The Braille Monitor                                                                                                  May 2005

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Medicare Outreach to People with Disabilities

From the Editor: The Centers for Medicare and Medicaid Services staff has requested that we publish the following important information. If you receive Medicare or Medicaid, you should read the following article:

If you have a chronic or disabling health condition, it's important that you stay as healthy as possible. A good way to stay healthy is to get preventive services to help keep secondary health conditions from developing or to find health problems early, when treatment works best.

If you have Medicare, you can take advantage of Medicare's many preventive services, Medicare-approved drug discount cards, and special Medicare programs called "demonstrations." Unfortunately, records from the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare, show that not many people with disabilities take advantage of the preventive services or Medicare-approved drug discount cards.

Medicare Basics

Medicare was created in 1965 as the national health insurance program for people age sixty-five or older, people under age sixty-five with certain disabilities, and people of all ages with end-stage renal disease (ESRD), permanent kidney failure requiring either dialysis or a kidney transplant. In most cases people under age sixty-five with disabilities are automatically enrolled in Medicare after they get disability benefits from Social Security for twenty-four months. There is a shorter wait period for people with ALS or ESRD. People with ALS may receive immediate coverage, but special eligibility rules for Medicare apply for people with ESRD.

Some people may also qualify for Medicaid. Medicaid is a joint federal and state program that helps pay medical costs for some people with limited incomes and resources. Medicaid programs vary from state to state.

Medicare benefits are divided into Part A and Part B benefits. People who are already getting benefits from Social Security will automatically get Medicare Part A starting the first day of the month they turn age sixty-five. Medicare Part A covers medically necessary hospital stays, skilled nursing facility care, home health care, and hospice care. Enrolling in Part B is a choice and requires a monthly premium. Medicare Part B helps cover doctors' services and outpatient care and pays for some services that Medicare A doesn't cover, such as physical and occupational therapy and some home health care. While a yearly deductible and 20 percent co-payment exist for most Medicare Part B services, some preventive services don't cost anything.

Preventive Services

When Medicare was created, it provided services only to diagnose and treat illness or injury. Preventive services to keep people healthy were not covered at all. However, as the value of preventive services has become better understood, Congress amended the Medicare law to pay for several preventive services for all people with Medicare.

Information about Medicare's preventive services can be found in the Guide to Medicare's Preventive Services (CMS Pub. No. 10110). You can get this booklet at <www.medicare.gov> on the Web or by calling (800) MEDICARE (800-633-4227). TTY users should call (877) 486-2048. Starting in 2005, Medicare covers three new preventive services:

• A one-time only Welcome to Medicare physical exam for people whose coverage begins on or after January 1, 2005. You must get this exam within the first six months you have Medicare Part B.

• A cardiovascular screening to check cholesterol and other blood fat (lipid) levels. Talk with your doctor about how often you can get this screening.

• Diabetes screenings (blood sugar tests) for people who are at high risk for diabetes because of obesity, high blood pressure, a history of abnormal cholesterol and triglyceride levels, or a history of high blood sugar.

The Medicare deductible and co-payments apply to these new preventive services. A fact sheet about the new benefits is available at <www.medicare.gov> on the Web.

Medicare-Approved Drug Discount Cards

Using a Medicare-approved drug discount card helps you save on your outpatient prescription drug costs. If you choose a Medicare-approved drug discount card and have a low income, you can also apply to get up to a $600 credit from Medicare to help pay for your prescription drug costs. The amount of the credit you get will depend on when you join. Here's how you can get more information about Medicare-approved drug discount cards:

• “Order Call, Enroll, and Save” (CMS Pub. No. 11081), an easy-to-read brochure with basic information about Medicare-approved drug discount cards. You can get this brochure by looking at <www.medicare.gov> on the Web or by calling (800) MEDICARE (800-633-4227). TTY users should call (877) 486-2048.

•Call the toll-free helpline or your local State Health Insurance Assistance Program (SHIP) for specific information about Medicare-approved drug discount cards and the $600 credit. You can find the phone number for your local SHIP in the Medicare and You Handbook, which is mailed each fall to people with Medicare.

• Look at the Prescription Drug database at <www.medicare.gov> on the Web.

