay Medicare Part B enrollment without paying higher premiums?

Yes. In certain cases, you can delay your Medicare Part B enrollment without having to pay higher premiums. If you didn't take Medicare Part B when you were first eligible because you or your spouse were working and had group health plan coverage through your or your spouse's employer or union, you can sign up for Medicare Part B during a Special Enrollment Period. You can sign up:

• Anytime you are still covered by the employer or union group health plan through your or your spouse's current or active employment, or
• During the 8 months following the month the employer or union group health plan coverage ends, or when the employment ends (whichever is first).

If you are disabled and working (or you have coverage from a working family member), the Special Enrollment Period rules also apply.

Effective date if you sign up during a Special Enrollment Period

If you enroll in Medicare Part B while covered by the group health plan or during the first full month after coverage ends, your Medicare Part B coverage starts on the first day of the month you enroll. You also can delay the start date for Medicare Part B coverage until the first day of any of the following 3 months.

If you enroll during any of the 7 remaining months of the Special Enrollment Period, your Medicare Part B coverage begins the month after you enroll.

Remember: If you do not enroll in Medicare Part B during your Special Enrollment Period, you'll have to wait until the next General Enrollment Period, which is January 1 through March 31 of each year. You may then have to pay a higher Medicare Part B premium because you could have had Medicare Part B and did not take it. Call the Social Security Administration at 1-800-772-1213 for more information or to enroll in Medicare. You can visit the Social Security web site .

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97. Are my spouse and dependent children eligible to get Medicare coverage?

Medicare is not offered as a family or dependent benefit. This means all people who have Medicare, must qualify on an individual basis. For example , a person under age 65 does not automatically receive Medicare because their spouse is 65 or older and enrolled in the Medicare program. In addition, when a parent qualifies for Medicare, this does not entitle their dependent children to Medicare coverage.

If you or someone you know needs health insurance and does not qualify for Medicare, you may wish to contact your State Health Insurance Assistance Program to discuss your options. You can get their phone number at Helpful Contacts section of Medicare.gov's web site.

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98. What if I'm over 65 and did not enroll in Medicare Part B during my Initial Enrollment Period?

Your Initial Enrollment Period starts 3 months before you turn age 65 and lasts for 7 months. Except in certain cases, if you do not enroll in Medicare Part B during your Initial Enrollment Period, you will have wait until the next General Enrollment Period to enroll. General Enrollment Periods are between January 1 and March 31 each year. When March 31 falls on a non-business day, the General Enrollment Period is extended to the next business day. If you sign up for Medicare Part B during a General Enrollment Period, your coverage starts on July 1 of that year. Your Medicare Part B premium may go up 10 percent for each 12 month period that you could have had Medicare Part B, but did not take it. For example, in 2005, the Medicare Part B premium is $78.20 per month. If you delayed enrolling in Medicare Part B for 24 months from the time you first could have had Medicare Part B, your premium in 2005 would be $93.84 per month.

Example: You delayed enrolling in Medicare Part B for 24 months

$78.20 base premium in 2005

+ $7.82 (10% of $78.20) for the first 12 month delay

+ $7.82 (10% of $78.20) for the second 12 month delay

= $93.84 will be your Medicare Part B premium for 2005

To enroll in Part B, call the Social Security Administration at 1-800-772-1213. For more information, call the Social Security Administration at 1-800-772-1213 or visit their web site .

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99. Important information you need to know regarding Medicare prescription drug and supply claims.

If you get Medicare covered prescription drugs, durable medical equipment, or supplies; make sure your pharmacy or supplier (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies � DMEPOS supplier) is enrolled in the Medicare Program. If you go to a DMEPOS supplier that is not enrolled in the Medicare Program, you are responsible for paying the entire bill for any drugs or supplies.

For Medicare covered supplies, in addition to finding out if the DMEPOS supplier is enrolled in the Medicare Program, you should also find out if they are participating.

• If they are enrolled and participating, they must accept assignment. This means they must accept the Medicare-approved amount as payment in full. You should only pay your 20% co-pay (and any remaining Medicare Part B deductible) when you get your supplies.
• If they are enrolled but not participating, they do not have to accept assignment. This means that charges may be higher, and you may pay more. You may also have to pay the entire charge at the time of service, and wait for Medicare to send you its share of the charge.

Please note that all Medicare enrolled pharmacies and suppliers must submit claims for glucose monitor test strips. You cannot submit claims for glucose test strips to Medicare directly.

For Medicare covered drugs and biologicals, it does not matter if your pharmacy is participating with Medicare. Under current law, all Medicare enrolled pharmacies must accept assignment for Medicare covered drugs and biologicals. If you purchase these items from a Medicare-enrolled pharmacy or supplier, you should only pay your 20% co-pay (and any remaining Medicare Part B deductible) when you get your prescriptions or supplies. Medicare will pay the remaining 80% directly to the pharmacy or supplier after they submit the claim.

