What is Medicare?
Medicare is health insurance for the following:
• People 65 years or older,
• People under age 65 with certain types of disabilities,
• People any age with End Stage Renal Disease (ESRD) (which is kidney failure that requires dialysis or even a kidney transplant).
There are four parts to Medicare:
• Medicare Part A is the hospital insurance that covers inpatient care in hospitals, skilled nursing facility, hospice services and home health care. For most, Medicare Part A has no additional premium costs.
• Medicare Part B is the medical insurance that covers doctors’ and other health care providers’ services, outpatient care, durable medical equipment (such as canes, crutches, walkers) and home health care. Part B also covers some preventive services to help you maintain your health and keep certain illnesses from getting worse. Coverage for Part B requires a premium payment. Premiums are determined by Social Security.
• Medicare Part C is also known as Medicare Advantage plans or Medicare Replacement plans. This part of Medicare replaces “traditional Medicare” and is run by private insurance companies that act as Medicare. As a tribal member, this type of Medicare coverage may not provide the best coverage as they may apply restrictions based on the county in which you reside. This could pose a problem if you are cared for in one of the many Choctaw health facilities located outside of the county in which you reside. Use caution when enrolling in Part C or a Medicare Advantage plan in order to maximize your healthcare benefits and coverage.
• Medicare Part D is the prescription drug coverage and helps cover the cost of prescription drugs. This part of Medicare designed to help lower prescription drugs costs. The premiums for Part D are determined by the type of plan selected and the out-of-pocket costs expected to be paid at the pharmacy. For those receiving extra help through Social Security or Medicaid may qualify for assistance in paying the Part D premium. Watch for valuable information coming in the mail before the enrollment period begins.
Choctaw tribal members that are Medicare eligible should consider signing up for the Part B (medical insurance) and Part D (prescription drug coverage) benefits as a “safety net” for health coverage.
What are the Benefits of Being a Tribal Member and a Medicare Beneficiary?
• Choctaw Nation health care facilities perform patient screening prior to your visit to determine if each patient has additional health care benefits. If so, insurance claims are filed to employer insurance plans, Medicare, Medicaid and many other types of insurance for reimbursement for services rendered. This allows each facility to be reimbursed for the services provided and continue to offer the quality health care to our members.
• In the event that our health care facilities cannot meet your medical needs, you may be transferred outside the Choctaw Nation health care system for medical care. If that happens, those outside medical providers will need/require your medical insurance information for insurance billing purposes. Medicare can and will be your insurance “safety net” for the care required. Not having Medicare benefits could cause additional financial responsibilities for you as a patient. Choctaw Referred Care (CRC) could be an option to assist with the additional out-of-pocket expenses, however CRC is always the payor of last resort and assistance through this appropriation is based on strict eligibility criteria.
• Medicare Part B has an annual deductible. Choctaw Nation will bill Medicare Part B for services provided and help you meet that deductible. This will help you in the event you see other health care providers outside of Choctaw Nation by helping satisfy the annual deductible, therefore reducing your out-of-pocket expenses at those other health care provider’s offices.
• The Part D prescription benefit does require a premium payment; however having this coverage under Medicare allows you to have prescriptions filled outside of the Choctaw Nation health care system. If you are in need of a prescription that is not dispensed through our local pharmacies, you will have to have that prescription filled with an outside pharmacy. Without Part D coverage the costs associated with getting the prescription(s) filled will be out-of-pocket to you as the patient. Having the Part D Medicare prescription drug coverage will act as a “safety net” for you as a patient.
Did You Know?
If you are currently working (or your spouse is currently working) with coverage through an employer insurance plan, Medicare would be the secondary (supplemental insurance) payer for any health care service provided. Make sure you always advise the Patient Registration staff of your (or your spouse) employment status and any other health insurance benefits you may have. This will ensure that your insurance profile within your chart is up-to-date and will allow for accurate and timely insurance claim submission.
Where Do I Get My Medicare Questions Answered?
