An Advance Beneficiary Notice (ABN), also known as a waiver of liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service. You may receive an ABN if
Archive for August, 2018
Original Medicare standard appeals
If you have Original Medicare and your health service or item was denied, you have the right to appeal. An appeal is a formal request you make if you disagree with a coverage or payment decision. Check your Medicare Summary Notice (MSN) to see if Medicare has paid for your
Troubleshooting when your provider refuses to file a claim
In certain situations, your health care provider may be unable or unwilling to submit a bill (file a claim) to Medicare. Listed below are a few reasons why your provider may refuse to file a Medicare claim, along with information about what to do in each situation. Your provider believes
Questions to ask before joining a Medicare Advantage Plan
When you are choosing between Original Medicare and Medicare Advantage or between Medicare Advantage Plans, here are some questions to keep in mind. Providers, hospitals, and other facilities Will I be able to use my doctors? Are they in the plan’s network? Do doctors and providers I want to see
SNP basics
Medicare Special Needs Plans (SNPs) are private companies that the federal government pays to administer Medicare benefits. Like all Medicare Advantage Plans, SNPs must provide you with the same benefits, rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs. Some SNPs offer
ESRD Medicare basics
Medicare for those with End-Stage Renal Disease (ESRD Medicare) provides you with health coverage if you have permanent kidney failure that requires dialysis or a kidney transplant. ESRD Medicare covers a range of services to treat kidney failure. In addition, you will also have coverage for all the usual services
PFFS basics
Medicare Private Fee-for-Service (PFFS) plans are private companies that the federal government pays to administer Medicare benefits. Like all Medicare Advantage Plans, PFFS plans must provide you with the same benefits, rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs. Some PFFS
MSA plan basics
Medicare Medical Savings Account (MSA) plans are private companies that the federal government pays to administer Medicare benefits. Like all Medicare Advantage Plans, MSA plans must provide you with the same benefits, rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs. Some
How to switch Medicare Advantage Plans or switch from Medicare Advantage to Original Medicare
Typically, you can only enroll in a different Medicare Advantage Plan or switch between Original Medicare and Medicare Advantage during specific times each year. Make sure to enroll in a timely manner to avoid gaps in coverage when using these enrollment periods. Fall Open Enrollment Period: You can make a
Medigap overview
Medigaps are health insurance policies that offer standardized benefits to work with Original Medicare (not with Medicare Advantage). They are sold by private insurance companies. If you have a Medigap, it pays part or all of certain remaining costs after Original Medicare pays first. Medigaps may cover outstanding deductibles, coinsurance,