From the web page 
http://www.Medicare.gov/publications/handbook.html

Medicare & You


We need your help.  This year, Medicare & You will be mailed as
a test document to all current Medicare beneficiaries in 5 pilot
states (Arizona, Florida, Ohio, Oregon and Washington.)  New
Medicare beneficiaries will also get a copy in the mail.  Next
year, Medicare & You will be mailed nationally to all Medicare
beneficiaries.  We will be using the results of the 5 state
pilot test to improve the Medicare & You publication before the
national mailing.  We also want your comments to help us improve
the Medicare & You publication.  Starting in mid September, we
will have an online evaluation form available to collect your
comments.  Please take the time to share your experience,
suggestions and comments with us!


Table of Contents

Introduction to Medicare & You
What Is the Original Medicare Plan?
Part A (Medicare Hospital Insurance) Covered Services
Part B (Medicare Medical Insurance) Covered Services
Medicare Preventive Services
Learning About Medicare Health Plans
Introduction
Step 1: Review Your Medicare Health Plan Choices
Step 2: Evaluate What's Important in a Medicare Health Plan
Step 3: Review the Medicare Health Plan Choices Available Where
You Live
Step 4: Get Information About Available Medicare Health Plan
Choices
Step 5: Make the Medicare Health Plan Choice That is Right for
You
Step 6: Enrolling/Disenrolling in a Medicare Health Plan
Telephone Directory
Phone Numbers for Assistance
Worksheet for Comparing Medicare Health Plans
Questions and Answers (Q & As) - Other Medicare Health Plans
Medicare Patients' Rights
Private Supplemental Insurance Policies
Questions and Answers (Q & As) - Original Medicare Plan
Protect Yourself Against Discrimination, Fraud, and Abuse

Railroad Retirement Beneficiaries: The Railroad Retirement Board
(RRB) helps the Health Care Financing Administration (HCFA)
administer certain aspects of the Medicare program for
beneficiaries covered under the Railroad Retirement Act.
Railroad Retirement beneficiaries should contact their local RRB
office for answers to Medicare questions. Railroad Retirement
beneficiaries can find their local office by calling
1-800-808-0772. Additional information about Medicare for
Railroad Retirement beneficiaries is available on the Internet
at www.rrb.gov.

Comments: HCFA welcomes your comments and suggestions about
Medicare & You. HCFA will be unable to respond to you directly,
but your comments may help us make improvements to future
versions of this handbook.

Send your comments to: Health Care Financing Administration
Medicare & You Comments
7500 Security Blvd.
Baltimore, MD 21244-1850

Medicare & You explains the Medicare Program, but it is not a
legal document. The official Medicare Program provisions are
contained in the relevant laws, regulations, and rulings.


Dear Medicare Beneficiaries:

Recent legislation included Medicare+Choice, which will result
in changes to the Medicare program. This new legislation will
help keep Medicare well funded. Importantly, you now have new
preventive health benefits and new patient protections. In
addition, starting in 1999, Medicare will offer new health plan
choices. You may want to look at these choices.

To help you understand these changes, we have revised Your
Medicare Handbook and given it a new name - Medicare & You. It
includes a description of the new preventive benefits available
to you (see page 8), the rights you have as a patient (see page
28), and the new health plan options available to you (see pages
9-17). It will help you identify some of the important questions
you will want to ask and includes a list of important resources
for you to use to get more information (see page 18). Medicare
information is also available on the Internet at
www.medicare.gov. If you don't have a computer, your local
library or senior center may be able to help you access the
Medicare website.

As you read this handbook, it is very important for you to
remember that if you are happy with the way you get your health
care now, you don't have to do anything. The choice is yours. No
matter what you decide, you are still in the Medicare program
and will receive all the Medicare covered services.

It is also important to remember that Medicare doesn't+t pay for
everything, and Medicare doesn't cover everything. To get more
coverage, you may purchase a Medicare Supplemental Insurance
Policy (see pages 29-30), or you may consider joining a
different health plan that may provide extra benefits.

If you are interested in changing the way you receive your care,
one of the new choices may be right for you. Caution: Changing
the way you receive your health care is an important decision.
You may wish to ask your family, friends, or doctor for help.
Special rules may apply if you choose to disenroll from a
Medicare health plan and return to the Original Medicare Plan
with a Supplemental Insurance Policy (see page 26). If you or
your spouse has health care coverage that supplements Medicare
through a former employer or union, contact your benefits
representative before you make a new health plan choice. If you
have Medicaid coverage, do not make changes until you contact
the State Medical Assistance Office.

Whether you are new to the Medicare program or not, we want you
to know of our deep commitment to keep Medicare working for you.

          Donna E. Shalala
                                            Nancy-Ann
          Min DeParle

          Secretary, Department of

          Health Care

          Health and Human Services
                                            Financing
          Administration


What is the Original Medicare Plan?

Deductible:
The amount you must pay
before Medicare begins to pay:
  * each benefit period for
    Part A. (Benefit periods are
    explained on Page 6.)
  * each year for Part B.

Coinsurance:
The percent of the approved
charge that you have to pay:
  * after you pay the Part A
    deductible. (See page 6)
  * after you pay the first $100
    deductible each year for
    Part B.

Premium:
Monthly payments for health
care coverage to:
  * Medicare
  * an insurance company, or
  * a health care plan.

Fiscal Intermediary:
A private insurance company
that has contracted with
Medicare to process bills
(claims) for Part A services

Medicare Carrier:
A private insurance company
that has contracted with
Medicare to process
beneficiary bills (claims) for
Part B Services.

Copayment:
In some health plans, the
amount you pay for each
medical service, like a doctor
visit.

Medicaid:
A joint Federal and State
program that provides medical
help for certain individuals
with low income and limited
resources (see page 33).

*The Social Security
Administration or the Railroad
Retirement Board will send
you information about the
1999 Part A and Part B
premium rates by
January 1, 1999. Or you can
check the Internet at
www.medicare.gov.  | a  |

Medicare Is a Health Insurance Program for:

  * People 65 years of age and older
  * Certain younger people with disabilities
  * People with End-Stage Renal Disease (people with permanent
    kidney failure who need dialysis or a transplant).

What is the Original Medicare Plan?

The Original Medicare Plan is the traditional pay-per-visit
arrangement (see page 6-8). You can go to any doctor,
hospital, or other health care provider who accepts Medicare.
You must pay the deductible. Then Medicare pays its
share, and you pay your share (coinsurance). The
Original Medicare Plan has two parts: Part A (Hospital
Insurance) and Part B (Medical Insurance). If you are in
the Original Medicare Plan now, the way you receive your
health care will not change unless you enroll in another
Medicare health plan.

What is Part A (Hospital Insurance)?

Part A (Hospital Insurance) helps pay for care in hospitals
and skilled nursing facilities, and for home health and
hospice care. If you are eligible, Part A - premium
free -- that is, you don't pay a premium because you or
your spouse paid Medicare taxes while you were working.
Your Fiscal Intermediary can answer your questions
on what Part A services Medicare will pay for and how
much will be paid (see page 19 f-g).

You are eligible for premium-free Medicare Part A
(Hospital Insurance) if:
  * You are 65 or older. You are receiving or eligible
    for retirement benefits from Social Security or the
    Railroad Retirement Board, or
  * You are under 65. You have received Social
    Security disability benefits for 24 months, or
  * You are under 65. You have received Railroad
    Retirement disability benefits for the prescribed
    time and you meet the Social Security Act
    disability requirements, or
  * You or your spouse had Medicare-covered
    government employment, or
  * You are under 65 and have End-Stage Renal Disease.

If you don't qualify for premium-free Part A, and you
are 65 or older, you may be able to buy it. (Contact Social
Security
Administration - See page 19a).

What is Part B (Medical Insurance)?

Part B (Medical Insurance) helps pay for doctors,
outpatient hospital care and some other medical
services that Part A doesn't cover, such as the
services of physical and occupational therapists.
Part B covers all doctor services that are
medically necessary. Beneficiaries may receive
these services anywhere (a doctor's office, clinic,
nursing home, hospital, or at home). Your Medicare
carrier can answer questions about Part B services
and coverage (% 19 b-c).

You are automatically eligible for Part B if you
are eligible for premium-free Part A. You are also
eligible if you are a United States citizen or
permanent resident age 65 or older. Part B cost $
43.80 per month in 1998.*

Part B is voluntary. If you choose to have Part B,
the monthly premium is deducted from your Social
Security, Railroad Retirement, or Civil Service
Retirement payment. Beneficiaries who do not receive
any of the above payments are billed by Medicare
every 3 months.

If you didn't take Part B when you were first
eligible, you can sign-up during 2 enrollment
periods:
  * General Enrollment Period: If you
    didn't take Part B, you can only sign up during
    the general enrollment period, January 1 through
    March 31 of each year. Your Part B coverage is
    effective July 1. Your monthly Part B premium may
    be higher. The Part B premium increases 10% for
    each 12-month period that you could have had Part B
    but did not take it.
  * Special Enrollment Period: If you
    didn't take Part B because you or your spouse
    currently work and have group health plan coverage
    through your current employer or union, you can
    sign up for Part B during the special enrollment
    period. Under the special enrollment period, you
    can sign up at any time you are covered under the
    group plan. In addition, if the employment or group
    health coverage ends, you have 8 months to sign up.
    The 8-month period starts the month after the
    employment ends or the group health coverage ends,
    whichever comes first. Generally, your monthly
    Part B premium is not increased when you sign up
    for Part B during the special enrollment period.
    Contact the Social Security Administration, or the
    Railroad Retirement Board to sign up for Part B
    (see 19 a).

What Are Your "Out-of-Pocket" Costs?

The Original Medicare Plan pays for much of your
health care, but not all of it. Your "out-of-pocket"
costs for health care will include your monthly
Part B premium. In addition, when you get health
care services, you will also have to pay deductibles
and coinsurance or copayments.
Generally, you will pay for your outpatient
prescription drugs. You also pay for routine
physicals, custodial care, most dental care, dentures,
routine foot care, or hearing aids. Physical therapy
and occupational therapy services, except for those
you get in hospital outpatient departments, are
subject to annual limits. The Original Medicare Plan
does pay for some preventive care, but not all of it.

Your Out-of-Pocket Costs May Depend On:
  * Whether your doctor accepts assignment.
  * How often you need health care.
  * What type of health care you need.

If You Choose Another Medicare Health Plan or Purchase
a Supplemental Policy, Out-of-Pocket Costs May Also Depend On:
  * Which Medicare health plan you choose.
  * What extra benefits are covered by the plan.
  * What your supplemental health insurance covers.

Help for Low-Income Medicare Beneficiaries

For certain older, low-income or disabled individuals
entitled to Medicare Part A, your State Medicaid program
will pay some or all of Medicare's premiums, and may
also pay Medicare's deductibles and coinsurance if you
have Part A, and your bank accounts, stocks, bonds, or
other resources do not exceed $4,000 for an individual,
or $6,000 for a couple, you may qualify for assistance.
If you think you may qualify, contact your State, county,
or local medical assistance office (see 19 m). (Income
limits will change slightly in 1999.) See page 33.


Medicare Part A (Hospital Insurance) Covered Services

Covered Services

Hospital Stays: Semiprivate room, meals,
general nursing and other hospital
services and supplies (but not private
duty nursing, a television or telephone
in your room, or a private room unless
medically necessary).  |

What You Pay*

For each benefit period you pay:
  * A total of $764 for a hospital stay of 1-60 days.
  * $191 per day for days 61-90 of a hospital stay.
  * $382 per day for days 91-150 of a hospital stay.**
  * All costs for each day beyond 150 days.

Skilled Nursing Facility (SNF) Care:
Semiprivate room, meals, skilled nursing and
rehabilitative services, and other services and
supplies.

More information on SNFs can be found on
page 34.  | For each benefit period you pay:
  * Nothing for the first 20 days.
  * Up to $95.50 per day for days 21-100.
  * All costs beyond the 100th day in the benefit period.

Contact your Fiscal Intermediary with questions about
Skilled Nursing Facility Care and conditions of coverage
(see 19 f-g).

Home Health Care: Intermittent skilled nursing
care, physical therapy, speech language pathology services,
home health aide services, durable medical equipment (such
as wheelchairs, hospital beds, oxygen, and walkers) and
supplies, and other services.  | You pay:
  * Nothing for Home Health Care services.
  * 20% of approved amount for durable medical equipment
    (such as wheelchairs, hospital beds, oxygen, and walkers).

Call your Regional Home Health Intermediary with questions
about Home Health Care and conditions of coverage (see 19 h-i).

Hospice Care***: Pain and symptom relief, and
supportive services for the management of a terminal illness.

Home care is provided. Also covers necessary inpatient
care and a variety of services otherwise not covered by
Medicare.  | You pay:
  * Limited costs for outpatient drugs and inpatient
    respite care (care given to a hospice patient so that
    the usual care giver can rest).

Call your Regional Home Health Intermediary about
Hospice Care and conditions of coverage (see 19 h-i).

Blood: From a hospital or skilled nursing
facility during a covered stay.  | You pay:
  * For the first 3 pints.