• General questions can be answered by calling 1-800-MEDICARE (800) 633-4227.
• Social Security Administration (SSA) can assist with questions as well as ordering a replacement Medicare card, changing your name or address or applying for extra help you may contact SSA at: (866) 237-4482.
• If you are a Railroad retiree and have questions relating to benefits, eligibility, replacing of your Medicare cards or to report a death, you may contact the Railroad Retirement Board at: (877-772-5772.
• You may also speak one-on-one with a Benefit Coordinator at any of the Choctaw Nation health care facilities for assistance. You may call (800) 349-7026 and request a Benefit Coordinator within the various facility locations.
• The Centers for Medicare and Medicaid Services (CMS) has published a detailed publication, Medicare & You, 2012, which provides details about Medicare. This publication covers enrollment, coverage and can be found at: http://www.medicare.gov/publications/pubs/pdf/10050.pdf
What to Expect From Medicare in the Future?
On March 23, 2010, President Obama signed the Affordable Care Act. This law sets into place health insurance reforms with will begin and continue into the next four years. Some important changes to look forward to:
• 50% discount for name-brand drugs during the Medicare Part D prescription drug coverage “donut hole”.
• Expand the number of Americans receiving preventive care for patients at little or no cost.
• Additional payments to hospitals that improve the quality of patient care.
• Payments to physicians based on value of patient care versus the volume of services provided.
Benefits under the Affordable Care Act not directly related to Medicare:
• Expansion of state Medicaid funding to provide preventive services for patients at little or no cost.
• Increase payments to designated primary care physicians treating Medicaid patients.
• Provides two additional years of funding for the Children’s Health Insurance Program (CHIP) to continue coverage for children not eligible for Medicaid benefits.
• Expansion of Medicaid enrollment will allow Americans who earn less than 133% of the poverty level (approximately $14,000.00 for an individual and $29,000.00 for a family of four) to be eligible to enroll in Medicaid. This will allow many without insurance coverage to qualify for additional healthcare benefits! States will receive additional funding during the first three years to support the expanded coverage.
• Beginning in 2014, if your employer does not offer insurance, you will be able to buy it directly in an Affordable Insurance Exchange. You will have the option to select a health insurance plan with specified benefits and cost standards.
• Under the law, those that can afford it will be required to obtain basic health insurance coverage through an Insurance Exchange or pay a fee to help offset the costs of caring for uninsured Americans.
• Additional tax credits to help middle class individuals afford insurance with income between 100% and 400% of the poverty line who are not eligible for other affordable coverage. This tax credit is immediate and will reduce the monthly premium cost. As an example, if the premium was to be $100.00 and you were to receive a $90.00 immediate tax credit the monthly premium would only cost you $10.00.
• Workers meeting certain requirements who cannot afford the coverage provided by their employer may take whatever funds the employer might have contributed to the insurance and use those resources to purchase a more affordable plan under the new Affordable Insurance Exchange.
• The new law will prohibit new plans and existing group plans from imposing annual dollar limits on the amount of coverage an individual may receive.
• The new law will prohibit insurance companies from refusing to sell coverage or renew policies because of an individual’s pre-existing conditions. Also provides criteria for certain companies to charge higher rates due to gender or health status.
• Allows small businesses a business tax credit to provide health insurance for employees.
Choctaw tribal members have access to a vast array of health care services located throughout the 10 ½ counties in Oklahoma. Members can receive health services in many different locations such as: the Choctaw Nation Health Care Center located in Talihina provides inpatient care plus multi-specialty outpatient care, outlying clinics in Atoka, Broken Bow, Hugo, Idabel, McAlester, Poteau, and Stigler. Choctaw Nation also has an Employee Health clinic located in Durant and the Community Clinic in downtown Talihina.
Having a Certificate of Degree of Indian Blood (CDIB) card as a benefit and the additional Medicare coverage, you can have the confidence that you are well protected with your health care needs.
What is Medicare?
Medicare is health insurance for the following: