Bøger af Centers For Medicare Medicaid Services

El manual "Medicare y usted" es su guía oficial de Medicare.Tiene información importante sobre:Beneficios, costos, derechos y protecciones de Medicare.Planes de salud y medicamentos.Respuestas a preguntas comunes.

The "Medicare & You 2024" handbook is your official guide to Medicare and Medicaid. It has important information about:Medicare benefits, costs, rights, and protections.Health and drug plans.Answers to common questions.

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A Guide to help choose a nursing home for a loved one.

La publicación con información sobre: Lo importante en el 2014 y Lo que cubre Medicare. Este es un momento histórico y especial para el cuidado de la salud en nuestra nación. Hoy, gracias a la Ley del Cuidado de Salud a Bajo Precio tenemos una cobertura médica fortalecida y más confiable para que todos los estadounidenses se mantengan saludables. Además, millones de personas con Medicare como usted han: Aprovechado la expansión de beneficios tales como los servicios preventivos, las evaluaciones para la detección del cáncer y las visitas médicas de "Bienestar", sin pagar ni un dólar de sus bolsillos; Ahorrado dinero durante la interrupción en la cobertura de sus recetas médicas ("donut hole") con grandes descuentos para los medicamentos de marca cubiertos; Utilizado las herramientas nuevas como el Botón Azul de Medicare que se encuentra en MiMedicare.gov -si aún no lo ha usado, ahora es el momento de hacerlo. Lo hemos expandido para que pueda ver y descargar más información sobre sus reclamaciones, y para brindarle una visión más completa sobre su salud. De este modo, podrá tomar decisiones más informadas sobre su cuidado y les proporcionará a sus proveedores de servicios médicos información completa sobre su historial clínico. Estos cambios son solo el principio. A partir del 1 de enero de 2014, millones de personas sin Medicare tendrán acceso a un seguro médico de calidad a través del Mercado de Seguros Médicos. Lo que significa que su familia, amigos y vecinos que no están asegurados, ahora tendrán acceso a lo que usted valora de Medicare, la tranquilidad de saber que tiene cobertura médica. El Mercado de seguros no modifica al programa Medicare. Independientemente del modo en que reciba Medicare, usted continuará obteniendo la seguridad y beneficios que recibe ahora. Medicare estará a su disposición y más fortalecido que nunca.

This guide helps people with Medicare understand Medigap (also called "Medicare Supplement Insurance") policies. A Medigap policy is health insurance sold by private insurance companies to fill gaps in Original Medicare coverage. Medigap policies can help pay your share (coinsurance, copayments, or deductibles) of the costs of Medicare-covered services. Some Medigap policies also cover certain benefits Original Medicare doesn't cover. Medigap policies don't cover your share of the costs under other types of health coverage, including Medicare Advantage Plans, stand-alone Medicare Prescription Drug Plans, employer/union group health coverage, Medicaid, Department of Veterans Affairs (VA) benefits, or TRICARE. Insurance companies generally can't sell you a Medigap policy if you have coverage through Medicaid or a Medicare Advantage Plan. Also available in Spanish.

Medicare is health insurance for: People 65 or older, Under 65 with certain disabilities, Any age with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). Medicare Part A (Hospital Insurance): Part A helps cover your inpatient care in hospitals. Part A also includes coverage in critical access hospitals and skilled nursing facilities (not custodial or long term care). It also covers hospice care and home health care. You must meet certain conditions to get these benefits. Medicare Part B (Medical Insurance): Part B helps cover medically necessary services like doctors' services, outpatient care, and other medical services that Part A doesn't cover. Part B also covers many preventive services. Part B is a voluntary program. However, you need to have Part B if you want to buy Part A. Also available in Spanish.

As your parents, grandparents, relatives, or friends face health care decisions, they might need to rely on you for help. Medicare can be an important factor in many of those decisions. If you aren't familiar with Medicare or the other resources that are available for the person you're caring for, or if you just want to brush up on what you already know, this publication is for you. "Medicare Basics" highlights several topics related to the health and care of a person with Medicare. For each of these topics, you will find basic information about Medicare and suggestions on where to go to find more information. Also available in Spanish.