*1999 Part A & B premium, coinsurance, and deductible amounts
will be available before January 1, 1999.

**You have 60 reserve days that may only be used once. For each
reserve day, Medicare pays all covered costs except for a daily
coinsurance ($382 in 1998).

***You must meet certain conditions in order for Medicare to
cover these services.

Benefit Period: Starts the day you are admitted to a hospital or
Skilled Nursing Facility and ends when you haven't received
hospital inpatient or Skilled Nursing Facility care for 60
consecutive days.

Call your Fiscal Intermediary for general questions about your
Medicare Part A coverage (see 19 f-g).


Medicare Part B (Medical Insurance) Covered Services

Covered Services

Medical Expenses:Doctors' services, inpatient and
outpatient medical and surgical services and supplies,
physical, occupational and speech therapy, diagnostic tests,
and durable medical equipment (DME).  |

What You Pay*

You pay:
  * $100 deductible (pay once per year).
  * 20% of approved amount after the deductible, except in
    the outpatient setting.
  * 50% for most outpatient mental health.
  * 20% of first $1,500 for all physical therapy services
    and 20% of first $1,500 for all occupational therapy
    services, and all charges thereafter. (Hospital
    outpatient therapy services do not count towards limit.)

Clinical Laboratory Service: Blood tests, urinalysis,
and more.  | You pay:
  * Nothing for services.

Home Health Care: (If you don't have Part A.)

Intermittent skilled care, home health aide services,
DME and supplies, and other services.  | You pay:
  * Nothing for services.
  * 20% of approved amount for DME.

Outpatient Hospital Services: Services for the diagnosis
or treatment of an illness or injury.  | You pay:
  * No less than 20% of the Medicare payment amount
    (after the deductible).

Blood: As an outpatient, or as part of a
Part B covered service.  | You pay:
  * For the first 3 pints plus 20% of approved amount
    for additional pints (after the deductible).

*1999 Part A & B premium, coinsurance, and deductible amounts
will be available before January 1, 1999.

Note: Actual amounts you must pay for coinsurance are higher if
the doctor does not accept assignment (see page 5).

Call your Medicare Carrier if you have general questions about
your Medicare Part b coverage (see 19 b-c).

Part B also helps pay for:

  * X-rays
  * Speech language pathology services
  * Artificial limbs and eyes
  * Arm, leg, back, and neck braces
  * Kidney dialysis and kidney transplants
  * Under limited circumstances, heart, lung, and liver
    transplants in a Medicare-approved facility
  * Preventive services (see next page)
  * Very limited outpatient drugs

  * Emergency care
  * Limited chiropractic services
  * Medical supplies: items such as ostomy bags, surgical
    dressings, splints, and casts
  * Breast prostheses following a mastectomy
  * Ambulance services (limited coverage)
  * The services of practitioners such as clinical
    psychologists, clinical social workers, and nurse
    practitioners
  * One pair of eyeglasses after cataract
    surgery with an intraocular lens


Medicare Preventive Services-Added Benefits to Help You Stay
Healthy

Covered Service

Eligible Benefciaries

What You Pay

Screening Mammogram:
Once per year.  | All female Medicare
beneficiaries age 40 and older.  | 20% of the Medicare
approved amount with no
Part B deductible.

Pap Smear and Pelvic Examination:
(Includes a clinical breast exam) Once
every three years. Once per year if you
are high risk for cancer of the cervix or
had an abnormal Pap smear in the
preceding three years.  | All female Medicare
beneficiaries.  | No coinsurance and no
Part B deductible for the
Pap smear (clinical
laboratory charge). For
doctor services and all
other exams, 20% of the
Medicare approved
amount with no Part B
deductible.

Colorectal Cancer Screening:

Fecal Occult Blood Test
Once every year.

Flexible Sigmoidoscopy
Once every four years.

Colonoscopy
Once every two years if you are
high risk for cancer of the colon.

Barium Enema
Doctor can substitute for
sigmoidoscopy or colonoscopy.  | All Medicare beneficiaries
age 50 and older.  | No coinsurance and no
Part B deductible for the
fecal occult blood test. For
all other tests, 20% of the
Medicare approved amount
after the annual
Part B deductible.

Diabetes Monitoring:
Includes coverage for glucose monitors,
test strips, lancets, and self-
management training.  | All Medicare beneficiaries with
diabetes (insulin users and non-users).  | 20% of the Medicare
approved amount after the
annual Part B deductible.

Bone Mass Measurements:
Varies with your health status.  | Certain Medicare
beneficiaries
at risk for losing bone mass.  | 20% of the Medicare
approved amount after the
annual Part B deductible.

Vaccinations:
Flu Shot:
Once per year.

Pneumococcal Vaccination:
One may be all you ever need - ask
your doctor.

Hepatitis B Vaccination:
If you are high risk for hepatitis.  | All Medicare
beneficiaries.  | No coinsurance and no
Part B deductible for flu or
pneumococcal vaccinations. For
Hepatitis B vaccination, 20% of the
Medicare approved amount after
the Part B deductible.


Learning About Medicare Health Plans

Introduction to Learning About
Medicare Health Plans.

If you are happy with the way
you get health care now, you
don't have to do anything. If
you do nothing, you will
continue to receive your
Medicare health care in the
same way you always have

*All health plan choices may
not be available in your area.
For the most current list of
your local Medical health
plan choices, look at the
Internet at www.medicare.gov.

Have you heard that Medicare
now offers more health plan
choices?

Different health plan choices
may affect your:

Cost:
What you pay.

Extra Benefits:
What extra benefits you get,
like prescription drugs.

Providers:
How much choice you have
among doctors, and hospitals,
and other health care
providers.

Steps 1 - 6 are on the
following pages.  | a  |

More Medicare Health Plan Choices

Starting in 1999, Medicare offers more health plan choices.
One of the new health plan choices might be right for you.
The choice is yours. No matter what you decide, you are
still in the Medicare program. All Medicare health plans
must provide all Medicare covered services described on
pages 6-8.

To be eligible for the other Medicare health plan choices*:
  * You must have Part A (Hospital Insurance)
    and Part B (Medical Insurance).
  * You must not have End-Stage Renal Disease. (ESRD is
    permanent kidney failure that requires dialysis or
    a transplant.) However, ESRD beneficiaries currently
    in a health plan will be able to remain in the plan they are
    in.
  * You must live in the service area of a health plan. The
    service area is the geographic area where the plan
    accepts enrollees. For plans that require you to use
    their doctors and hospitals, it is also the area where
    services are provided. The plan may disenroll you if
    you move out of the plan's service area. If you are
    disenrolled, you are automatically covered under the
    Original Medicare Plan. You can also choose to join a
    Medicare health plan in your new area.

Your out-of-pocket costs may depend on:
  * Which Medicare health plan you choose.
  * How often you need health care.
  * What type of health care you need.
  * Which extra benefits are covered by the plan.
  * What your supplemental health insurance covers.
  * Whether your doctor accepts assignment
    (Original Medicare Plan only).

Understand Your Medicare Health Plan Choices

Medicare has new health plan choices.

If you want to learn about the new health plan choices,
please keep reading. Think about your current health care
needs or the needs you may have in the future. Consider
how each health plan would meet your needs. No matter
what you decide, you are still in the Medicare program.
You will continue to receive at least all the Medicare
covered services (see pages 6-8).

If you are happy with the way you get health care now,
you don't have to do anything! If you do nothing, the
way you receive your health care now will not change.

If you want to look at the choices, the steps below
will help you compare your Medicare health plan choices.

Steps to Choosing a Health Plan:

Step 1: Review your Medicare health plan choices.

Step 2: Evaluate what's important in a Medicare
health plan.

Step 3: Review the Medicare health plan choices
available where you live.

Medicare health plan information is available on the
Internet at www.medicare.gov. If you don't have a
computer, your local library or senior center may be
able to help you get information on the plans
available in your area.

Step 4: Get information about available Medicare
health plan choices.

Step 5: Make the Medicare health plan choice
that is right for you.

Step 6: Enrolling/Disenrolling in a Medicare health plan.


Learning About Medicare Health Plans - Step 1

Step 1: Review Your Medicare Health Plan Choices

All of the Medicare health plan choices are listed below.
However, they may not all be available in your area.
  * The Original Medicare Plan
  * the Original Medicare Plan with a Supplemental Insurance
    Policy
  * Medicare Managed Care Plans

Health Maintenance Organizations (HMO's)
HMO's with Point of Service Options (POS)
Provider sponsored Organizations (PSO's)
Preferred Provider Organizations (PPO's)

  * Private Fee-for-Service Plans
  * Medicare Medical Savings Account Plans (MSA's)
  * Religious Fraternal Benefit Society Plans (RFB's)

These health plan choices are explained in pages 14 - 16.

Caution


If you answer yes to any of these questions, your health plan
choices may be different or better.

If you answer yes to this question  | Please follow these
instructions...

  * Are you (or your spouse) retired? Do you
    have health insurance through the former employer or union?

Contact your former employer or union before
you make a health plan choice.

  * Are you (or your spouse) still working?
    Do you have health insurance through
    the employer or union?

Contact your or your spouse's employer or
union before you make a health plan choice.

  * Do you have Medicaid or is your income low
    enough that you may qualify for Medicaid?

Contact your State Medical Assistance Office
(Ph. # page 19 m) See Page 33.

  * Are you a military retiree?

Contact your local military base.

  * Are you a veteran entitled to Veterans
    Administration (VA) benefits?

Contact your local Veterans Administration
office.

  * Do you have End-Stage Renal
    Disease (ESRD)?

You are only eligible for the Original Medicare
Plan. You may be eligible for the Original
Medicare Plan with Supplemental Insurance (see
page 29).

  * Do you have only Medicare Part A or
    only Part B?

You are only eligible for the Original Medicare
Plan. You may be eligible for the Original
Medicare Plan with Supplemental Insurance (see
page 29).


Learning About Medicare Health Plans - Step 2

Step2: Evaluate What's Important in a Medicare Health Plan

Remember: The Original Medicare plan doesn't pay for or cover
everything. To get more coverage,
you may purchase a Supplemental Insurance Policy, or you may
consider joining a Medicare Managed Care
Plan or Private Fee-for-Service Plan. Another choice is the
Medicare Medical Savings Account (MSA)
Plan (see Enrolling (Disenrolling) in a Medicare Health plan on
page 17.) You should look at how
all the health plan choices differ on cost, choice of doctors
and hospitals, and benefits.


Cost

What you pay:
  * All beneficiaries pay the Part B premium of $43.80 (in
    1998).
  * Monthly premiums tend to be lower in Medicare Managed Care
    Plans (if you follow the
    plan rules) than in most Supplemental Insurance Policies and
    some Private Fee-for-Service
    Plans.
  * Your out-of-pocket costs (what you must pay) tend to be
    lower in most Managed Care Plans and
    the Original Medicare Plan with some Supplemental Insurance
    Policies. Costs often are higher in the
    Original Medicare Plan without a Supplemental Insurance
    Policy.
  * In Medicare MSA Plans, there is no monthly premium. You pay
    for all the costs of services
    prior to meeting the high deductible for your plan. Your
    Medicare MSA can help pay the costs of
    services prior to your meeting the high deductible (page
    16).
  * In Private Fee-For-Service Plans and Medicare MSA Plans, you
    may be asked to pay extra
    charges by doctors, hospitals, and other providers who don't
    accept the plan's fee as payment in
    full.


Providers

How you choose doctors and hospitals:
  * The Original Medicare Plan, the Original Medicare Plan with
    a Supplemental Insurance
    Policy, Private Fee-for-Service Plans, and certain Medicare
    MSA Plans have the widest choice of
    doctors and hospitals.
  * In most Medicare Managed Care Plans, and in some Medicare
    MSA Plans, you must choose
    your doctors and hospitals from a list provided by the plan.
    You may want to check if your
    current doctor is on the plan's list, and is accepting new
    Medicare patients under that plan.
    There is no guarantee that a particular doctor will stay
    with the plan.
  * You can go to any specialist who accepts Medicare in the
    Original Medicare Plan,
    the Original Medicare Plan with a Supplemental Insurance
    Policy, Private Fee-for-Service Plans,
    and some Medicare MSA Plans. Most Medicare Managed Care
    Plans and some Medicare MSA Plans
    require a referral from your primary care doctor for you to
    see a specialist.
  * In Private Fee-For-Service Plans and Medicare MSA plans, you
    may be asked to pay
    extra charges by doctors, hospitals, and other providers who
    don't accept the plan's fee as
    payment in full.


Extra Benefits - What Services You Get

  * In Medicare Managed Care Plans or Private Fee-For-Service
    Plans, you may get extra benefits,
    like vision or dental care + beyond the benefits covered by
    the Original Medicare Plan or the
    Original Medicare Plan with a Supplemental Insurance Policy.
    In lieu of extra benefits, enrollees
    in Medicare MSA Plans receive a deposit in their Medicare
    MSA from Medicare. Look on the Internet at
    www.medicare.gov for more information.


Prescription Drugs - An Important Extra Benefit

  * In general, the Original Medicare Plan does not cover
    outpatient prescription drugs. Many
    Medicare Managed Care Plans and a few of the more expensive
    Supplemental Insurance Policies cover
    certain prescription drugs up to a specified dollar limit.
    In general, the Original Medicare Plan
    only covers medication while you are in a hospital or
    skilled nursing facility.


Other Important Things To Think About

  * In the Original Medicare Plan, Medicare pays doctors and
    other healthcare providers directly for
    each service that you receive. For all other Medicare health
    plans, Medicare pays the health plan a
    lump sum amount of money; the plan oversees the services you
    receive.
  * Plan benefits and costs can change each year. These changes
    are usually effective the first day of
    the new year.
  * Medicare health plans may terminate their contract with
    Medicare at any time. If the plan
    terminates its contract with Medicare, you would be notified
    by the plan and automatically returned to
    the Original Medicare Plan. See page 32 for information on
    how this would affect your ability to get a
    Supplemental Insurance Policy should you want to stay with
    the Original Medicare Plan. You may join
    another plan in the area, but you will be covered by the
    Original Medicare Plan until the new coverage
    is in effect.
  * Except for Medicare MSA Plans, you may leave (disenroll
    from) most Medicare health plans at any
    time and either return to the Original Medicare Plan, or
    switch to another plan. Special rules may
    apply if you choose to return to your Supplemental Insurance
    Policy or your employer's health
    insurance (see page 26). Contact your State Health Insurance
    Advisory Program, your State Insurance
    Department, or your employer for more information (see 19
    d).
  * As a Medicare beneficiary, you have rights. All Medicare
    health plans are required to have an
    appeal and grievance (complaint) process and must respond to
    your concerns (see pages 27 and 28).

Learning About Medicare Health Plans - Step 2

Original Medicare Plan
The traditional pay-per-visit
arrangement that covers Part
A and Part B services is now
called the Original Medicare
Plan.

 Original Medicare Plan With a
Supplemental Policy Managed Care Plans
A group of health plans that include:

HMO:
Health Maintenance
Organization

POS:
HMO with a Point of Service
Option

PSO:
Provider Sponsored
Organization

PPO:
Preferred Provider
Organization

Private Fee-for-Service Plan
A private insurance plan that
accepts Medicare beneficiaries.

*The Social Security
Administration or the Railroad
Retirement Board will send
you information about the
1999 Part A and Part B
premium rates by
January 1, 1999. Or you can
check the Internet at
www.medicare.gov.

Medicare Medical Savings
Account (MSA) Plan
A test program for 390,000
Medicare beneficiaries. If you
choose a Medicare MSA Plan,
you must stay in it for a full year.
Medicare MSA Plans first
become available in November
1998.

Religious Fraternal Benefit
Society Plans

*The Social Security
Administration or the Railroad
Retirement Board will send
you information about the
1999 Part A and Part B
premium rates by
January 1, 1999. Or you can
check the Internet at
www.medicare.gov.  | >  |

Original Medicare Plan

The Original Medicare Plan is the traditional system, run by the
Federal government, that covers your Part A and Part B services.
Medicare pays its share of the bill and you pay the balance.

Cost: You pay the $43.80* Part B premium, Part A and Part B
deductibles, and the coinsurance.

Providers: You can go to any doctor or hospital that accepts
Medicare.

Extra Benefits: You receive all the Medicare covered services
listed on pages 6 - 8, but no extra benefits.

Original Medicare Plan with a Supplemental Policy

The Original Medicare Plan is the traditional system that covers
your Part A and Part B services. Medicare pays its share of the
bill, and you pay the balance. You may purchase one of ten
standard Supplemental Insurance Policies (Medigap or Medicare
SELECT) for extra benefits ( see pages 29 - 30). Some policies
help pay Medicare's coinsurance amounts and deductibles.

Cost: You pay the Part B premium of $43.80*. You also pay an
additional monthly premium for your Supplemental Insurance
Policy. The premium varies by State and insurer, and often
varies by age. Most policies pay Medicare's coinsurance amounts
and some also pay for Medicare's deductibles.

Providers:

Medigap: You can go to any doctor or hospital that accepts
Medicare.

Medicare SELECT: You must use plan hospitals and in some cases
plan doctors in order to be eligible for full Medigap benefits.

Extra Benefits: You receive all the Medicare covered services
listed on pages 6 - 8. Some Supplemental Policies also cover
services the Original Medicare Plan doesn't (see pages 29 - 30).

Managed Care

A Managed Care Plan involves a group of doctors, hospitals, and
other health care providers who have agreed to provide care to
Medicare beneficiaries in exchange for a fixed amount of money
from Medicare every month. Managed Care Plans include HMOs, HMOs
with a POS option, PSOs, and PPOs.

Cost: You pay the Part B premium of $43.80.* Some plans charge
you an extra monthly premium. You may also pay the plan a
copayment per visit or service. You will also pay more if you
don't follow plan rules. No Supplemental Insurance Policy is
necessary if you join a Managed Care Plan (see page 29).

Providers: Your choice of doctors and hospitals varies by the
type of Medicare Managed Care Plan you choose. HMOs and PSOs are
usually more restrictive - you must use the plan's doctors and
hospitals. PPOs and HMOs with POS options are generally less
restrictive - you may use doctors and hospitals outside of the
plan for an additional cost.

Extra Benefits: You receive all the Medicare covered services
listed on pages 6-8. Many Medicare Managed Care Plans offer
additional benefits not covered under the Original Medicare Plan.

Private Fee-for-Service Plan

You choose a private insurance plan that accepts Medicare
beneficiaries. You may go to any doctor or hospital you want.
The insurance plan, rather than the Medicare program, decides
how much to reimburse for the services you receive. You may have
extra benefits the Original Medicare Plan doesn't cover.

Cost: You pay the Part B premium of $43.80*, any monthly premium
the Private Fee-for-Service Plan charges, and an amount per
visit or service. Providers are allowed to bill beyond what the
plan pays, and you will be responsible for paying whatever the
plan doesn't cover. You may pay more for services.

Providers: You can go to any doctor or hospital.

Extra Benefits: You receive all the Medicare covered services
listed on pages 6-8. Some Private Fee-for-Service Plans may
offer additional benefits that the Original Medicare Plan
doesn't cover.

Medicare Medical Savings Account (MSA) Plan

This is a test program for 390,000 eligible Medicare
beneficiaries. You choose a Medicare MSA Plan + a health
insurance policy with a high deductible. Medicare pays the
premium for the Medicare MSA Plan and makes a deposit to the
Medicare MSA that you establish. You use the money deposited in
your Medicare MSA to pay for medical expenses. If you don't use
all the money in your Medicare MSA, next year's deposit will be
added to your balance. Money can be withdrawn from a Medicare
MSA for non-medical expenses, but that money will be taxed. If
you enroll in a Medicare MSA Plan, you must stay in it for a
full year. You can only sign up for a Medicare MSA Plan in
November of each year, or during special enrollment periods.
Medicare MSA Plans first become available in November 1998.

Cost: You pay the Part B premium of $43.80.* You use the money
in your Medicare MSA to pay for medical expenses. Unlike other
Medicare health plans, there are no limits on what providers can
charge you above the amount paid by your Medicare MSA Plan. If
you use all your Medicare MSA money, you are responsible for
paying all of your medical expenses until you meet the
deductible for your Medicare MSA Plan. The deductible can be
considerably higher than those of other Medicare health plans.
Your Medicare MSA can help pay these costs.

Providers:Depending on the Medicare MSA Plan you choose, you may
be able to go to any doctor or hospital, or you may be limited
to a network of providers.

Extra Benefits:Money in your Medicare MSA pays for things that
the Original Medicare Plan covers, plus other services it does
not cover. A Medicare MSA Plan may offer additional benefits the
Original Medicare Plan doesn't cover, but it doesn't pay for
them until you meet your annual deductible.

Religious Fraternal Benefit Society Plans

These plans are offered by a Religious Fraternal Benefit Society
for members of the society. Only members of the society may
enroll. The society must meet Internal Revenue Service (IRS) and
Medicare requirements for this type of organization. No other
information on Religious Fraternal Benefit Society Plans is
available at this time.


Learning About Medicare Health Plans - Step 3 - 6

Step 3: Review the Medicare Health Plan Choices Available Where
You Live

The Internet, at www.medicare.gov, lists health plans available
in your local area (see page 1).

Step 4: Get Information About Available Medicare Health Plan
Choices

Call specific Medicare health plans for more detailed
information.

Step 5: Make the Medicare Health Plan Choice That is Right for
You

You may want to talk with family, friends, or your doctor about
your health plan choices before making a final decision. You may
also call your State Health Insurance Advisory Program for
assistance (% 19 d). For more help, please see the worksheet on
pages 20-25.

Step 6: Enrolling (Disenrolling) in a Medicare Health Plan

You don't need to do anything if you want to keep the Original
Medicare Plan or your current Medicare Managed Care Plan. If you
have another health plan, you must disenroll to return to
Original Medicare.

How to enroll/disenroll: Medicare Managed
Care or Private Fee-for-Service Plan  | How to enroll/disenroll:
Medicare Medical
Savings Account (MSA) Plan

You can enroll in a Medicare Managed Care
Plan or a Private Fee-for-Service Plan at any time.

To enroll:
  * Call the plan to request an enrollment form
    (plan numbers are available on the Internet
    at www.medicare.gov, or in your local
    phone book).
  * Complete and mail the form to the plan.
  * You will receive a letter from the plan telling
    you when your membership begins.
  * The plan cannot refuse to enroll you.

To disenroll:
  * You may disenroll (leave) a plan at any time
    for any reason.
  * Call the plan or the Social Security
    Administration (see 19 a) and tell them you
    want to disenroll.
  * Your disenrollment becomes effective
    as early as the first of the month after your
    request for disenrollment is received.

You can only enroll in a Medicare MSA Plan:
  * During the 3-month period before you are
    entitled to Part A and Part B, or
  * During November of each year starting in 1998.
    (The first time you enroll in November, you have
    until December 15 of the same year to change your
    mind. If you do not change your mind, you must stay
    in the Medicare MSA for one full calendar year.)

To enroll:
  * You set up a special Medicare MSA at a
    bank/savings institution.
  * You choose from among available Medicare
    MSA plans.
  * Your enrollment will be effective January 1.

To disenroll:
  * You can leave the Medicare MSA Plan by
    filing a request for disenrollment in November.
    Your disenrollment will be effective December 31.

Special rules may apply if you choose to disenroll from a health
plan and return to your Supplemental Insurance Policy or your
employer's health insurance policy (see page 26).


Telephone Directory

Phone Numbers for Assistance

Call your...  | If you have questions or need information
about...  | Call number on page...

Social Security Administration (SSA)  | Lost Medicare card,
address change, Social Security benefits, Medicare enrollment,
Medicare premium amounts  | 19a

State Health Insurance Advisory Program  | Medicare bills,
information on Supplemental Insurance Policies & long term care
insurance, payment denials and appeals, Medicare rights and
protections, treatment complaints, and help choosing a Medicare
health plan  | 19d

Medicare Carrier  | Part B coverage and bills, medical services,
and recognizing fraud and abuse  | 19b-c

Durable Medical Equipment Regional Carrier (DMERC)  | Bills and
coverage for durable medical equipment and a list of Medicare
approved suppliers  | 19e

Fiscal Intermediary (FI)  | Part A coverage and bills, hospital
care and skilled nursing care  | 19f-g

Health Care Financing Administration (HCFA) Regional Office  |
Local seminars and health fairs on your new Medicare health plan
choices  | 19n

Medicare Hotline  | Ordering other Medicare publications  | 19a

Office for Civil Rights  | Discrimination  | 19n

Office of the Inspector General  | How to report Medicare fraud
and abuse  | 19a

Peer Review Organization (PRO)  | Complaints about quality of
care  | 19j-k

Regional Home Health Intermediary (RHHI)  | Information on
coverage for home health care and hospice care  | 19h-i

State Insurance Department  | Medicare Supplemental Insurance
Policies available in your area  | 19-l

State Medical Assistance Office  | Medicaid, low-income
assistance  | 19m

Railroad Retirement Board (Railroad Retirement beneficiaries
only)  | RRB - Medicare bills and coverage

RRB benefits, lost Medicare card, Medicare premium amounts,
enrolling in Medicare  | 19a

19a


National Numbers:Social Security Administrator, Medicare MSA
Information Line, Medicare Hotline, Office of the Inspector
General, and Railroad Retirement Board

Do you have a question about...  | Then you should call...  |
Who is...  | The phone number is...

  * A lost Medicare card or address change
  * Social Security benefits
  * Supplemental Security Income (SSI) benefits
  * Applying for (enrolling in) Medicare
  * The Medicare premium amount deducted from your Social
    Security check

Social Security Administration  | Social Security Administration
 | 1-800-772-1213

TTY for the hearing and speech impaired:

1-800-325-0778

How to Order Medicare Publications, such as The Guide to Health
Insurance for People with Medicare  | Medicare Hotline  |
Medicare Hotline  | 1-800-638-6833

en Espanol?
1-800-638-6833

How to report Medicare fraud and abuse  | Office of the
Inspector General  | Office of the Inspector General  |
1-800-HHS-TIPS
(1-800-447-8477

TTY for the hearing and speech impaired:
1-800-377-4950

Railroad Retirement Beneficiaries Only

Your bill or Medicare coverage for:
  * doctor services
  * outpatient care
  * other medical services

Your bill or Medicare coverage for:
  * hospital care
  * skilled nursing facility area
  * home health care
  * hospice care
  * Railroad Retirement Benefits
  * Social Security benefits
  * Apply for (enrolling in) Medicare
  * The Medicare premium amount deducted from Railroad
    Retirement checks
  * Lost Medicare card or address change

Your RRB Medicare carrier

Your Fiscal Intermediary (FI)

Railroad Retirement Board  | United HealthCare

See page 19 f-g

Railroad Retirement Board  | 1-800-833-4455

See page 19 f-g

Call the nearest RRB field office or 1-800-808-0772


Medicare Carriers:Call for questions on Part B coverage, bills
and medical services or for information on how to recognize
Medicare fraud and abuse

ALABAMA
Blue Cross/Blue Shield of Alabama, 1-800-292-8855 or
1-205-988-2244  | DELAWARE
Medicare Customer Service Center, 1-800-444-4606  | KANSAS
Blue Cross/Blue Shield of Kansas, 1-800-432-3531 or
1-785-291-4000 (in
Topeka) or 1-800-432-0216 (out of state)

ALASKA
Blue Cross/Blue Shield of North Dakota, 1-800-444-4606  |
DISTRICT OF COLUMBIA
Medicare Customer Service Center, 1-800-444-4606  | KENTUCKY
AdminaStar Federal, 1-800-999-7608 or 1-502-425-6759

AMERICAN SAMOA
Blue Cross/Blue Shield of North Dakota, 1-800-444-4606  | FLORIDA
Blue Cross/Blue Shield of Florida, 1-800-333-7586  | LOUISIANA
Arkansas Blue Cross/Blue Shield, Inc., 1-800-462-9666 or Baton
Rouge 1-504-927-3490

ARIZONA
Blue Cross/Blue Shield of North Dakota, 1-800-444-4606  | GEORGIA
Cahaba, 1-800-727-0827 or 1-912-927-0934  | MAINE
National Heritage Insurance Company, 1-800-492-0919 or
1-781-741-5258

ARKANSAS
Arkansas Blue Cross/Blue Shield, 1-800-482-5525 or
1-501-378-2320  | GUAM
Blue Cross/Blue Shield of North Dakota, 1-800-444-4606  |
MARYLAND
Medicare Customer Service Center, 1-800-444-4606

CALIFORNIA
Transamerica Occidental Life Insurance, Counties of Los Angeles,
Orange, San Diego, Ventura, Imperial, San Luis Obispo & Santa
Barbara 1-800-675-2266 or 1-213-748-2311  | HAWAII
Blue Cross/Blue Shield of North Dakota, 1-800-444-4606  |
MASSACHUSETTS
National Heritage Insurance Company, 1-800-882-1228 or
1-781-741-5256

IDAHO
CIGNA Medicare, 1-800-627-2782 or 1-615-244-5650  | MICHIGAN
Wisconsin Physicians Services (WPS) 1-800-482-4045

ILLINOIS
Wisconsin Physicians Services (WPS) 1-800-642-6930 or
1-312-938-8000 or TDD 1-800-535-6152  | MINNESOTA
United HealthCare Insurance Co., 1-800-352-2762 or
1-612-884-7171

COLORADO
Blue Cross/Blue Shield of North Dakota, 1-800-332-6681 or
1-303-831-2661  | INDIANA
AdminaStar Federal, 1-800-622-4792 or 1-317-842-4151  |
MISSISSIPPI
United HealthCare Insurance, 1-800-682-5417 or 1-601-956-0372

CONNECTICUT
United HealthCare, 1-800-982-6819 (in CT only) or 1-203-237-8592
 | IOWA
Blue Cross/Blue Shield of North Dakota, 1-515-245-4785 or
1-800-532-1285  | MISSOURI
Blue Cross/Blue Shield of Kansas (Kansas City area)
1-800-892-5900 or 1-816-561-0900; Arkansas Blue Cross/Blue
Shield (rest of state) 1-800-392-3070 or 1-314-843-8880

MONTANA
Blue Cross/Blue Shield of Montana, 1-800-332-6146 or
1-406-444-8350  | NORTHERN MARIANA ISLANDS
Blue Cross/Blue Shield of North Dakota, 1-800-444-4606  | TEXAS
Blue Cross/Blue Shield of Texas, 1-800-442-2620

NEBRASKA
Blue Cross/Blue Shield of Kansas, 1-800-633-1113  | OHIO
Nationwide Mutual Insurance Co., 1-800-282-0530 or
1-614-249-7157  | UTAH
Blue Cross/Blue Shield of Utah, 1-800-426-3477 or 1-801-333-2430

NEVADA
Blue Cross/Blue Shield of North Dakota, 1-800-444-4606  |
OKLAHOMA
Arkansas Blue Cross/Blue Shield, 1-800-522-9079 or
1-405-848-7711  | VERMONT
National Heritage Insurance Company, 1-800-447-1142 or
1-781-741-5256

NEW HAMPSHIRE
National Heritage Insurance Company, 1-800-447-1142 or
1-781-741-5256  | OREGON
Blue Cross/Blue Shield of North Dakota, 1-800-444-4606  |
VIRGINIA
Medicare Customer Service Center - Counties of Arlington and
Fairfax, 1-800-444-4606
United HealthCare (rest of state), 1-800-552-3423 or
1-540-985-3931

NEW JERSEY
Xact Medicare Service, 1-800-462-9306  | PENNSYLVANIA
Xact Medicare Service, 1-800-382-1274

NEW MEXICO
Arkansas Blue Cross/Blue Shield, 1-800-423-2925 or
1-505-872-2551  | PUERTO RICO
Triple-S, Inc., 1-800-981-7015 in Puerto Rico
In a Metro Area, 1-787-749-4900  | VIRGIN ISLANDS
Triple-S, Inc., 1-800-474-7448

NEW YORK
Empire BC/BS: Bronx, Brooklyn, Columbia, Delaware, Dutchess,
Greene, Manhattan, Nassau, Orange, Putnam, Richmond, Rockland,
Suffolk, Sullivan, Ulster & Westchester, 1-800-442-8430; Group
Health Ins.: Queens, 1-212-721-1770; BC/BS of Western NY:
1-800-252-6550  | RHODE ISLAND
Blue Cross/Blue Shield of Rhode Island, 1-800-662-5170 (on in
RI) or 1-401-861-2273  | WASHINGTON
Blue Cross/Blue Shield of North Dakota, 1-800-444-4606

SOUTH CAROLINA
Blue Cross/Blue Shield of South Carolina, 1-800-868-2522 or
1-803-788-3882  | WEST VIRGINIA
Nationwide Mutual Insurance Co., 1-800-848-0106 or
1-614-249-7157

NORTH CAROLINA
CIGNA, 1-800-672-3071 or 1-336-665-0348  | SOUTH DAKOTA
Blue Cross/Blue Shield of North Dakota, 1-800-437-4762  |
WISCONSIN
Medicare/WPS, 1-800-944-0051 or 1-608-221-3330 or TTY/TDD:
1-800-828-2837

NORTH DAKOTA
Blue Shield of North Dakota, 1-800-332-6681 or 1-800-247-2267 or
1-701-277-2363  | TENNESSEE
CIGNA Medicare, 1-800-342-8900 or 1-615-244-5650  | WYOMING
Blue Cross/Blue Shield of North Dakota, 1-800-442-2371 or
1-307-632-9381

State Health Insurance Advisory Program: Call for assistance
with Medicare bills, questions on buying a Supplemental
Insurance Policy or long term care insurance, dealing with
payment denials or appeals, Medicare rights and protections,
submitting comments about your care or treatment or for help
choosing a Medicare health plan

ALABAMA
1-800-243-5463 OR 1-334-242-5743  | FLORIDA
1-800-963-5337 or 1-850-414-2060  | KENTUCKY
1-800-372-2973 or 1-502-564-7372  | MONTANA
1-406-444-7781 or 1-800-332-2272 (Mt only)  | OHIO
1-800-686-1578 or 1-614-644-3399  | TEXAS
1-800-252-9240 or 1-512-424-6840

ALASKA
1-800-478-6065 OR 1-907-269-3680  | GEORGIA
1-800-669-8387  | LOUISIANA
1-800-259-5301 or 1-504-342-0825  | NEBRASKA
1-402-471-2201  | OKLAHOMA
1-800-763-2828 or 1-405-521-6628  | UTAH
1-800-439-3806 or 1-801-538-3910

AMERICAN SAMOA
1-808-586-7299  | GUAM
1-808-586-7299  | MAINE
1-800-750-5353  | NEVADA
1-800-307-4444 or 1-702-486-4602  | OREGON
1-800-722-4134 or 1-503-947-7250  | VERMONT
1-800-642-5119

ARIZONA
1-800-432-4040 (AZ only) or 1-602-542-6595  | HAWAII
1-808-586-7299  | MARYLAND
1-800-243-3425 (MD only) or 1-410-767-1100 TTY: 1-410-767-1083
| NEW HAMPSHIRE
1-800-852-3388 or 1-603-225-9000  | PENNSYLVANIA
1-800-783-7067 or 1-717-783-8975  | VIRGINIA
1-800-552-3402 or 1-804-662-9333

ARKANSAS
1-800-852-5494 or 1-501-371-2785  | IDAHO
1-800-247-4422 (Boise); 1-800-488-5725 (Lewiston);
1-800-488-5731 (Twin Falls); 1-800-488-5764 (Pocatello)  | NEW
JERSEY
1-800-792-8820  | PUERTO RICO
1-800-981-4355 or 1-787-721-8590  | VIRGIN ISLANDS
1-809-778-6311 EXT. 2338

CALIFORNIA
1-800-434-0222 (CA only) or 1-916-323-7315 (out of State)  |
MASSACHUSETTS
1-800-882-2003  | NEW MEXICO
1-800-432-2080 or 1-505-827-7640  | RHODE ISLAND
1-800-322-2880 or 1-401-222-2880  | WASHINGTON
1-800-397-4422 OR 1-206-654-1833

COLORADO
1-800-544-9181 or 1-303-894-7499 ext. 356  | ILLINOIS
1-800-548-9034 or 1-217-785-9021  | MICHIGAN
1-800-803-7174  | NEW YORK
1-800-333-4114 or 1-212-869-3850 (New York City)  | SOUTH
CAROLINA
1-800-868-9095 or 1-803-253-6177  | WEST VIRGINIA
1-800-642-9004 or 1-304-558-3317

CONNECTICUT
1-800-994-9422  | INDIANA
1-800-452-4800- or 1-317-233-3475  | MINNESOTA
1-800-333-2433  | NORTH CAROLINA
1-800-443-9354 or 1-919-733-0111  | SOUTH DAKOTA
1-800-822-8804 1-605-733-3656 (Pierre) 1-605-773-3656 (Sioux
Falls) 1-605-342-3494 (Rapid City)  | WISCONSIN
1-800-242-1060 or 1-608-267-3201

DELAWARE
1-800-336-9500 or 1-302-739-6266  | IOWA
1-800-351-4664  | MISSISSIPPI
1-800-948-3090 or 1-601-359-4956  | NORTH DAKOTA
1-800-247-0560 or 1-701-328-2977  | WYOMING
1-800-856-4398 or 1-307-856-6880

DISTRICT OF COLUMBIA
1-202-676-3900  | KANSAS
1-800-860-5260 or 1-316-337-7386  | MISSOURI
1-800-390-3330 or 1-573-893-7900 ext. 137  | NORTHERN MARIANA
ISLANDS
1-808-586-7299  | TENNESSEE
1-800-525-2816 or 1-615-242-0438

Durable Medical Equipment Regional Carrier (DMERC):Call for
questions on bills or Medicare coverage for durable medical
equipment such as wheelchairs or walkers, or for a list of
Medicare approved suppliers of this equipment

If you live in:  | Your DMERC is:  | If you live in:  | Your
DMERC is:

Connecticut
Delaware
Maine
Massachusetts
New Hampshire
New Jersey
New York
Pennsylvania
Rhode Island
Vermont  | United HealthCare
1-800-842-2050
1-717-735-7383  | District of Columbia*
Illinois
Indiana
Maryland*
Michigan
Minnesota
Ohio
Virginia
West Virginia
Wisconsin

*1-800-444-4606  | AdminaStar Federal Inc.
1-800-270-2313

If you live in:  | Your DMERC is:  | If you live in:  | Your
DMERC is:

Alabama
Arkansas
Colorado
Florida
Georgia
Kentucky
Louisiana
Mississippi
New Mexico
North Carolina
Oklahoma
Puerto Rico
South Carolina
Tennessee
Texas
Virgin Islands  | Palmetto Government
Benefits Administrators
Medicare DMERC
Operations
1-800-213-5452
Spanish:
1-800-213-5446  | Alaska
American Samoa
Arizona
California
Guam
Hawaii
Idaho
Iowa
Kansas
Missouri
Montana
Nebraska
Nevada
North Dakota
Northern Mariana Is.
Oregon
South Dakota
Utah
Washington
Wyoming  | CIGNA Medicare
1-800-899-7095

Fiscal Intermediary:Call for questions on Part A coverage,
bills, hospital care and skilled nursing care

ALABAMA
Blue Cross/Blue Shield of Alabama, 1-800-292-8855 or
1-205-988-2244  | FLORIDA
Blue Cross/Blue Shield of Florida, 1-904-355-8899  | LOUISIANA
Blue Cross/Blue Shield of Mississippi, 1-601-936-0105 (local) or
1-800-932-7644 est. 4594

ALASKA
Blue Cross of Washington and Alaska, 1-425-670-1010  | GEORGIA
Blue Cross/Blue Shield of Georgia, Inc., 1-706-571-5371  | MAINE
Associated Hospital of Maine, 1-888-896-4997

AMERICAN SAMOA
Hawaii Medical Service Association, 1-808-948-5247  | GUAM
Hawaii Medical Service Association, 1-808-948-6247  | MARYLAND
Medicare Customer Service Center, 1-800-444-4606

ARIZONA
Blue Cross of Arizona, 1-602-864-4297  | HAWAII
Hawaii Medical Service Association, 1-808-948-6247  |
MASSACHUSETTS
Associated Hospital Services of Maine, 1-888-896-4997

ARKANSAS
Arkansas Blue Cross/Blue Shield, 1-501-378-2000  | IDAHO
Medicare Northwest, 1-503-721-7000  | MICHIGAN
Health Care Service Corporation, 1-800-482-4045 or
1-313-225-8317

CALIFORNIA
Blue Cross of California, 1-818-593-2006  | ILLINOIS
Health Care Service Corporation, 1-312-653-6266  | MINNESOTA
Blue Cross/Blue Shield of Minnesota, 1-800-382-2000 ext. 5503 or
1-651-456-8000 (local)

COLORADO
Blue Cross/Blue Shield of Texas, 1-903-463-4658  | INDIANA
AdminaStar Federal, 1-800-622-4792  | MISSISSIPPI
United HealthCare Insurance Company, 1-800-682-5417 or
1-601-956-0372

CONNECTICUT
United HealthCare Insurance Company, 1-203-639-3222  | IOWA
Wellmark, Inc., 1-712-279-8650  | MISSOURI
Blue Cross/Blue Shield of Mississippi, 1-800-932-7644

DELAWARE
Empire Blue Cross ad Blue Shield, 1-800-444-4606  | KANSAS
Blue Cross/Blue Shield of Kansas, Inc., 1-800-445-7170  | MONTANA
Blue Cross/Blue Shield of Montana, 1-800-447-7828 or
1-406-791-4086

DISTRICT OF COLUMBIA
Medicare Customer Service Center, 1-800-444-4606  | KENTUCKY
AdminaStar Federal, 1-800-999-7608 or 1-502-425-6759  | NEBRASKA
Blue Cross/Blue Shield of Nebraska, 1-402-390-1850

NEVADA
Blue Cross of California, 1-818-593-2006  | OREGON
Medicare Northwest, 1-503-721-7000  | VIRGINIA
TRIGON Blue Cross and Blue Shield, 1-540-985-3931

NEW HAMPSHIRE
New Hampshire-Vermont Health Service, 1-603-695-7204  |
PENNSYLVANIA
Veritus, Inc., 1-800-853-1419  | VIRGIN ISLANDS
Cooperative de Seguros de Vida Puerto Rico, 1-787-758-9733

NEW JERSEY
Blue Cross/Blue Shield of New Jersey, 1-973-456-2112  | PUERTO
RICO
Cooperative de Seguros de Vida Puerto Rico, 1-787-758-9733  |
WASHINGTON
Blue Cross/Blue Shield of Washington and Alaska, 1-425-670-1010

NEW MEXICO
Blue Cross/Blue Shield of Texas, Inc.,  | RHODE ISLAND
Blue Cross/Blue Shield of Rhode Island, 1-401-861-2273 or
1-800-662-5170 (RI)  | WEST VIRGINIA
TRIGON Blue Cross and Blue Shield, 1-540-985-3931

NEW YORK
Empire Blue Cross and Blue Shield, 1-800-442-8430  | SOUTH
CAROLINA
Blue Cross/Blue Shield of South Carolina, 1-800-521-3761 or
1-803-432-5703 (local)  | WISCONSIN
Blue Cross/Blue Shield of Wisconsin, 1-414-224-4954

NORTH CAROLINA
Blue Cross/Blue Shield of North Carolina, 1-919-688-5528  |
SOUTH DAKOTA
IASD Health Service Corp., 1-515-246-0126  | WYOMING
Blue Cross/Blue Shield of Wyoming, 1-307-634-1393 or
1-800-442-2376

NORTH DAKOTA
Blue Cross/Blue Shield of North Dakota, 1-800-332-6681 or
1-303-831-2661 (local)  | TENNESSEE
Blue Cross/Blue Shield of Tennessee, 1-423-755-5955  |

NORTHERN MARIANA ISLANDS
Hawaii Medical Service Association, 1-808-948-6247  | TEXAS
Blue Cross/Blue Shield of Utah, 1-801-333-2410  |

OHIO
AdminaStar Federal, 1-317-842-4151  | UTAH
Blue Cross/Blue Shield of Utah, 1-801-333-2410  |

OKLAHOMA
Group Health Services of Oklahoma (Blue Cross/Blue Shield of
Oklahoma), 1-918-560-3367  | VERMONT
New Hampshire-Vermont Health Service, 1-603-695-7200  |

Regional Home Health Intermediary:Call for information on
coverage for home health care and hospice care.

If you live in:  | Your Regional Home Health Intermediary is:

Alabama
Arkansas
Florida
Georgia
Illinois
Indiana
Kentucky
Louisiana
Mississippi
New Mexico
North Carolina
Ohio
Oklahoma
South Carolina
Tennessee
Texas
Texas  | Palmetto Government Benefits Administrators
1-727-773-9225

If you live in:  | Your Regional Home Health Intermediary is:

Alaska
American Samoa
Arizona
California
Guam
Hawaii
Idaho
Nevada
Northern Mariana Islands
Oregon
Washington  | Blue Cross of California
1-818-593-2009

If you live in:  | Your Regional Home Health Intermediary is:

Colorado North Dakota
Delaware Pennsylvania
Iowa South Dakota
Kansas Utah
Missouri Virginia
Montana West Virginia
Nebraska Wyoming  | Wellmark, Inc.
1-515-246-0126

If you live in:  | Your number to call about Medicare home
health benefits is:

District of Columbia
Maryland  | Medicare Customer Service Center
1-800-444-4606

If you live in:  | Your Regional Home Health Intermediary is:

Michigan
Minnesota
New Jersey
New York
Puerto Rico
Virgin Islands
Wisconsin  | Medicare Part A United Government Services
1-414-224-4954

If you live in:  | Your Regional Home Health Intermediary is:

Connecticut
Maine
Massachusetts
New Hampshire
Rhode Island
Vermont  | Associated Hospital Service of Maine
1-888-896-4997

Peer Review Organization (PRO):Call for questions or complaints
about quality of care.

ALABAMA
Alabama Quality Assurance Foundation, 1-800-760-3540  | FLORIDA
Florida Medical Quality Assurance, 1-800-844-0795 or
1-813-354-9111  | LOUISIANA
Louisiana Health Care Review, Inc., 1-800-433-4958 or
1-504-926-6353

ALASKA
PRO-WEST in Anchorage, 1-800-445-6941, TTY 1-800-251-8890  |
GEORGIA
Georgia Medical Care Foundation, 1-800-979-7217 or
1-404-982-7575  | MAINE
Northeast Health Care Quality Foundation, 1-800-772-0151

AMERICAN SAMOA
Mountain Pacific Quality Health Foundation, 1-800-524-6550 or
1-800-545-2550  | GUAM
Mountain Pacific Quality Health Foundation, 1-800-524-6550 or
1-800-545-2550  | MARYLAND
Delmarva Foundation for Medical Care, 1-800-492-5811 or
1-800-645-0011 (outside Maryland)

ARIZONA
Health Service Advisory Group, Inc., 1-800-626-1577  | HAWAII
Mountain Pacific Quality Health Foundation, 1-800-524-6550 or
1-800-545-2550 (Oahu)  | MASSACHUSETTS
MassPRO, 1-800-252-5533 or 1-781-890-0011

ARKANSAS
Arkansas Foundation for Medical Care, Inc., 1-800-272-5528 or
1-501-649-8501  | IDAHO
PRO-WEST, 1-800-445-6941 or 1-208-343-4617 (Boise), TTY
1-800-251-8890  | MICHIGAN
Michigan Peer Review Organization, 1-800-365-5899

CALIFORNIA
California Medical Review, Inc., 1-800-841-1602 or
1-415-882-5800 (collect calls accepted)  | ILLINOIS
Illinois Foundation for Medical Care, 1-800-647-8089  | MINNESOTA
Stratus Health, 1-800-444-3423 or 1-612-854-3306

COLORADO
Colorado Foundation for Medical Care, 1-800-727-7086 or
1-303-695-3333  | INDIANA
HealthCare Excel, 1-800-288-1499  | MISSISSIPPI
Mississippi Foundation for Medical Care, 1-601-354-0304 or
1-800-844-0600

CONNECTICUT
Connecticut Peer Review Organization, Inc., 1-800-553-7590 or
1-860-632-2008  | IOWA
Iowa Foundation for Medical Care, 1-800-752-7014 or
1-515-223-2900  | MISSOURI
Missouri Patient Care Review Foundation, 1-800-347-1016

DELAWARE
West Virginia Medical Institute, Inc., 1-800-642-8686 ext. 266
or 1-302-655-3077 (Wilmington)  | KANSAS
The Kansas Foundation for Medical Care, 1-800-432-0407 or
1-785-273-2552  | MONTANA
Mountain Pacific Quality Health Foundation, 1-800-497-8232 or
1-406-443-4020

DISTRICT OF COLUMBIA
Delmarva Foundation for Medical Care, Inc., 1-800-999-3362  |
KENTUCKY
HealthCare Excel, Inc., 1-800-288-1499  | NEBRASKA
Iowa Foundation for Medical Care, the Sunderbruch Corporation,
1-800-247-3004 or 1-402-474-7471

NEVADA
Health Insight, 1-800-748-6773 or 1-702-385-9933 or
1-702-826-1996 (Reno)  | OREGON
Oregon Medical Profession Review, 1-800-344-4354 or
1-503-279-0100  | VIRGINIA
Virginia Health Quality Center Review Organization (DC, MD, VA),
1-800-545-3814 or 1-804-289-5320 or 1-804-289-5397

NEW HAMPSHIRE
Northeast Health Care Quality Foundation, 1-800-772-0150 or
1-603-749-1641  | PENNSYLVANIA
Keystone Peer Review Organization, Inc., 1-800-332-1914 or
1-717-564-8288  | VIRGIN ISLANDS
Virgin Islands Medical Institute, 1-809-778-6470

NEW JERSEY
The PRO of New Jersey, Inc., 1-800-624-4557 or 1-732-238-5570  |
PUERTO RICO
Quality Improvement Professional Research, 1-800-981-5062 or
1-787-753-6708  | WASHINGTON
PRO-West, 1-800-445-6941, TTY1-800-251-8890

NEW MEXICO
New Mexico Medical Review Association , Inc., 1-800-279-6824 or
1-505-998-9898  | RHODE ISLAND
Rhode Island Quality Partners, 1-800-662-5028  | WEST VIRGINIA
West Virginia Medical Institute, Inc., 1-800-642-8686, ext., 266
or 1-304-346-9864

NEW YORK
Island Peer Review Organization, Inc., 1-800-331-7767 or
1-800-446-2247 (Appeals)  | SOUTH CAROLINA
Carolina Medical Review, 1-800-922-3089 or 1-803-731-8225  |
WISCONSIN
Wisconsin Peer Review Organization, 1-800-362-2320 or
1-608-274-1940

NORTH CAROLINA
Medical Review of North Carolina, 1-919-851-2955 or
1-800-772-0468  | SOUTH DAKOTA
South Dakota Foundation for Medical Care, 1-800-658-2285 or
1-605-336-3505  | WYOMING
Mountain Pacific Quality Health Foundation, 1-800-768-2572
(local) or 1-800-497-8232

NORTH DAKOTA
North Dakota Health Care Review, Inc., 1-800-472-2902 or
1-701-852-4231  | TENNESSEE
Mid-South Foundation Care, 1-800-489-4633  |

NORTHERN MARIANA ISLANDS
Mountain Pacific Quality Health Foundation, 1-800-524-6550 or
1-808-545-2550  | TEXAS
Texas Medical Foundation, 1-800-725-8315 or 1-512-329-6610  |

OHIO
Peer Review Systems, Inc., 1-800-837-0664 or 1-800-589-7337
(Ohio Only)  | UTAH
Health Insight, 1-800-274-2290 or 1-801-487-2290  |

OKLAHOMA
Oklahoma Foundation for Medical Quality, 1-800-522-3414 or
1-405-840-2891  | VERMONT
Northeast Health Care Quality Foundation, 1-603-749-1641 or
1-800-772-0151  |

State Insurance Department: Call for questions about the
Medicare Supplemental Insurance Policies available in your area.

ALABAMA

334-269-3550  | DISTRICT OF COLUMBIA

202-727-8000  | KENTUCKY

502-564-3630 or

800-595-6053  | NEBRASKA

402-471-2201  | OKLAHOMA

800-522-0071 or

405-521-2828  | VERMONT

802-828-2900 or

800-631-7788

ALASKA

907-269-7900  | FLORIDA

800-342-2762 or

850-922-3100  | LOUISIANA

800-259-5301 or

504-342-5301  | NEVADA

800-992-0900 or

702-687-4270  | OREGON

800-722-4134 or

503-947-7984  | VIRGINIA

800-522-7945 or

804-371-9691

AMERICAN SAMOA

011-684-633-4116  | GEORGIA

404-656-2070  | MAINE

207-624-8475 or

800-300-5000  | NEW HAMPSHIRE

603-271-2261 or

800-852-3416  | PENNSYLVANIA

717-787-2317  | VIRGIN ISLANDS

809-773-6449

ext. 248

ARIZONA

602-912-8444  | GUAM

1-0-671-475-1817  | MARYLAND

410-468-2000  | NEW JERSEY

609-292-5363  | PUERTO RICO

787-722-8686  | WASHINGTON

360-753-3613 or

800-562-6900

ARKANSAS

800-852-5494  | HAWAII

808-586-2790  | MASSACHUSETTS

617-521-7777  | NEW MEXICO

505-827-4601 or

800-947-4722  | RHODE ISLAND

800-222-2223  | WEST VIRGINIA

304-558-3386 or

800-642-9004

CALIFORNIA

800-927-4357 or

213-897-8921  | IDAHO

800-247-4422  | MICHIGAN

517-373-0240  | NEW YORK

800-342-3736  | SOUTH CAROLINA

800-768-3467 or

803-737-6180  | WISCONSIN

609-266-0103 or

800-236-8519

ILLINOIS

217-782-4515  | MINNESOTA

612-296-4026  | NORTH CAROLINA

800-443-9354 or

919-733-0111  | SOUTH DAKOTA

605-773-3656  | WYOMING

307-777-7401 or

800-438-5768

COLORADO

800-930-3745  | INDIANA

800-622-4461  | MISSISSIPPI

601-359-3569 or

800-562-2640  | NORTH DAKOTA

701-328-2240 or

800-247-0560  | TENNESSEE

800-525-2816 or

615-463-6515

CONNECTICUT

860-297-3800  | IOWA

515-281-5707  | MISSOURI

800-726-7390 or

573-751-2640  | NORTHERN MARIANA ISLANDS

Not Available  | TEXAS

800-252-3439 or

512-463-6515

DELAWARE

302-739-6266 or

800-336-9500  | KANSAS

800-432-2484 or

785-296-3071  | MONTANA

406-444-2040  | OHIO

800-686-1526 or

614-644-2673  | UTAH

801-538-3805

State Medical Assistance Office:  Call for questions about low
income assistance, qualifying for Medicaid or Medicaid claims.

ALABAMA

800-362-1504  | DISTRICT OF COLUMBIA

202-727-0735 or

202-724-5506  | KENTUCKY

502-564-6885  | NEBRASKA

402-471-9147  | OKLAHOMA

405-530-3439  | VERMONT

802-241-2880

ALASKA

800-770-5650  | FLORIDA

850-488-3560  | LOUISIANA

504-342-3855 or

504-342-5716  | NEVADA

702-687-4775  | OREGON

503-945-5811  | VIRGINIA

804-786-7933

AMERICAN SAMOA

011-684-633-4590  | GEORGIA

800-282-4536  | MAINE

207-624-5277  | NEW HAMPSHIRE

603-271-4344  | PENNSYLV- ANIA

717-787-1870  | VIRGIN ISLANDS

809-774-4624

ARIZONA

602-417-4680  | GUAM

1-0-671-734-7264  | MARYLAND

410-767-1432  | NEW JERSEY

609-588-2600  | PUERTO RICO

787-765-1230  | WASHINGTON

800-562-3022

ARKANSAS

501-682-8487  | HAWAII

808-586-5391  | MASSACHUSETTS

800-841-2900  | NEW MEXICO

505-827-3100  | RHODE ISLAND

401-464-2121  | WEST VIRGINIA

800-642-3607

CALIFORNIA

800-952-5253  | IDAHO

208-334-5747  | MICHIGAN

800-642-3195  | NEW YORK

518-486-4803  | SOUTH CAROLINA

803-253-6100  | WISCONSIN

608-266-2522

ILLINOIS

800-252-8635  | MINNESOTA

800-657-3739  | NORTH CAROLINA

800-662-7030  | SOUTH DAKOTA

605-773-3495  | WYOMING

307-777-5500

COLORADO

303-866-2993  | INDIANA

317-232-4966  | MISSISSIPPI

601-359-6056  | NORTH DAKOTA

800-755-2604  | TENNESSEE

615-741-0213

CONNECTICUT

860-424-5008  | IOWA

515-281-8621  | MISSOURI

573-751-3425  | NORTHERN MARIANA ISLANDS

011-670-234-8950

Ext. 2905  | TEXAS

512-438-3219

DELAWARE

302-577-4901  | KANSAS

785-296-3349  | MONTANA

406-444-5900  | OHIO

800-324-8680  | UTAH

801-538-6155

Office of Civil Rights: Call for questions regarding
discrimination or to report discrimination.

If you live in...  | Call the Number:

Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island,
Vermont  | 1-617-565-1340. TDD 1-617-565-1343

New York, New Jersey, Puerto Rico, Virgin Islands  |
1-212-264-3313, TDD 1-212-264-2355

Delaware, District of Columbia, Maryland, Pennsylvania,
Virginia, West Virginia  | 1-215-861-4441, TDD 1-215-861-4440

Alabama, Florida, Georgia, Kentucky, Mississippi, North
Carolina, South Carolina, Tennessee  | 1-404-562-7886, TDD
1-404-562-7884

Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin  |
1-312-886-2359, TDD 1-312-353-5693

Arkansas, Louisiana, New Mexico, Oklahoma, Texas  |
1-214-767-4056, TDD 1-214-767-8940

Iowa, Kansas, Missouri, Nebraska  | 1-816-426-7277, TDD
1-816-426-7065

Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming  |
1-303-844-2024, TDD 1-303-844-3439

American Samoa, Arizona, California, Guam, Hawaii, Nevada,
Northern Mariana Is.  | 1-415-437-8310, TDD 1-415-437-8311

Alaska, Idaho, Oregon, Washington  | 1-206-615-2290, TDD
1-206-615-2296

Health Care Financing Administration (HCFA) Regional Offices:
Call for information about local seminars and health fairs or
your new Medicare health plan changes or to report a complaint
directly to HCFA.

If you live in...  | The Regional Office is:  | The phone number
is:

Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island,
Vermont  | Boston  | 1-617-565-1232

New York, New Jersey, Puerto Rico, Virgin Islands  | New York  |
1-212-264-3657

Delaware, District of Columbia, Maryland, Pennsylvania,
Virginia, West Virginia  | Philadelphia  | 1-215-861-4226

Alabama, Florida, Georgia, Kentucky, Mississippi, North
Carolina, South Carolina, Tennessee  | Atlanta  | 1-404-562-7500

Illinois, Indiana, Michigan, Minnesota, Ohio, Wisconsin  |
Chicago  | 1-312-353-7180

Arkansas, Louisiana, New Mexico, Oklahoma, Texas  | Dallas  |
1-214-767-6401

Iowa, Kansas, Missouri, Nebraska  | Kansas City  |
1-816-426-2866

Colorado, Montana, North Dakota, South Dakota, Utah, Wyoming  |
Denver  | 1-303-844-4024

American Samoa, Arizona, California, Guam, Hawaii, Nevada,
Northern Mariana Is.  | San Francisco  | 1-415-744-3602

Alaska, Idaho, Oregon, Washington  | Seattle  | 1-206-615-2354


Worksheet for Comparing Medicare Health Plans

Worksheet for Comparing Medicare Health Plans

Medicare doesn't pay for everything, and Medicare doesn't cover
everything. To get more coverage, you may purchase a Medicare
Supplemental Insurance Policy (see pages 29-30), or you may
consider joining a different Medicare health plan, which may
provide you with extra benefits.

All Medicare health plans must provide all Medicare covered
services described on pages 6-8.

You may choose from many types of health plans. There may be
real differences among them, such as cost, choice of providers,
extra benefits, quality, paperwork, complaints, and convenience.
Use the worksheet on pages 20-25 to ask questions and compare
answers. The information you gather will help you compare plans
and make the health plan choice that is right for you. Write in
the plan names and the answers from each plan to keep a record.

Each worksheet section begins with important information about
the Original Medicare Plan and about the differences among the
Medicare health plans.

All of the Medicare health plans approved by the Health Care
Financing Administration (HCFA) have met a wide variety of
standards. However, HCFA does not rate its plans. You can
compare plans with the information you get from the Internet at
www.medicare.gov or from the plans themselves. Your doctor,
friends, and relatives also may be able to help you make your
choice. Your decision should be based on your health care needs
and personal preferences.

Cost

In all Medicare health plans, including the Original Medicare
Plan, you must pay the monthly Part B premium.

In the Original Medicare Plan, you must pay additional costs
such as hospital deductibles and coinsurance. The Original
Medicare Plan does not pay for prescription drugs. You may be
able to cover these out-of-pocket costs by purchasing a
Supplemental Insurance Policy or by joining one of the other
Medicare health plans. The additional costs with these health
plan choices depend on the plan's monthly premium (if any),
copayments, and whether providers are allowed to bill extra.
Costs vary from plan to plan.

In some Medicare health plans, you must get all covered services
from doctors and hospitals that belong to the plan. If you are
in one of these plans, you may get services from doctors or
hospitals outside your Medicare health plan, but you will be
responsible for paying for these services. The exception is an
emergency, or when you require urgently needed care and are out
of the health plan's service area. Emergency and urgently needed
care are described on page 26.

  | Write the plan names in the blocks below.

Call the Plan.
Does the plan..  | Plan  | Plan  | Plan

Charge a premium in addition to the Medicare Part B premium?  |
 |   |

Charge copayments for doctor visits?  |   |   |

Pay for prescriptions? How much?  |   |   |

Charge more if I use a doctor or hospital outside the plan? How
much?  |   |   |

Have maximum amounts it will pay for different services?  |   |
 |

Set limits on what doctors and hospitals charge you?  |   |   |

Charge a deductible or coinsurance for inpatient hospital
services, home health, or skilled nursing facility services?  |
 |   |

Doctors, Hospitals, and Other Health Care Professionals

In the Original Medicare Plan and the Original Medicare Plan
with a Supplemental Insurance Policy, you may use any provider
who accepts Medicare. Private Fee-for-Service Plans provide
similar choice. In a Medicare MSA plan, you may be able to go to
any doctor or hospital, or you may be limited to a network of
providers. Many Medicare Managed Care Plans require that you use
the plan's doctors, hospitals, and other health care providers.
They also may require a referral from your primary care doctor
to a specialist. Some allow you to visit certain specialists
within the plan like optometrists, gynecologists, or
psychiatrists without a referral. If you like your current
doctor, first ask if he or she belongs to any of the plans you
are considering.

Call the Plan, then ask..  | Plan  | Plan  | Plan

Are my doctors in the plan?  |   |   |

Is there a selection of the doctors, health professionals, and
hospitals that I might need?  |   |   |

Can I get the doctor I want? Is he/she accepting new patients
under that plan?  |   |   |

Can I see the same doctor on most visits?  |   |   |

Can I change doctors once I am in the plan?  |   |   |

What's the plan's policy if it does not have the type of
specialist I need?  |   |   |

Does the plan cover the drugs I use?  |   |   |

May I use my regular pharmacy?  |   |   |

Are mail-order pharmacies available?  |   |   |

What is the annual or quarterly dollar limit on prescription
drug coverage?  |   |   |

Will I have to pay more if I prefer to use brand name instead of
generic drugs?  |   |   |

Is there a maximum out-of-pocket cost for prescription drugs?
What is it?  |   |   |

Does the plan limit the drugs it pays for to those on a list of
drugs (called a formulary)?  |   |   |

Quality

All Medicare doctors must be licensed in their State. Medicare
certifies hospitals, nursing homes, and suppliers. Medicare also
requires that Medicare Managed Care Plans establish quality
assurance programs to get a Medicare contract. Once operating,
Medicare Managed Care Plans must meet standards set by State and
Federal governments.

Beyond these basic standards, the quality of care in plans may
vary. Three main types of information will tell you about the
quality of care in a Medicare health plan.

1) Accreditation. This is an additional seal of approval by a
private independent non-profit group, which evaluates a plan and
gives it an official status based on that evaluation.
Organizations that accredit Medicare Managed Care Plans include
the National Committee for Quality Assurance, the Joint
Commission on Accreditation of Health Care Organizations, and
the American Accreditation Healthcare Commission.

2) Satisfaction surveys. These surveys ask beneficiaries how
well they believe a plan meets their needs.

3) Performance measures. These are special reports that describe
the provision of care, such as whether a plan regularly provides
mammograms for women. In late 1998, some of these reports will
be available on the Internet at www.medicare.gov.

Ask..  | Plan  | Plan  | Plan

The plan: Is the plan accredited by an independent group?  |   |
  |

Your friends and relatives: Do they like the plan? do they get
the care they need, when they need it?  |   |   |

Where available: How does the plan compare on performance
measures and consumer satisfaction surveys? (You can get some of
this information on the Internet at www.medicare.gov in late
1998.  |   |   |

Paperwork

For most services, Medicare Managed Care Plans do not require
you to file a claim form. With the Original Medicare Plan, the
Original Medicare Plan with a Supplemental Insurance Policy,
Private Fee-for-Service Plans, and Medicare MSA Plans, you may
have more paperwork. You may have to pay for covered services
when you receive them, and then wait to be reimbursed.

Call the plan, and ask..  | Plan  | Plan  | Plan

Do I have to file claims myself?  |   |   |

Complaints

You have a right to appeal many decisions concerning your
Medicare benefits. In the Original Medicare Plan, you are
entitled to an appeal, in most cases, if you believe Medicare
did not pay enough for services, or if you believe that you have
inappropriately been denied payment of health care services you
received. You can also appeal to a Peer Review Organization if
you believe that you are being discharged too soon from a
hospital.

To participate in Medicare, each health plan must have an appeal
and grievance (complaint) process for members. If you have any
concerns or problems with the plan, you have a right to
complain. The first step is to contact the plan. If your problem
with a service or payment denial is not resolved with the plan,
follow the instructions in the Questions and Answers regarding
appeals on page 27.

Call the plan, and ask..  | Plan  | Plan  | Plan

If the plan has a patient advocate/ombudsman to assist members?
|   |   |

What is the plan's record regarding complaints?  |   |   |

Convenience

Location, hours of operation, and similar details, may be
important to you. Contact each plan to decide if it is
convenient for you.

Call the plan, and ask..  | Plan  | Plan  | Plan

Are the hours and location of its doctors, clinics and other
health care providers convenient?  |   |   |

Is my access to emergency care convenient?  |   |   |

Are the doctors' offices, labs, and other services convenient?
|   |   |

How fast can I be seen for urgent (non-emergency) care?  |   |
|

Is there a telephone hotline I can call for medical advice?  |
|   |


Other Medicare Health Plans

Q: What are primary care doctors?

Q: May I change my primary care doctor? What if my primary care
doctor leaves the health plan?

Q: What is a referral?

Q: Can I leave a Managed Care Plan or Private
Fee-for-Service Plan and return to the Original
Medicare Plan?

Q: What happens to my Supplemental Insurance
Policy (Medigap) if I join a Medicare health plan,
drop my Supplemental Insurance Policy, and then later disenroll
from the health plan?

Q: What is a medical emergency? How do I get
emergency care?

Q: What is "urgently needed care"?
How do I get urgently needed care?

Q: Does travel affect my health care?  How does the health plan
handle coverage when I'm not in the service area?

Q: If I join a Medicare Managed Care Plan or Private
Fee-for-Service Plan, will I lose any of my Medicare covered
services?

Q: How do I question or appeal a Medicare
Managed Care Plan or Private Fee-for-Service
plan or Medicare Medical Savings Account Plan
coverage decision?

Q: Can I find out how a Medicare Managed
Care Plan pays its doctors?  | a  |

Questions and Answers (Q & A's)

A: Primary care doctors are trained to provide basic care. In
many Medicare Managed Care Plans, they coordinate and provide
most or all of your health care. Many plans require you to see
your primary care doctor for a referral to a specialist. When
you join a Medicare Managed Care Plan, you may be asked to
choose a primary care doctor from among the doctors who belong
to the plan. If you already have a doctor you would like to keep
seeing, ask your doctor if he or she is in the plan and
accepting new patients under that plan.

A: Yes, you may change. To change your primary care doctor,
check your health plan member handbook for instructions. You may
also call the plan's member services number. In some cases, the
effective date of such a change may be the end of the current
month. If your doctor leaves the plan, you may choose a new
doctor in the plan.

A: A referral is permission from your primary care doctor to see
a certain specialist or receive certain services. Some Medicare
health plans may require referrals. Important: if you either see
a different doctor than the one on the referral, or the service
isn't for an emergency or urgently needed care, you may be
responsible for the entire bill.

A: Yes. You may disenroll from a Medicare Managed Care Plan or
Private Fee-for-Service Plan any time, for any reason. However,
beginning January 1, 2002, disenrollment opportunities will be
limited. To disenroll, give a signed written request to the
plan, a SSA Office, or the RRB. You must receive services from
the plan until you are disenrolled. Your Original Medicare plan
coverage can start as early as the first day of the month after
your request is received.

A: You can return to your Medigap policy if you dropped it to
enroll in a Medicare health plan or a Medicare SELECT policy.
However: (1) this must be the first time that you enrolled in a
health plan or a SELECT policy; (2) you must leave the health
plan or SELECT policy within one year after joining; and (3)
after leaving your health plan or SELECT policy, you must choose
a Medigap policy within 63 days. If you meet these requirements,
you can return to your original Medigap policy, if it is still
offered, or policies A, B, C, or F (see pages 29, 30 and 32).
Call your State Health Insurance Advisory Program for
information (see 19 d).

A: A medical emergency includes severe pain, an injury, sudden
illness, or suddenly worsening illness that you believe may
cause serious danger to your health if you do not get immediate
medical care. Your plan is required to provide access to
emergency and urgently needed care services 24 hours a day, 7
days a week. Your plan must pay for your emergency care and
cannot require prior authorization for emergency care you
receive from any provider. You can receive emergency care
anywhere in the United States. When you receive emergency care,
the doctor or hospital that provides the service will bill
either you or your plan. If you receive the bill, give it to
your plan, and keep a copy for your own record. Following a
medical emergency, your plan must also pay for care you need
before your condition is stable enough for you to return to your
plan's provider. If your condition lets you return to the plan
service area, you will need to get follow-up care from your
Medicare Managed Care Plan. You should let your plan know of
emergencies as soon as medically possible. If what you believed
was an emergency turns out not to be, the plan must still pay.
Your plan can require that you pay the entire cost of care
received in an emergency room for a problem that you knew was
not an emergency. You can appeal a denial of payment for
emergency services (see pages 27 and 28).

A: Unexpected illness or injury that needs immediate medical
attention, but is not life threatening, is urgently needed care.
Your primary care doctor generally provides urgently needed
care. If you are temporarily out of the plan's service area and
cannot wait until you return home, the health plan must pay for
urgently needed care.

A: If you travel a lot or live in another State part of the
year, you should contact the plan and ask if the plan provides
coverage for services when you are out of the service area. The
Original Medicare plan does not cover care outside the United
States. Some Managed Care Plans and Private Fee-for-Service
Plans, as well as some of the more expensive Supplemental
Insurance Policies, cover care outside of the U.S. (Railroad
Retirement Board [RRB] beneficiaries have different rules.
Contact the RRB or RRB carrier for information (see 19 a).)

A: No. When you enroll in a Managed Care Plan or Private
Fee-for-Service Plan, you are still entitled to all the covered
services of the Medicare program. All Medicare Managed Care
Plans and Private Fee-for-Service Plans must provide, at least,
all the services covered under the Original Medicare Plan. This
includes Part A (Hospital Insurance) and Part B (Medical
Insurance). Hospice benefits are provided by a Medicare approved
hospice in your service area. Medicare Managed Care Plans and
Private Fee-for-Service Plans also may provide additional
benefits.

A: You have a right to appeal many decisions about your Medicare
covered services. You have this right whether you are enrolled
in a Medicare Managed Care Plan, Private Fee-for-Service Plan,
or a Medicare Medical Savings Account Plan. Your health plan
must provide you with written instructions on how to appeal. You
may file an appeal if your health plan denies a service, or
terminates or refuses to pay for services that you believe
should be covered. After you file an appeal, the health plan
reviews its decision. Then, if your health plan does not decide
in your favor, the appeal automatically goes to an independent
review organization that contracts with Medicare. You may be
eligible for a fast decision (within 72 hours) if your health or
ability to function could be seriously harmed by waiting the
amount of time needed for a standard decision. See the health
plan's membership materials or contact your health plan for
details about your Medicare appeal rights. If you believe you
are being discharged too soon from a hospital, you have a right
to immediate review by the Peer Review Organization (PRO) (see
19 j-k). During the immediate review, you may be able to stay in
the hospital at no charge and the hospital cannot discharge you
before the PRO reaches a decision.

A: Medicare Managed Care Plans current members and those
interested in joining the plan have a legal right to know (in
writing) how the plan pays its doctors. If you want this
information, call the plan.


Medicare Patients' Rights

Medicare Patients' Rights

As a Medicare beneficiary you have certain guaranteed rights
that:
  * Protect you when you get health care.
  * Assure your access to needed health care services.
  * Protect you against unethical practices.

They protect you whether you are in the Original Medicare Plan
or one of the Medicare health plans now available to you. Your
rights include, but are not limited to:

The Right to Receive Emergency Care: If you have severe pain, an
injury, sudden illness, or a suddenly worsening illness that you
believe may cause your health serious danger without immediate
care, you have the right to receive emergency care.
  * You never need prior approval for emergency care.
  * You may receive emergency care anywhere in the United
    States.

The Right to Appeal the Original Medicare plan's or Your
Medicare Health plan's Decisions About Payment or Services: If
you are in the Original Medicare Plan, you have the right to
appeal a denial of payment for a service you have been provided.
Likewise, if you are enrolled in one of the other Medicare
health plans, you have the right to appeal the plan's denial for
a service to be provided. As a Medicare beneficiary you always
have the right to appeal these decisions.

The Right to Information About All Treatment Options: You have
the right to information about all your health care treatment
options from your health care provider. Medicare forbids its
health plans from making any rules that would stop a doctor from
telling you everything you need to know about your health care,
including treatment options. If you think your Medicare health
plan may have kept your health care provider from telling you
everything you need to know about your health care treatment
options, you have a right to appeal.

The Right to Know How Your Medicare Health Plan Pays Its Doctors
(You must request this information.):
  * If you request information on how a Medicare health plan
    pays its doctors, the plan must give it to you in writing.
  * You have the right to know whether your doctor has a
    financial interest in a health care facility (such as a
    laboratory) since it could affect the medical advice he or
    she gives you.

Private Supplemental Insurance Policies

Supplemental policies

 Medicare Supplemental
(Medigap) Insurance

Medicare SELECT

For More Information on
Medicare Supplemental
Insurance Policies, get a copy
of the The Guide to Health
Insurance for People with
Medicare or contact your
State Health Insurance
Advisory Program (see 19d)  | a  |

Supplemental Policies

If you choose the Original Medicare Plan rather than a Managed
Care Plan or Private Fee-for-Service Plan, you may decide that
you need more coverage than Medicare provides. Supplemental
Insurance Policies only work with the Original Medicare Plan.
Many private insurance companies sell Medicare Supplemental
(Medigap) Insurance Policies for the specific purpose of filling
the "gaps" in Original Medicare Plan coverage. Similar coverage
may also be available to retirees through an employer or union
health plan. Other types of insurance may also be available to
you (see page 31).

In all States except Minnesota, Massachusetts, and Wisconsin,
Federal law forbids insurers from selling you Medicare
Supplemental (Medigap) Policies that are not one of 10 standard
supplemental policies. These 10 types of policies must be
labeled with the letters A through J, to make it simple for
consumers to compare policies. State law may limit the types of
policies that are actually sold in your State.

These policies may pay for some or all of the Medicare
coinsurance amounts; some or all deductibles; and certain
services not covered by the Original Medicare Plan at all. These
may include outpatient prescription drugs, some preventive
screenings, some care in your home, and emergency medical care
for travel outside the United States. Some policies provide
coverage of health care provider charges over the amount
Medicare will pay.

Medicare SELECT refers to a type of Medigap Policy. It must meet
all of the requirements that apply to a Medigap Policy, and it
must be one of the 10 prescribed benefit packages. The only
difference is that a Medicare SELECT Policy may require you to
use doctors and hospitals within its network in order for you to
be eligible for full benefits. Because of this limitation, a
Medicare SELECT Policy will generally have a lower premium than
a regular Medigap Policy.

The types of Supplemental Insurance Policies are listed on the
next page.

