MEDICARE
Centers for Medicare and Medicaid Services (CMS)

PURPOSE
Medicare is a federal health insurance plan administered by the Centers for Medicare and Medicaid Services for persons age 65 and older, and for eligible individuals with disabilities. The Social Security Administration (SSA) helps CMS by enrolling people in Medicare and by collecting Medicare premiums.
Eligibility is NOT based on need or income/asset limits.
Medicare - Part A covers hospital and related health care.
Medicare - Part D is a voluntary insurance for prescription drugs.
Medicare - Part B is a voluntary medical insurance program that provides assistive technology (AT) purchased as Durable Medical Equipment (DME) and must be “necessary and reasonable.”

CONTACT
For information about applying for Medicare, eligibility, or replacing a lost Medicare card contact the Social Security
Administration:
(800) 772-1213
www.medicare.gov
For general Medicare information call the Medicare Hotline:
(800) 633-4227

CONTACT
Questions regarding general information about Medicare, Medicaid, managed care plans and the various types of health insurance available to supplement Medicare, assistance with sorting out medical bills, and filing insurance, contact the Senior Health Insurance Counseling Program (SHICP) of the Oklahoma Insurance Department.
(405- 521-6628
(800) 763-2828
For general information about Medicare, concerns about being asked to leave the hospital too soon, and complaints about the Medicare paid settings, contact the Peer Review Organization, Oklahoma Foundation for Medical Quality.
(405) 840-2891
(800) 522-3414
To apply for the QMBP or SLMB programs, See Appendix B for Oklahoma Department of Human Services County Offices.

FINANCIAL CRITERIA
•None

ELIGIBILITY
Persons 65 years of age or older, or
Persons who are blind and permanently disabled and must have been receiving Social Security Disability Insurance (SSDI) payments for twenty-four (24) months, or
Persons with End Stage Renal Disease or Amyotrophic Lateral Sclerosis (ALS).

AT SERVICES PROVIDED/COVERED
Assessments & Evaluations
Fabrication of Devices
Training for Consumer & Family
Maintenance & Repairs

AT DEVICES PROVIDED/COVERED
Aids for Daily Living
Medical Supplies
Aids for Vision Impaired
Prosthetics & Orthotics
Augmentative Communication
Seating & Positioning Equipment
Hospital Beds
Wheelchairs & Mobility Aids

APPLICATION PROCESS
Applications for a Medicare health insurance card are taken at all local offices of the Social Security Administration.
For eligibility information and to locate the Social Security Office nearest you, call the Social Security information hotline at (800) 772-1213.

APPEALS PROCESS
If Medicare does not pay for an item or service you have been given, or if you are not given an item or service you think you should get, you can appeal. If you file an appeal, ask your doctor or provider for any information related to the bill that might help your case. Your appeal rights are on the back of the Explanation of Medicare Benefits or Medicare Summary Notice that is mailed to you from a company that handles bills for Medicare. The notice will also tell you why your bill was not paid and what appeal steps you can take.
There are new provisions for the Medicare appeals process which mandate that all second-level appeals, also known as reconsiderations, be conducted by Qualified Independent Contractors (QICs). In December 2006 Centers for Medicare and Medicaid contracted with RiverTrust Solutions, Inc to be the QIC for DME reconsiderations.
If you have any questions contact:
RiverTrust Solutions, Inc.
PO Box 180208
Chattanooga, TN 37401-7208
(423) 535-4386
customer.service@rtrust.org
http://www.rivertrustsolutions.com/default.htm
3.To check the status of your reconsideration you can call 1-800-Medicare (800)-633-4227.

PIECES OF THE PUZZLE
Medicare - Part B had monthly premiums of $93.50 in 2007, an annual deductible of $131.00 and a co-payment of 20%. Premium amounts change annually and may be different depending upon the annual income of the recipient. Durable Medical Equipment (DME) is covered under Part B.
Medicare covers DME that your doctor prescribes for use in your home. Only your own doctor can prescribe medical equipment for you. Durable Medical Equipment is:
long lasting or durable,
used for a medical reason,
not usually useful to someone who is not sick or injured, and
used in your home.
Medicare pays for different kinds of DME in different ways; some equipment must be rented. Other equipment may be purchased, and you may choose rental or purchase for some equipment.
The amount you pay varies. If a supplier of DME doesn’t accept assignment, there is no limit to what can be charged. You also may have to pay the entire bill (your share and Medicare’s share) at the time you get the DME. Ask if the supplier is a participating supplier in the Medicare Program before you get your DME. If the supplier is a participating supplier, they must accept assignment. If the supplier is enrolled in Medicare but isn’t “participating,” they have the option to accept assignment. Make sure your supplier is enrolled in Medicare and has a Medicare supplier number. Suppliers have to meet strict standards to qualify for a Medicare supplier number. If the supplier isn’t enrolled in Medicare, then Medicare won’t pay your claim.
The rate schedules place a cap on how much Medicare will pay for a particular DME item. If the provider’s price is higher than the amount allowed under Medicare, the consumer will have to pay the difference. Because of low reimbursement, it may be necessary and advantageous to combine Medicare with private sources, or the consumer may need to pay the remainder. This process can be useful in obtaining higher quality products.
Medicare covers power-operated vehicles (scooters), walkers, and wheelchairs as DME that your doctor prescribes for use in your home. Before Medicare helps pay for a power wheelchair you must have a face-to-fact examination and a written prescription from a doctor or other treating provider.