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100. I have more than one insurance. How do I know who pays first?

If any of the following situations apply to you, your other insurance may be primary to Medicare, meaning the other insurance pays first:

• You have Medicare; are still working; and are covered by your employer's health insurance plan;
• You have Medicare, are retired, but your spouse is working and has a health plan that also covers you; or
• You are injured on the job, in an automobile accident, or slip and fall at a shopping center (worker's compensation, auto insurance or liability insurance may cover the cost of medical care related to the accident).

You can contact the Coordination of Benefits Contractor at 1-800-999-1118 for questions about, or to report changes in, your primary insurance. Medicare has a dedicated �Coordination of Benefits Contractor� that keeps track of when Medicare is primary or when another insurer is primary. If you have other insurance and it pays after Medicare, it is called your supplemental insurance. Supplemental insurance often covers the deductible and/or co-payments required by Medicare. Examples include:

• Retiree insurance from your former employer or union;
• Medigap insurance;
• Tricare for Life (for military retirees); and
• Medicaid.

If you change your supplemental insurance, or are experiencing problems with supplemental insurance payments, you need to call your old and new supplemental insurance companies. If you have questions about how your supplemental insurance works with Medicare, contact the supplemental insurer. If you need Medicare to start or stop sending claims information to a supplemental insurance company, again, this is something the supplemental insurer must resolve. The Medicare publication, Medicare and Other Health Benefits: Your Guide to Who Pays First contains additional information on this topic that you may find useful. Our frequently asked question titled, has additional information that may be helpful to you.

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101. I want to add Part B to my Medicare. When can I do that?

You can sign up for Medicare Part B:

1) When you first enroll in Medicare (your Initial Enrollment Period). Your Initial Enrollment Period starts 3 months before you turn age 65 and lasts for 7 months.

2) January 1 - March 31 of each year (your General Enrollment Period). If you enroll in Part B during a General Enrollment Period, it will be effective July 1 of the year in which you apply. Your Medicare Part B premium may go up 10 percent for each 12 month period that you could have had Medicare Part B, but did not take it.

3) If you didn't take Medicare Part B when you were first eligible because you or your spouse were working and had group health plan coverage through your or your spouse's employer or union, you can sign up for Medicare Part B during a Special Enrollment Period.

You can sign up:

• anytime you are still covered by the employer or union group health plan through your or your spouse's current or active employment, or
• during the 8 months following the month the employer or union group health plan coverage ends, or
• when the employment ends (whichever is first).

You should contact the Social Security Administration at 1-800-772-1213 to add Medicare Part B.

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102. I have Medicare and Other Health Insurance. Whom do I contact when there is a change or problem?

PRIMARY INSURANCE When you have Medicare and another insurance, there are times when the other insurance is primary to Medicare, meaning the other insurance pays first. Medicare has a dedicated �Coordination of Benefits Contractor� that keeps track of when Medicare is primary or when another insurer is primary.

One common situation where your other health insurance may be primary to Medicare occurs when you have Medicare; are still working; and are covered by your employer's health insurance plan. Another is when you have Medicare, are retired, but your spouse is working and has a health plan that also covers you. If you are injured on the job, in an automobile accident, or slip and fall at a shopping center, often the cost of related medical care is covered by another insurer. You can contact the Coordination of Benefits Contractor at 1-800-999-1118 for questions about, or to report changes in, your primary insurance.

SUPPLEMENTAL (Secondary) INSURANCE If you have other insurance and it pays after Medicare, it is called your supplemental insurance. Supplemental insurance often covers the deductible and/or co-payments required by Medicare. Examples include retiree insurance from your former employer or union, Medigap insurance, and Tricare for Life (for military retirees) and the Medicaid Program. If you change your supplemental insurance, or are experiencing problems with supplemental insurance payments, you need to call your old and new supplemental insurance companies. If you have questions about how your supplemental insurance works with Medicare, contact the supplemental insurer.

If you need Medicare to start or stop sending claims information to a supplemental insurance company, again, this is something the supplemental insurer must resolve. Medicare does not keep any record of your supplemental insurance. If your supplemental insurance company has an agreement with Medicare, the process is as follows. Your supplemental insurance company periodically sends an electronic list of those it insures (who are also covered by Medicare) to Medicare-claims-processing contractors. This file is used to get copies of claims paid by Medicare. This helps the supplemental insurance company to automatically pay its share of your claim. This is why you need to contact your supplemental insurance company directly to ask it to update its records when you make changes in your supplemental insurance. Finally, if the problem seems to be related to claims from particular doctors or other providers, you should make sure that these providers have the right information on file about your supplemental insurance. It could be they are forwarding old, or inaccurate information on the claims they submit. The Medicare publication, Medicare and Other Health Benefits: Your Guide to Who Pays First contains additional information on this topic that you may find useful.

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