Demonstrations

CMS conducts a number of projects to look at potential new services and new ways to provide or pay for existing services. These demonstration projects evaluate the effects program changes might have on people with Medicare and providers and the cost to Medicare before making changes to the Medicare program. If you live in an area where CMS is conducting a demonstration, you may be able to get additional services. For example, the Medicare Replacement Drug Demonstration (MRDD) is a national demonstration project that is trying to simplify how people with Medicare with certain life-threatening health conditions get prescription drugs. Medicare has traditionally reimbursed for some drugs used to treat certain illnesses, but only when these drugs are administered in a doctor's office. However, if you are part of this demonstration, you can get other drugs that are self-administrable that you can take in your home instead.

Some examples of health conditions covered in this demonstration are multiple sclerosis, pulmonary hypertension, Paget's disease, and hepatitis C. Recently the application date for admission to the program was extended, and more health conditions and drugs were added. Here's how you can learn if you qualify to take part in this demonstration:

• Visit <www.cms.hhs.gov> on the Web. Look for the link for "Demonstrations." Then click on the link for the Medicare Replacement Drug Demonstration. You should be able to view and print out a pamphlet and application for this demonstration.

• Call (800) 563-5386. A representative will tell you about the program and send you an application if you are eligible. TTY users should call (800) 563-5387.

If you have questions about Medicare, you can get help from your local SHIP, the customer service staff of your Medicare carrier, or (800) MEDICARE (800-633-4227).

2005 List of CMS Alternative-Format Publications

This document provides the name and a brief description of the publication, the order number, and the format. Keys to the format are as follows: Braille (B), English Audio-Tape (RE), Spanish Audio Tape (RS), Large Print English (LE) or Large Print Spanish (LS). Individual copies may be ordered by calling (800) 633-4227 MEDICARE.

Publications

2004 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare: A comprehensive guide to Medicare Supplement (Medigap) Insurance.

Braille--02110-B, English Large Print--02110-LE, English Audio--02110-RE

Choosing a Doctor: A guide to help Medicare beneficiaries choose a doctor for quality care. Braille only. 10908

Choosing a Medicare Health Plan: A guide to help Medicare beneficiaries make health plan choices for quality care. Braille only. 02219-B

Choosing Long Term Care: A guide to help Medicare beneficiaries make long term care choices for quality care. Braille only. 02223-B

Choosing Treatments: A guide to help Medicare beneficiaries make treatment choices for quality care. Braille only. 10910

Does Your Doctor Accept Assignment? An explanation with examples of how assignment can save you money in the Original Medicare Plan. Braille--10134-B, Audio Tape English--10134-RE, and Audio Tape Spanish--10134-RS.

Guide to Choosing a Medicare-Approved Drug Discount Card: Detailed information on how to choose a Medicare-approved drug discount card. Braille--11062-B. Audio Tape English--11062 RE.

Guide to Choosing a Nursing Home: Detailed information about how to choose a nursing home. Braille--02174-B, Audio Tape English--02174 RE, Audio Tape Spanish--02174 RS.

Guide to Medicare’s Preventive Services: Description of preventive services covered by Medicare. Braille--10110-B, Audio Tape English--10110 RE.

Medicare and You 2005: National version of Medicare’s beneficiary handbook. Braille--10050-B, Large Print English--10050 LE, Large Print Spanish--10050-LS, Audio Tape English--10050-RE, Audio Tape Spanish--10050-RS.

Medicare and Home Health Care: An explanation of Medicare’s home health coverage. Braille--10986, Audio Tape English--95152, and Audio Tape Spanish--95153.

Medicare coverage of Kidney Dialysis and Kidney Transplant Services: Information about coverage for those with End Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant). Audio Tape English–10128 RE, Audio Tape Spanish–101028-RS.

Medicare Coverage of Skilled Nursing Facility (SNF): Information on Medicare coverage of care in a skilled nursing facility. Braille--10153-B, Audio Tape English--10153-RE, Audio Tape Spanish--10153-RS, Large Print English--10153-LE, Large Print Spanish--10153-LS.

Medicare Hospice Benefits: An explanation of Medicare’s hospice care coverage. Braille--10942, Audio Tape English--95156, Audio Tape Spanish--10166, Large Print English--02154-LE, Large Print Spanish--02154-LS.

The Facts About Upcoming New Benefits in Medicare: Highlights changes in the Medicare program expected 2004-2006 as a result of the Medicare Modernization Act of 2003. Braille--11054-B, Audio Tape English--11054 RE.

Your Medicare Benefits: An explanation of Part A and Part B benefits for people in Original Medicare. Braille--10116-B and Audio Tape English--10116-RE.

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