People with Medicare

General Medicare Frequently Asked Questions (FAQs)

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What is the Medicare Summary Notice (MSN)? (Revised 02/15/11)
How long should I wait before contacting the Medicare carrier to check on the status of a claim? (Revised 07/21/10)
What is a "participating provider"? (Revised 07/11/11)
What is a "non-participating provider"? (Revised 02/14/11)
What is coinsurance? (Revised 02/14/11)
What is the difference between Medicare and Medicaid? (Revised 02/14/11)
How do I sign up for Medicare? (Revised 02/14/11)
Is it true that if you delay enrolling in Medicare that you may have to pay a penalty when enrolling at a later date?
(Revised 02/14/11)
I receive Social Security disability benefits. When will my Medicare benefits start? (Revised 02/14/11)
How do I replace a lost or stolen Medicare card? (Revised 02/14/11)
How do I update my permanent address with Medicare Part B? (Revised 02/14/11)
When can I leave my managed care plan and return to fee-for-service Medicare? (Revised 10/17/11)
May I receive services from a provider/supplier that are not covered by Medicare? (02/15/11)
Who should I contact if I have a complaint about quality of care? (Revised 10/17/11)
Will Medicare pay for a routine yearly physical examination? (Revised 10/17/11)
How long does a provider have to submit a claim? (Revised 10/17/11)
How often will Medicare Part B pay for a mammogram? (02/15/11)
Can my provider/supplier bill me for filing claims? (02/15/11)
Will Medicare Part B cover services when I am out of the country? (Revised 10/17/11)
Is a physician or practitioner allowed to withdraw from the Medicare Program? (Revised 10/17/11)
Why is the eye refraction portion of my visit to the optometrist not covered? (Revised 10/17/11)
Does Medicare pay for flu shots? (02/15/11)
Does Medicare cover dental services? (02/15/11)
What is an Advance Beneficiary Notice of Non-Coverage (ABN) and how can it help me? (Revised 10/17/11)
Does Medicare cover colonoscopies? (02/15/11)
Can I pay my deductible directly to Medicare? (Revised 10/17/11)
Who decides which preventative visits are covered by Medicare? (02/15/11)
If I miss the 7-month enrollment period, when is my next chance to enroll? Also, is there a higher premium if you enroll late? (Revised 07/21/10)
When I enroll in Medicare Part B, do I lock into the premium for that year? (02/15/11)
I am no longer working (retired). Who is responsible to update my insurance record at Medicare? (02/15/11)
What does "Medically Necessary" mean? (Revised 10/17/11)
What is the "Welcome to Medicare Physical" and can I have one? I am signed up for Medicare Part A and B.
(02/15/11)

All FAQs are current as of the date noted next to the question.

What is the Medicare Summary Notice (MSN) (Revised 02/15/11)

The MSN is a statement Medicare sends to beneficiaries that summarizes all of your inpatient and outpatient claims information processed by Medicare over a 90-day period. It is important that you check your MSN to make sure that you received the services that Medicare paid for and report any instances of fraud to 1-(800) MEDICARE (1-(800) 633-4227).

How long should I wait before contacting the Medicare carrier to check on the status of a claim? (Revised 07/21/10)

WPS Medicare processes most claims within 30 days of receipt; however, if we need to develop for additional information from you or your provider, it may take longer. To check the status of a claim at any time, please contact the Beneficiary Contact Center at 1-(800) MEDICARE (1-(800) 633-4227). If you are not due a payment check from Medicare, your Medicare Summary Notices (MSNs) will be mailed to you on a quarterly basis (every 90 days). You will no longer receive a monthly statement in the mail for these types of MSNs. If you do not receive your MSNs timely, please contact the Beneficiary Contact Center at 1-(800) MEDICARE (1-(800) 633-4227).

What is a "participating provider"? (Revised 07/11/11)

A participating provider is a health care provider that has entered into a contract with the Medicare Part B program. The contract states he/she must accept the Medicare Part B approved amount as payment in full for services provided. Medicare Part B will usually pay 80% of the approved amount. The remaining 20%, called coinsurance, is your responsibility. Some Medicare supplement insurance plans may help pay your 20% coinsurance.

What is a "non-participating provider"? (Revised 02/14/11)

A non-participating provider is a health care provider who does not accept assignment on Medicare claims. These providers may charge more than Medicare's approved amount but not more than the limiting charge. The limiting charge is 115 % of the Medicare approved amount. They also may collect full payment directly from the patient at the time of service. Medicare then pays the patient 80% of the approved amount, less any unmet portion of the Part B deductible. In Minnesota, the Minnesota Care Law requires doctors to bill at Medicare's allowed charge. This law applies only for Minnesota residents who receive services from a doctor in Minnesota.

What is coinsurance? (Revised 02/14/11)

Coinsurance is the amount the patient is responsible for paying once their deductible has been meet. This amount is equal to the difference between the Medicare approved amount and the Medicare payment, or 20% of the approved amount. If a patient has supplemental insurance, it may help pay this amount.

What is the difference between Medicare and Medicaid? (Revised 02/14/11)

Medicare is a federal health insurance program for the elderly and disabled. Medicaid is a medical assistance program jointly financed by the state and federal governments for eligible low-income individuals.

How do I sign up for Medicare? (Revised 02/14/11)

If you are already receiving Social Security payments when you turn 65, you will automatically receive your Medicare card in the mail. The card will show your entitlement to Parts A and B and the effective dates of each.

If you are not receiving Social Security payments, you may have to apply for Medicare. Please check with the Social Security Administration office at 1-(800) 772-1213 for more information. If you must file for Medicare benefits, you should do so three months before you turn 65.

Is it true that if you delay enrolling in Medicare that you may have to pay a penalty when enrolling at a later date? (Revised 02/14/11)

Yes, it is true. Late enrollment into Medicare will increase your premium by 10% for each year you could have been enrolled but were not.

However, if you did not take Medicare Part B when you were first eligible because you or your spouse were working and you were covered by a group health plan or union, you can enroll at a later date without having to pay a penalty if you 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).
Contact Social Security Administration for more information at 1-800-772-1213 or visit http://www.ssa.gov(external link).

I receive Social Security disability benefits. When will my Medicare benefits start? (Revised 02/14/11)

You will be automatically enrolled in Medicare after you have received your disability benefits for two years. If you have Lou Gehrig's disease (ALS), your Medicare benefits begin the first month you receive disability benefits from Social Security. For more information contact Social Security Administration at 1-(800) 772-1213 or visit their website at http://www.ssa.gov(external link).

How do I replace a lost or stolen Medicare card? (Revised 02/14/11)

To replace your card, you should contact the Social Security Administration. You may either visit them at the field office nearest your home or contact them by telephone at 1-800-772-1213. To find the Social Security Administration office closest to you, check the government pages of your telephone directory under United States, Social Security Administration.

How do I update my permanent address with Medicare Part B? (Revised 02/14/11)

The Social Security Administration maintains and updates your Medicare Part B enrollment file, including your address. To update your address, you may either visit the Social Security Administration field office nearest your home or contact the Social Security Administration by telephone at 1-(800) 772-1213.

When can I leave my managed care plan and return to fee-for-service Medicare? (Revised 10/17/11)

Between October 15 and December 7, anyone can join, switch, or drop a Medicare managed care plan. Your changes become effective on January 1.Between January 1 and February 14, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage.

For more information about disenrolling from your managed care plan, contact 1-(800) MEDICARE (1-(800) 633-4227).

May I receive services from a provider/supplier that are not covered by Medicare? (02/15/11)

Yes. A physician may provide services to a beneficiary even if the services are not covered by Medicare. A provider does not have to bill Medicare for any service that is not covered. However, you may ask if your provider will submit a claim to Medicare for denial before billing you for the service.

Who should I contact if I have a complaint about quality of care? (Revised 10/17/11)

Every state has a Quality Improvement Organization to address quality of care issues. Please contact the Quality Improvement Organization in your area. You can contact 1-(800) MEDICARE (1-(800) 633-4227) to find the contact information for your area's Quality Improvement Organization.

Will Medicare pay for a routine yearly physical examination? (Revised 10/17/11)

No. However, starting in 2011, Medicare began to cover an annual wellness visits (AWV). An AWV is not a physical, but it does include a review of the beneficiary's basic health measurements (e.g., height, weight, blood pressure, etc.) and his or her medical history. The doctor also reviews the beneficiary's risk factors for certain other diseases and conditions, and develops a personalized plan for prevention services.

How long does a provider have to submit a claim? (Revised 10/17/11)

Claims must be submitted to Medicare within one calendar year after the date of the service. For example, for a service provided on November 25, 2010, Medicare must receive the claim no later than November 24, 2011.

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How often will Medicare Part B pay for a mammogram? (02/15/11)

Medicare Part B covers screening mammograms on a yearly basis for female beneficiaries age 40 or older. One screening mammography is covered for female beneficiaries between their 35th and 40th birthdays. Medicare does not cover screening mammograms for women younger than age 35. Diagnostic mammograms are performed when there is a sign or symptom of breast disease. The coverage of diagnostic mammograms is based on medical necessity, not frequency.

Can my provider/supplier bill me for filing claims? (02/15/11)

No. Congress passed legislation that requires providers to file your Medicare Part B claims for you. They cannot, under this law, charge you for filing claims or give you completed claims to mail. If your provider doesn't file your claims, please call 1-(800) MEDICARE (1-(800) 633-4227).

Will Medicare Part B cover services when I am out of the country? (Revised 10/17/11)

In general, care provided outside of the United States (and its territories) is not covered by the Medicare Part B program. There are limited exceptions, including some cases when Medicare may pay for services that you get while on board a ship within the territorial waters adjoining the land areas of the U.S. More information on this subject is available in the Centers for Medicare & Medicaid Services (CMS), "Medicare & You," handbookAdobe Portable Document Format.

