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I. Guide to Medicare CoverageWhat are the Medicare premiums and coinsurance rates for 2009?
Answer
The following is a listing of the Medicare premium, deductible, and coinsurance rates that will be in effect in 2009:
Medicare Premiums for 2009:
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 $244.00 per month for people having 30-39 quarters of Medicare-covered employment.
The Part A premium is $443.00 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
$96.40 per month*
Medicare Deductible and Coinsurance Amounts for 2009:
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 (2009 = $1,068) 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:
Skilled Nursing Facility Coinsurance
$133.50 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)
$135.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $135.00 deductible.)
Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2009 is available in the September 19, 2008 Fact Sheet titled, "CMS Announces Medicare Premiums, Deductibles for 2009" on the www.cms.gov website.
*Note: If your income is above $85,000 (single) or $170,000 (married couple), then your Medicare Part B premium may be higher than $96.40 per month.
How much are the 2009 monthly premiums for Medicare Part B?
Answer
Most people will pay the standard monthly Part B premium of $96.40 in 2009. Some people will pay a higher premium based on their modified adjusted gross income.
Your monthly premium will be higher if you file an individual tax return and your annual income is more than $85,000, or if you are married (file a joint tax return) and your annual income is more than $170,000.
If you meet these criteria, Social Security will use the income reported two years ago on your IRS income tax return to determine your premium (if unavailable, SSA will use income from three years ago). For example, the income reported on your 2007 tax return will be used to determine your monthly Part B premium in 2009. If your income has decreased since 2007, you can ask that the income from a more recent tax year be used to determine your premium, but you must meet certain criteria.
At the end of each year, Social Security will send you a letter if your Part B premium will increase based on the level of your income and to tell you what you can do if you disagree. For more information about Part B premiums based on income, call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778.
The chart below shows the Part B monthly premium amounts based on income. These amounts change each year. There may be a late-enrollment penalty.
How do I pay for the coverage?
Answer
In general, there are three ways to pay your Medicare drug plan premium:
You can have your premium automatically deducted from a savings or checking account, or charged to a credit or debit card. You can have the premium deducted from benefits you get from Social Security if your monthly payment covers your necessary deduction.
Your Medicare drug plan can send you a bill each month. (For more information about your Medicare drug plan premium or ways to pay for it, call your plan.)
Note: It will take two to three months for your premium deduction to begin after your coverage starts. When you first join a Medicare drug plan, your premiums for your first two or three months of coverage will be combined. For example, if you enroll in or switch Medicare drug plans in December for coverage that begins in January, your first premium payment will probably be due in February. It will include your premium for January and February.
Will I get Medicare at age 65 if I am not yet eligible for Social Security?
Answer
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 (or your former 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).
II. Medicare Supplier Standards.
1. A supplier must be in compliance with all applicable Federal and State licensure and regulatory requirements.
2. A supplier must provide complete and accurate information on the DMEPOS supplier application. Any changes to this information must be reported to the National Supplier Clearinghouse within 30 days.
3. An authorized individual (one whose signature is binding) must sign the application for billing privileges.
4. A supplier must fill orders from its own inventory, or must contract with other companies for the purchase of items necessary to fill the order. A supplier may not contract with any entity that is currently excluded from the Medicare program, any State health care programs, or from any other Federal procurement or non-procurement programs.
5. A supplier must advise beneficiaries that they may rent or purchase inexpensive or routinely purchased durable medical equipment, and of the purchase option for capped rental equipment.
6. A supplier must notify beneficiaries of warranty coverage and honor all warranties under applicable State law, and repair or replace free of charge Medicare covered items that are under warranty.
7. A supplier must maintain a physical facility on an appropriate site.
8. A supplier must permit CMS (formerly HCFA), or its agents to conduct on-site inspections to ascertain the supplier’s compliance with these standards. The supplier location must be accessible to beneficiaries during reasonable business hours, and must maintain a visible sign and posted hours of operation.
9. A supplier must maintain a primary business telephone listed under the name of the business in a local directory or a toll free number available through directory assistance. The exclusive use of a beeper, answering machine or cell phone is prohibited.
10. A supplier must have comprehensive liability insurance in the amount of at least $300,000 that covers both the supplier’s place of business and all customers and employees of the supplier. If the supplier manufactures its own items, this insurance must also cover product liability and completed operations.
11. A supplier must agree not to initiate telephone contact with beneficiaries, with a few exceptions allowed. This standard prohibits suppliers from calling beneficiaries in order to solicit new business.
12. A supplier is responsible for delivery and must instruct beneficiaries on use of Medicare covered items, and maintain proof of delivery.
13. A supplier must answer questions and respond to complaints of beneficiaries, and maintain documentation of such contacts.
14. A supplier must maintain and replace at no charge or repair directly, or through a service contract with another company, Medicare-covered items it has rented to beneficiaries.
15. A supplier must accept returns of substandard (less than full quality for the particular item) or unsuitable items (inappropriate for the beneficiary at the time it was fitted and rented or sold) from beneficiaries.
16. A supplier must disclose these supplier standards to each beneficiary to whom it supplies a Medicare-covered item.
17. A supplier must disclose to the government any person having ownership, financial, or control interest in the supplier.
18. A supplier must not convey or reassign a supplier number; i.e., the supplier may not sell or allow another entity to use its Medicare billing number.
19. A supplier must have a complaint resolution protocol established to address beneficiary complaints that relate to these standards. A record of these complaints must be maintained at the physical facility.
20. Complaint records must include: the name, address, telephone number and health insurance claim number of the beneficiary, a summary of the complaint, and any actions taken to resolve it.
21. A supplier must agree to furnish CMS (formerly HCFA) any information required by the Medicare statute and implementing regulations.
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