Supplemental Insurance (Medigap or Medicare SELECT)

Comparison Information The following chart is provided to assist
you in comparing the Original Medicare Plan with Supplemental
Insurance Policies to the Medicare health plan choices. The
benefits offered by these policies are not completely described.
For more complete information, you can request a copy of The
Guide to Health Insurance for People with Medicare, or call your
State Health Insurance Advisory Program (see 19 d).

What's Most Important to You  | Supplemental Insurance Policy A
| Supplemental Insurance Policies B, C, D, E, F*, G  |
Supplemental Insurance Policies H, I, J*

COST
Doctor Visits

Inpatient Hospital  | You pay the first $100 only

You pay $764 for days 1-60, nothing for days 61-90, and $382 per
day for days 91-150**  | You pay nothing ***

You pay nothing for days 1-60, nothing for days 61-90, and $382
per day for days 91-150**  | You pay the first $100 only

You pay nothing for days 1-60, nothing for days 61-90, and $382
per day for days 91-150**

PRESCRIPTION DRUGS  | You pay 100% for most drugs.  | You pay
100% for most drugs.  | You pay 50% per prescription. After
meeting a $250 per year deductible, Policies H & I cover up to
$1,250 of your prescription drugs. Policy J covers up to $3,000
of your prescription drugs.

EXTRA BENEFITS

Physical Exams  | Physical Exams not covered.  | Physical Exams
not covered except under Policy E.  | Physical Exams not covered
except under Policy J.

* New high deductible policies will become available in most
States beginning in 1998. Some supplemental policies may not be
available in your state.

** If you have exhausted your 60 lifetime reserve days (see page
6).

***  Policies C, F, and J pay the first $100.

Doctor Choice:

Medigap - You may see any doctor, specialist, or provider who
accepts Medicare.
Medicare SELECT - You must use plan hospitals and, in some
cases, plan doctors to be eligible for full benefits.

Premiums: In addition to your Part B premium, you will pay a
Supplemental Insurance Policy premium. These premiums vary by
State and usually by age. In general, Supplemental Policies A,
B, and C are less expensive than H, I, and J. Policies D, E, F,
and G are usually in between. Vision: Cataract related benefits
only.

Dental: In general, you are not covered for dental services.

Employer and Union-Provided Health Insurance: Some employer and
union-provided health insurance policies can continue or switch
over to provide coverage for you when you are 65 and retired.
Contact your former employer or union for information on your
plan.

Medicare has special rules that apply to beneficiaries who have
group health plan coverage through their own or their spouse's
current employment. Group health plans of employers with 20 or
more employees must offer these people the same health insurance
benefits under the same conditions that younger workers and
spouses receive. If your group health plan (participation is
based on current employment) denies you coverage, or offers you
different coverage, call your State Insurance Department (see 19
l).

If you or your spouse stops working and you are already enrolled
in Part B:
  * Notify your Medicare carrier by phone or in writing that you
    or your spouse's employment situation has changed (% 19 b-c).

Give the carrier the name and address of the employer plan, your
policy number with the plan, the date coverage stopped, and why.

  * When receiving health care services, tell the provider that
    Medicare is now your primary payer and should be billed
    first. Give the date your group health coverage stopped.

If you have employer or union-provided health insurance and
disenroll from that group health plan to join another Medicare
health plan, you may or may not be able to get the same policy
back for the same premium.

Other Types of Private Insurance

The following types of private insurance don't work with
Medicare, but may help pay for services not covered by Medicare
health plans, such as custodial care. However, these policies
should not be confused with Medicare Supplemental Insurance
Policies (Medigap), which are required by Federal law to meet
certain minimum standards for your protection.

Long-Term Care Insurance can help pay for skilled nursing care
or custodial care by paying a cash amount for each day of
covered nursing home or at-home care. For a free copy of A
Shopper's Guide to Long-Term Care Insurance, write to: National
Association of Insurance Commissioners (NAIC), Publications
Dept., 120 West 12th Street, Suite 1100, Kansas City, MO 64105,
or call your State Health Insurance Advisory Program (see 19 d).

Hospital Indemnity Policies pay cash amounts to you for each day
of inpatient hospital services.

Specified Disease Policies pay for services only when you need
treatment for the insured disease.

Questions and Answers - Original Medicare Plan

Q: What is a Private, Contract and what does it mean?

Q: If I lose my health plan coverage will I be able to get a
Supplemental Insurance Policy?

Q: When would other insurance pay first? (Medicare would be a
secondary payer)

Q: What is an Advance Beneficiary Notice (ABN)?

Q: What is Medicaid?

Q: How can Medicaid help low-income Medicare beneficiaries

HCFA publishes a number of booklets and pamphlets on specific
parts of the Medicare program. You can request these
publications by telephone (see 19a) or on the Internet at
www.medicare.gov.

Q: How are my bills (claims) paid in the Original Medicare Plan?

Q: How do I appeal a Medicare payment or coverage decision under
the Original Medicare Plan?

Q: What can I do if I think I'm being discharged from the
hospital to soon?

Q: Are there rules that protect me in a Skilled Nursing Facility
(SNF)?  | a  | A:A Private Contract is a contract between a
Medicare beneficiary and a doctor or other practitioner who has
decided not to provide services through the Medicare Program
(Not bill for any service or supplies to any Medicare
beneficiary for at least 2 years). Under a Private Contract:
  * No Medicare payment will be made for the services you receive
  * You will have to pay whatever the doctor or practitioner
    charges you with no limit on the charges ( the limiting
    charge will not apply).
  * Medicare Managed Care Plans will not pay for these services.
  * No claim should be submitted, and Medicare will not pay if
    one is.
  * If you have a Supplemental Insurance Policy, it will not pay
    anything for this service. Contact your insurer before you
    receive the service.
  * Many other insurance plans also will not pay for the service

The Private Contract only applies to the services provided by
the doctor who asked you to sign it. You cannot be asked to sign
a private contract when you are facing an emergency or urgent
health situation. You may want to talk with someone in you State
Health Advisory Program (see 19d) before signing a Private
Contract. If you want to pay on your own for services the
Original Medicare Plan doesn't cover, your doctor does not have
to leave Medicare to ask you to sign a Private Contract. You are
always free to obtain non-covered services on your own if you
choose to pay for the service yourself.

A: If you lose your health plan coverage under certain
circumstances, you will have a right to purchase a Medigap
Policy (A, B, C or F) that is sold in your State, as long as you
apply within 63 days of losing your other health coverage.
Special protections apply for pre-existing conditions. The
circumstances include the following:
  * Your Medicare Managed Care Plan, Medicare MSA Plan or
    Private Fee-for-Service Plan terminates or stops providing
    care in your area.
  * You move outside the plan's service area.
  * You leave the plan because it failed to meet its obligations
    to you.
  * You were in an employer health plan that terminated coverage.
  * Your Supplemental insurer terminates your policy (and you're
    not at fault).

A: All Medicare payments are made on the condition that you will
pay Medicare back if benefits could be paid by insurance that is
primary to Medicare. Types of insurance that should pay before
Medicare include employer group health plans, no-fault
insurance, automobile medical insurance, liability insurance,
and workers' compensation. Call your Medicare carrier (see
19b-c) or Fiscal Intermediary (see 19f-g).

A: There are two situations in which a doctor must give you an
Advance Beneficiary Notice (ABN) in writing. One is before he or
she gives you a service that he or she knows or believes
Medicare doesn't consider medically necessary, and the other is
when he or she knows or believes that Medicare will not pay for
the service. If you are not given an ABN before you get the
service, you are not responsible for paying for that service.
But, if you do receive written notice, sign an agreement,
receive the service, and Medicare does not pay for the service,
then you must pay for it.

A: Medicaid is a joint Federal and State program that provides
payment for some medical costs for certain individuals who are
older, have low incomes and limited assets, or are disabled.
Coverage and eligibility vary from State to State, but most of
your health care costs are covered if you qualify for both
Medicare and Medicaid. Medicaid recipients may also receive
benefits such as nursing home care and outpatient prescription
drugs.

A: Medicaid has programs that pay some or all of Medicare's
premiums and may also pay Medicare deductibles and coinsurance
for certain older, low-income, or disabled individuals entitled
to Medicare Part A. If you do not have Part A or do not know if
you are eligible, check with your local Social Security office,
or call 1-800-772-1213.

If you have Part A, and your bank accounts, stocks, bonds, or
other resources do not exceed $4,000 for an individual, or
$6,000 for a couple, you may qualify for assistance as a
Qualified Medicare Beneficiary (QMB), Specified Low-Income
Medicare Beneficiary (SLMB), or Qualifying Individual (QI).

Monthly Income Limit*

  | Individual  | Couple  | Benefit - Pays Medicare's

QMB  | $691  | $925  | Premiums, deductibles
and coinsurance

SLMB  | $825  | $1,105  | Part B premium

QI-1  | $926  | $1,241  | Part B premium

QI-2  | $1,194  | $1,603  | Part of the Part B premium

If you think you may qualify, contact your State, county, or
local medical assistance office (% 19 m) - not a Federal office.

*Slightly higher amounts are allowed in Alaska and Hawaii.
Income limits will change slightly in 1999.

A: When you receive services covered by the Original Medicare
Plan, your provider sends the bill (claim) to a private
insurance company that contracts with Medicare. These companies
are called the Fiscal Intermediary (for Part A services) or the
Medicare carrier (for Part B services). After they process the
claim, you receive a Medicare Summary Notice (MSN), or an
Explanation of Medicare Benefits (EOMB) (for Part B services) or
a Medicare Benefits Notice (for Part A services).

You have a right to request an itemized statement from the
provider of the service. You must receive it within 30 days of
your request. Please check the notice to be sure you were not
billed for services, medical supplies, or equipment that you did
not receive. If you have any questions about bills or services
listed on the notice, contact the carrier or Fiscal Intermediary
(the name and phone number are on the notice). If you disagree
with a claims decision, you have the right to file an appeal.
The notices tell you how to file an appeal. See below.

A: If you are dissatisfied, you have a right to appeal any
decision concerning your Medicare covered services in the
Original Medicare Plan. You can file an appeal if you believe
Medicare did not pay enough for services or should have paid for
health care services you received. Your appeal rights will be
detailed on the back of the Medicare Summary Notice (MSN) or
Explanation of Medicare Benefits (EOMB) that is mailed to you.

A: If you believe you are being discharged too soon from a
hospital, you have a right to immediate review by the Peer
Review Organization (PRO) (% 19 j-k). You can stay in the
hospital at no charge and cannot be discharged before the PRO
makes a decision.

A: Every Medicare Skilled Nursing Facility (SNF) must meet
quality standards. They can't require you to pay a deposit or
other payment to be admitted to the facility unless it is clear
that Medicare does not cover the cost of services. If the SNF
staff decides you don't need the level of skilled care covered
by Medicare, you must be told immediately. If you disagree with
this decision, the SNF must request an official Medicare
decision on coverage. The SNF can't require you to pay a deposit
for services that Medicare may not cover until Medicare gives
its decision. You must pay for any coinsurance while your claim
is being processed, and for services not covered by Medicare. If
you have questions about SNF care, contact your Fiscal
Intermediary (% 19 f-g).

Protect Yourself Against Discrimination, Fraud and Abuse

Fraud and Abuse

Medicare is improving its capability to crack down on those who
take advantage of this program. We are using four methods to
fight fraud and abuse: prevention, early detection, coordination
with other government agencies, and prosecution of wrongdoers.

We need your help to make this work. Every year millions of
dollars are stolen from Medicare, and beneficiaries pay for it
with higher premiums. You can help protect Medicare and yourself
by reporting all suspected instances of fraud and abuse.

Whenever you receive a payment notice from Medicare, review it
for errors. Make sure Medicare did not pay for services, medical
supplies, or equipment that you did not receive.

If you have a questionable charge on your bill, call the
provider, your Fiscal Intermediary (for Part A bills) or your
Medicare carrier (for Part B bills). If you believe that a
health care provider may be cheating or abusing the Medicare
program, call the Medicare carrier or intermediary that sent you
the payment notice. The carrier's or intermediary's name,
address, and telephone number will be on the payment notice.

You may also call the Inspector Generals hotline to report
suspected cases of fraud (see 19 a).

Medicare will not disclose your name if you request
confidentiality.

Protect Yourself Against Health Care Fraud

  * Never give your Medicare or Medicaid number over the
    telephone or to people you do not know.
  * Beware of providers and suppliers that use phone calls and
    door-to-door selling as a way to sell you goods or services.
  * Be suspicious of companies that offer free medical equipment
    or offer to waive your co- payment without first asking
    about your ability to pay.
  * Beware of health care providers who say they represent
    Medicare or a branch of the Federal government, or providers
    who use pressure tactics to get you to accept a service or
    product.

Discrimination

Every facility or agency that participates in Medicare must
comply with the law. Laws ban discrimination on the basis of
race, color, sex, national origin, disability, or age. If you
believe that you have been discriminated against based on any of
these categories, contact the Office for Civil Rights in your
State

 (see 19 n).

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End of Document

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