Is a physician or practitioner allowed to withdraw from the Medicare Program? (Revised 10/17/11)

Yes, in some cases providers may opt out of the Medicare program. If a beneficiary sees a provider who has opted out of Medicare, the beneficiary will be asked to sign a contract before receiving any services from the provider. The contract makes the beneficiary responsible for full payment of the provider's charges. By signing the contract, the beneficiary agrees not to submit a claim to Medicare. A beneficiary may not be asked to sign a private contract if facing an emergency or urgent health situation.

You may see a list of physicians and practitioners who have OPTED OUT of the Medicare program by selecting this link.

If a Medicare beneficiary sees one of these physicians or practitioners, the beneficiary will be asked to sign a contract, unless the visit is an emergency or urgent situation. The contract makes the patient SOLELY responsible for payment. A beneficiary may not be asked to sign a private contract if facing an emergency or urgent health situation.

Why is the eye refraction portion of my visit to the optometrist not covered? (Revised 10/17/11)

Most services pertaining to the provision of glasses and contact lenses are excluded from coverage. Expenses for all refractive procedures are excluded because a refraction is a routine service.

Does Medicare pay for flu shots? (02/15/11)

Yes, Medicare pays for a flu shot once every flu season. Medicare pays 100% of the allowed amount for the flu shot.

Does Medicare cover dental services? (02/15/11)

Medicare does not cover routine dental care or procedures. This includes cleanings, fillings, teeth extractions or dentures.

What is an Advance Beneficiary Notice of Non-Coverage (ABN) and how can it help me? (Revised 10/17/11)

An ABN is a written notice that tells you why Medicare probably (or certainly) will not pay for a service or supply and that you will be responsible for the charges. It protects you from unexpected bills. If you are presented with an ABN, you will need to make a decision whether or not to receive the service or supply. If Medicare does not pay for it, then you are responsible for the charges. You should be provided a copy of the ABN for your records.

Read the ABN carefully. It should include -
- A description of the service or supply
- The reasons why they believe Medicare will not pay
- The date (must be on or before the date you receive the service or supply)
For services that Medicare never covers, such as a routine exam, your doctor does not need to provide you an ABN.

Does Medicare cover colonoscopies? (02/15/11)

Yes, once every 24 months if you are at high risk for colorectal cancer. If you are not at high risk for colorectal cancer, it is covered once every 10 years, but not within 48 months of a screening flexible sigmoidoscopy.

Can I pay my deductible directly to Medicare? (Revised 10/17/11)

No. Medicare notifies your doctors and clinics which claims have deductible applied. Your doctors and clinics then collect your deductible from you or a supplemental insurer.

Who decides which preventative visits are covered by Medicare? (02/15/11)

Coverage decisions are made by the Legislature, the Department of Health and Human Services (DHHS), and the Centers for Medicare & Medicaid Services (CMS).

If I miss the 7-month enrollment period, when is my next chance to enroll? Also, is there a higher premium if you enroll late? (Revised 07/21/10)

There is an open enrollment period from January 1 - March 31 of every year. Usually there is a 10% increase in your premium for each year you were not enrolled after you were eligible. There can be exceptions depending on the circumstances. To determine if you must pay a higher premium, please contact the SSA at 1-800-772-1213 or visit your local SSA office. You can also find information on the SSA website(external link).

When I enroll in Medicare Part B, do I lock into the premium for that year? (02/15/11)

No, you do not lock in to a premium fee. You have to pay the premium price for each specific year.

I am no longer working (retired). Who is responsible to update my insurance record at Medicare? (02/15/11)

It is the beneficiary's responsibility to contact the Coordination of Benefits Contractor(COBC) at 1-(800) 999-1118 to have records updated.

What does "Medically Necessary" mean? (02/15/11)

"Medically Necessary" is defined as a service, treatment, procedure, equipment, drug, device, or supply provided by a hospital, physician, or other health care provider that is required to identify or treat a beneficiary's illness or injury, and:
- Is proper and needed for the diagnosis, or treatment of your medical condition;
- Is provided for the diagnosis, direct care, and treatment of your medical condition;
- Meets the standards of good medical practice in the local area; and
- Is not mainly for the convenience of you or your doctor.

What is the "Welcome to Medicare Physical" and can I have one? I am signed up for Medicare Part A and B. (Revised 10/17/11)

The Medicare Modernization Act (MMA) added payment for the "Welcome to Medicare Physical Exam." If you have Medicare Part B on or after January 1, 2005, Medicare will cover a one-time preventive physical exam within the first 12 months that you have Part B. The "Welcome to Medicare Physical Exam" includes a measure of your height, weight, and blood pressure, training, and guidance. You can find more information regarding the "Welcome to Medicare Physical Exam," on the following website:http://www.medicare.gov/navigation/manage-your-health/preventive-services/medicare-physical-exam.aspx(external link)

Page Last Updated: Monday, 24-Oct-2011 07:24:08 CDT