Mental health conditions like depression or anxiety can come at any age and can happen to anyone. If you think you may have problems that affect your mental health, you can get help. Talk to your doctor or other health care provider if you have: Thoughts of ending your life (like a fixation on death or suicidal thoughts or attempts); Sad, empty, or hopeless feelings; Loss of self worth (like worries about being a burden, feelings of worthlessness, or self-loathing); Social withdrawal and isolation (reluctance to be with friends, engage in activities, or leave home); Little interest in things you used to enjoy; A lack of energy; Trouble concentrating; Trouble sleeping (like difficulty falling asleep or staying asleep, oversleeping, or daytime sleepiness); Weight loss or loss of appetite; Increased use of alcohol or other drugs. Mental health care includes services and programs to help diagnose and treat mental health conditions. These services and programs may be provided in outpatient and inpatient settings. Medicare helps cover outpatient and inpatient mental health care, as well as prescription drugs you may need to treat a mental health condition. This publication gives you information about mental health benefits in Original Medicare. Also available in Spanish.

If you or someone you care for needs Skilled Nursing Facility (SNF) care, read this publication so you will know the following information: What Medicare covers and what you pay for services; How to find and compare skilled nursing facilities; How your care is planned; Your rights and protections; Where you can get help. Skilled care is health care given when you need skilled nursing or rehabilitation staff to manage, observe, and evaluate your care. Examples of skilled care include intravenous injections and physical therapy. Medicare will only cover skilled care when you meet certain conditions. A Skilled Nursing Facility could be part of a nursing home or hospital. Medicare certifies these facilities if they have the staff and equipment to give skilled nursing care and/or skilled rehabilitation services, and other related health services. Also available in Spanish.

Many health care treatments that were once offered only in a hospital or a doctor's office can now be done in your home. Home health care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility. In general, the goal of home health care is to provide treatment for an illness or injury. Home health care helps you get better, regain your independence, and become as self-sufficient as possible. Medicare pays for you to get certain health care services in your home if you meet certain eligibility criteria and if the services are considered reasonable and necessary for the treatment of your illness or injury. This is known as the Medicare home health benefit. If you get your Medicare benefits through a Medicare health plan (not Original Medicare) check your plan's membership materials, and contact the plan for details about how the plan provides your Medicare-covered home health benefits. This publication has important information about the following: Who is eligible; What services are covered; How to find and compare home health agencies; Your Medicare rights. Also available in Spanish.

Medicare's Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) changes the amount Medicare pays for certain DMEPOS items and makes changes to which suppliers Medicare will pay to supply these items to you. The first phase of the program is already in effect in 9 areas of the country. Starting July 2013, Medicare is scheduled to expand the competitive bidding program to more areas. The program replaces the outdated, inflated fee-schedule prices Medicare is currently paying with lower, more accurate prices. Under this program, suppliers submit bids to provide certain medical equipment and supplies at a lower price than what Medicare pays for these items now. Medicare uses these bids to set the amount it will pay for those equipment and supplies under the competitive bidding program. Qualified, accredited suppliers with winning bids are chosen as Medicare contract suppliers. The program: Helps you and Medicare save money; Ensures that you have access to quality medical equipment, supplies, and services from suppliers you can trust; Helps limit fraud and abuse in the Medicare Program. If you have Original Medicare, live in one of the competitive bidding areas, and use equipment or supplies included under the program (or get the items while visiting a competitive bidding area), you generally must use Medicare contract suppliers if you want Medicare to help pay for the item. If you live in one of the areas where the program is expanding and you're renting oxygen or certain other durable medical equipment (DME) at the time the program starts, you'll be able to continue renting these items from your current supplier if that supplier becomes a contract supplier or decides to participate in the program as a "grandfathered" supplier. If you live in (or get these items while visiting) these areas and don't use a Medicare contract or a grandfathered supplier, Medicare won't pay for the item, and you may have to pay full price. It's important to know if you're affected by this program to make sure Medicare will help pay for your item and to avoid any disruption of service. The competitive bidding program applies to Original Medicare only. If you're enrolled in a Medicare Advantage Plan (like an HMO or PPO), your plan will notify you if your supplier is changing. If you're not sure, contact your plan. Also available in Spanish.

Learning that you have permanent kidney failure isn't easy. Even though you may feel sad, confused, or frustrated, you can still take control of your life. The fact that you're reading this publication is a start. This publication explains how Medicare helps pay for kidney dialysis and kidney transplant services in Original Medicare. In most cases, you can't join a Medicare Advantage Plan (like an HMO or PPO) if you have End-Stage Renal Disease. If you're in a Medicare Health Plan, your plan must give you at least the same coverage that Original Medicare gives, but your costs, rights, protections, and/or choices of where you get your care may be different. You may also be able to get extra benefits. You can read this publication to understand what Medicare covers, but you'll need to read your plan materials or call your benefits administrator for more information about plan rules. Talk with your health care team to learn more about permanent kidney failure and your treatment options. Your doctors, nurses, social workers, dieticians, and dialysis technicians make up your health care team. They are there to help you decide what's best for you based on your situation. Also available in Spanish.

Medicare works with private insurance companies to offer you ways to get your health care coverage. These companies can choose to offer a consumer-directed Medicare Advantage Plan, called a Medicare Medical Savings Account (MSA) Plan. This type of plan combines a high-deductible health insurance plan with a medical savings account that you can use to pay for your health care costs. Medicare MSA Plans give you freedom to control your health care dollars and provide you with important coverage against high health care costs. Information in this publication can help you make an informed decision about your health care. However, you will need more information than this publication provides for you to decide if a Medicare MSA Plan is the right health plan choice for you. In addition to reading this publication, you should also carefully read plan materials before you decide to join a Medicare MSA Plan. Also available in Spanish.

Medicare prescription drug coverage (Part D) adds to your Medicare health care coverage. It helps you pay for both brand-name and generic drugs. Medicare drug plans are offered by insurance companies and other private companies approved by Medicare. You can get coverage two ways: Medicare Prescription Drug Plans (sometimes called "PDPs") add prescription drug coverage to Original Medicare, some Medicare Private Fee-for-Service (PFFS) Plans, some Medicare Cost Plans, and Medicare Medical Savings Account (MSA) Plans; Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer prescription drug coverage. You generally get all of your Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), and Medicare Part D (prescription drug coverage) through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called "MA-PDs." In this publication, the term "Medicare drug plans" means all plans that provide Medicare prescription drug coverage. You must choose and join a Medicare drug plan to get Medicare prescription drug coverage. Everyone with Medicare has to make a decision about prescription drug coverage. If you don't use a lot of prescription drugs now, you still may think about joining a Medicare drug plan to help lower your prescription drug costs now and help protect against higher costs in the future. If you're new to Medicare and already have other prescription drug coverage, you have new options to think about. If you aren't new to Medicare, you may want to look over your options to find drug coverage that meets your needs. You can join or switch Medicare drug plans between October 15-December 7 each year, with your coverage beginning January 1 of the following year. To join a Medicare Prescription Drug Plan, you must have Medicare Part A or have Medicare Part B (Medical Insurance). To join a Medicare Advantage Plan or other Medicare health plan with prescription drug coverage, you must have Medicare Part A and Part B. You must also live in the service area of the Medicare health plan or drug plan you want to join. Medicare drug plans may be different from each other in the prescription drugs they cover, how much you have to pay, and which pharmacies you can use. All Medicare drug plans must give at least a standard level of coverage set by Medicare. However, plans offer different combinations of coverage and cost sharing. Having more than one plan to choose from helps you get the coverage you want at a price you can afford. Also available in Spanish.

This publication explains Medicare coverage of diabetes supplies and services in Original Medicare and with Medicare prescription drug coverage (Part D). Original Medicare is fee-for-service coverage under which the government pays your health care providers directly for your Medicare Part A (Hospital Insurance) and/or Part B (Medical Insurance) benefits. If you have other insurance that supplements Original Medicare, like a Medicare Supplement Insurance (Medigap) policy, it may pay some of the costs for the services described in this publication. If you have a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan, your plan must give you at least the same coverage as Original Medicare, but it may have different rules. Your costs, rights, protections, and choices for where you get your care might be different if you're in one of these plans. You might also get extra benefits. Also available in Spanish.

An appeal is the action you take if you disagree with a coverage or payment decision made by Medicare, your Medicare Advantage Plan (like an HMO or PPO), other Medicare health plan, or your Medicare Prescription Drug Plan. You have the right to appeal if Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan denies one of these: A request for a health care service, supply, item, or prescription drug that you think you should be able to get; A request for payment of a health care service, supply, item, or prescription drug you already got; A request to change the amount you must pay for a health care service, supply, item, or prescription drug. You can also appeal if Medicare or your plan stops providing or paying for all or part of a health care service, supply, item, or prescription drug you think you still need. This publication has important information about: How to file an appeal if you have Original Medicare; How to file an appeal if you have a Medicare Advantage Plan or other Medicare health plan; How to file an appeal if you have Medicare prescription drug coverage; Where to get help with your questions. Also available in Spanish.

Now is the time to get the most out of your Medicare. The best way to stay healthy is to live a healthy lifestyle. You can live a healthy lifestyle and prevent disease by exercising, eating well, keeping a healthy weight, and not smoking. Medicare can help. Medicare pays for many preventive services to keep you healthy. Preventive services can find health problems early, when treatment works best, and can keep you from getting certain diseases. Preventive services include exams, shots, lab tests, and screenings. They also include programs for health monitoring, and counseling and education to help you take care of your own health. The Affordable Care Act makes many improvements to Medicare. If you have Original Medicare, you can get a yearly "Wellness" visit and many other covered preventive services. Whether it's online, in person, or on the phone, Medicare is committed to helping people get the information they need to make smart choices about their Medicare benefits. This publication covers preventive services, and services that help keep certain illnesses from getting worse. The services listed in this booklet are covered if you have Medicare Part B (Medical Insurance). However, the amount you pay for these services varies depending on whether you get your Medicare benefits through Original Medicare or through a Medicare Advantage Plan (like an HMO or PPO). This publication explains the way preventive services are covered if you have Part B under Original Medicare. If you get your health care coverage through a Medicare Advantage Plan, call your plan for more information. Also available in Spanish.

Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies (list of covered drugs) to best meet the specific needs of the groups they serve. This publication has important information about Medicare Special Needs Plans, including the following: How they work; Services and benefits; Joining and switching; Deciding if one is right for you. You can join a Medicare SNP if you have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), live in the plan's service area, and meet the plan's eligibility requirements, such as one of the following: Chronic Condition SNP (C-SNP): You have one or more of the following severe or disabling chronic conditions: Chronic alcohol and other drug dependence; Autoimmune disorders; Cancer (excluding pre-cancer conditions); Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; End-stage liver disease; End-Stage Renal Disease (ESRD) requiring any mode of dialysis; Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Stroke; Institutional SNP (I-SNP): You live in an institution (like a nursing home), or you require nursing care at home; Dual Eligible SNP (D-SNP): You have both Medicare and Medicaid. Each Medicare SNP limits its membership to people in one of these groups, or a subset of one of these groups. For example, a Medicare SNP may be designed to serve only people diagnosed with congestive heart failure. The plan might include access to a network of providers who specialize in treating congestive heart failure, and it would feature clinical case management programs designed to serve the special needs of people with this condition. The plan's drug formulary would be designed to cover the drugs usually used to treat congestive heart failure. People who join this plan would get benefits specially tailored to their condition, and have all their care coordinated through the Medicare SNP. Also available in Spanish.

Most people check restaurant ratings or read consumer reviews before they make a choice. Shouldn't you also check the quality of the hospitals you rely on when you need medical care? In an emergency, your life may depend on getting to the nearest hospital. When you can plan ahead, you and your doctor should discuss which hospital will best meet your health care needs. Information is available to help you make an informed choice. Whether you have Medicare or another type of insurance, this publication can help you find and use information about hospital quality. Also available in Spanish.

Si usted o alguna persona a su cuidado necesitan atención en un SNF, lea este folleto para averiguar: Lo que paga Medicare y lo que usted debe pagar; Cómo localizar y comparar centros deenfermería especializada; Cómo se planifica su cuidado; Sus derechos y protecciones; Dónde obtener ayuda. Un Centro de Enfermería Especializada (SNF por sus siglas en inglés) puede ser parte de un asilo de ancianos o de un hospital. Medicare certifica estos centros si tienen el personal y el equipo para brindar cuidado de enfermería especializado y/o servicios de rehabilitación especializado y otros servicios relacionados. El cuidado especializado es el cuidado brindado cuando usted necesita servicios de enfermería especializada o personal de rehabilitación para controlar, observar y evaluar su cuidado. Por ejemplo, administrar inyecciones intravenosas o brindar servicios de terapia física. Medicare sólo pagará por el cuidado especializado si cumple con ciertos requisitos.

This publication describes the health care services and supplies that Medicare covers, and how to get those benefits through Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance). It includes: What specific benefits you can get and when; How much Medicare pays for each service and how much you pay; Where to get help with any questions you may have. The Affordable Care Act makes many improvements to Medicare, including many of the preventive services included in this booklet.

If you have Medicare and other health coverage, each type of coverage is called a "payer." When there's more than one payer, "coordination of benefits" rules decide who pays first. The "primary payer" pays what it owes on your bills first, and then your provider sends the rest to the "secondary payer" to pay. In some cases, there may also be a "third payer." Whether Medicare pays first depends on a number of things. Be sure to tell your doctor and other health care providers if you have coverage in addition to Medicare. This will help them send your bills to the correct payer to avoid delays. Some people with Medicare have other coverage that must pay before Medicare pays its share of your bill. This guide tells how Medicare works with other kinds of coverage and who should pay your bills first. Also available in Spanish.

El manual "Medicare y usted" es su guía oficial de Medicare.Tiene información importante sobre:Beneficios, costos, derechos y protecciones de Medicare.Planes de salud y medicamentos.Respuestas a preguntas comunes.

The "Medicare & You" handbook is your official guide to Medicare.It has important information about:Medicare benefits, costs, rights, and protections.Health and drug plans.Answers to common questions.