Listed below is some general information concerning Medicare, products, and protocol. We hope you find the information helpful.

• What is Medicare?
• How do I get a new Medicare card if my card is lost, stolen, or damaged?
• How can I get my name and address changed?
• How do I report a death of a beneficiary?
• What is an ABN?
• Is a power wheelchair or scooter supplier supposed to waive my coinsurance or Part B deductible?
• What is a Medicare deductible?
• What is Durable Medical Equipment?
• What is included in the DME Category?
• Do I need a prescription to get a supply?
• What is a certificated of Medical Necessity?
• What supplies require a certificate of medical necessity (CMN)?
• What is a "capped rental" item?
• What are some "capped rental" products?

What is Medicare?
Medicare is a Federal health insurance program for people 65 years or older, certain people with disabilities, and people with end-stage renal disease (ESRD). Medicare has two parts: Part A, which is hospital insurance; and Part B, which is medical insurance.

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How do I get a new Medicare card if my card is lost, stolen, or damaged?
You can now request a replacement red, white, and blue Medicare card online on Social Security's Web site. Your card will be mailed within 30 days to the address SSA has on record. This service can be accessed during the following hours:

To make an online request, you will need the following information:

You may also need:

This new service can be accessed via the Social Security Administration Web site. If you prefer, or if you are unable to use the online request to obtain a replacement Medicare card, call Social Security's toll-free number, 1-800-772-1213. Their representatives there will be glad to help you. You can also visit a local social security office. For the office closest to you try their Field Office Locator.

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How can I get my name and address changed?
You may report a change of name or address by calling the Social Security Administration at 1-800-772-1213 or by visiting your local field office. Addresses and directions to the Social Security field offices may be obtained from the Social Security Office Locator. You can get more information on changing your name on Social Security's Web site. If you get benefits from the Railroad Retirement Board, call your local RRB office, or call 1-800-808-0772.

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How do I report the death of a beneficiary?
A family member or other person responsible for the beneficiary's affairs should do the following:

A one-time payment of $255 is payable to the surviving spouse if he or she was living with the beneficiary at the time of death, OR if living apart, was receiving Social Security benefits on the beneficiary's earnings record. If there is no surviving spouse, the payment is made to a child who was eligible for benefits on the beneficiary's earnings record in the month of death.

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What is an Advance Beneficiary Notice (ABN)?
An ABN is a written notice (the standard government form CMS-R-131), that you may receive from physicians, providers, or suppliers, before they furnish a service or item to you, notifying you:

How does receiving an Advance Beneficiary Notice (ABN) help the Medicare Beneficiary?
When you receive an ABN:
The ABN protects the beneficiary from unexpected financial liability in cases where Medicare denies payment. The "bad news" is that Medicare probably will not pay. The "good news" is that the beneficiary may have the opportunity to choose whether or not to receive the service or item. The ABN helps the beneficiary make an informed consumer decision about whether to obtain the service or item and be prepared to pay for it (that is, either out of your own pocket or by your other insurance coverage) or to choose not to receive it. The ABN allows the beneficiary to have your claim reviewed by Medicare if you do receive the service or item. This also means that you will have the right to appeal Medicare's decision.

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Is a power wheelchair or scooter supplier supposed to waive my coinsurance or Part B deductible?
The Medicare Part B deductible is the amount you must pay for health care before Medicare begins to pay. The coinsurance is the percent of the Medicare-approved amount that you have to pay after you pay the Part B deductible. In the Original Medicare Plan, the Medicare Part B coinsurance is generally 20 percent of the Medicare-approved amount for the item.

Medicare law requires a supplier of durable medical equipment, such as power wheelchairs and scooters, to bill Medicare for the supplier's actual charge. Medicare pays 80 percent of the lesser of the supplier's actual charge or the fee schedule amount, and you pay the remaining 20 percent. It is unlawful for a supplier to routinely waive the Medicare Part B coinsurance and deductible, because that results in Medicare paying 100 percent of the supplier's actual charge. However, a supplier may waive your coinsurance and/or deductible if you have a financial hardship and can't pay your Medicare Part B deductible or coinsurance. If this applies to you, the supplier must document and show that an effort was made to collect your deductible and coinsurance.

Note: If your power wheelchair or scooter supplier routinely waives Medicare copayments and deductibles, you should report these actions to the appropriate Durable Medical Equipment Regional Carrier (DMERC) or by contacting the Inspector General's Hotline at 1-800-HHS-TIPS.

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What is a Medicare deductible?
A deductible is the amount you must pay each year before Medicare begins paying its portion of your medical bill. There are deductibles for both the Part A (Hospital Insurance) and Part B (doctor services) portions of Medicare. Your deductible is taken out of your claims when Medicare receives them. Medicare will not start paying on your claims until you have met your annual deductible. The Medicare Part A deductible for 2005 is $912.00 per benefit period. The Medicare Part B deductible for 2005 is $110.00. If you have any questions on the status of your deductible please contact 1-800-MEDICARE (1-800-633-4227).

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What is Durable Medical Equipment?
Durable Medical Equipment (or DME) is equipment which meets all of the following requirements:

Often a physician will prescribe special equipment for use by a beneficiary in his/her home. The equipment may provide therapeutic benefits or enable the beneficiary to perform certain tasks that s/he is unable to undertake due to certain medical conditions and/or illnesses.

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What is included in the DME Category?
Some of the items included in the Durable Medical Equipment category, but not limited to:

Do I need a prescription to get a supply?
Certain covered items can be reimbursed by Medicare only if the doctor has furnished the supplier with a written prescription for the item before delivery. Supplies that require a prescription are listed below:

Important Note: If the item is prescribed after the purchase date, the claim will be denied. In other words, you must have your prescription in hand before the item!

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What is a Certificate of Medical Necessity?
A Certificate of Medical Necessity (CMN) is a form required by Medicare authorizing the use of certain durable medical items and equipment prescribed by a physician. This form is to be completed by your doctor or the doctor's employee. Your supplier will coordinate with your doctor to see that all the necessary information is submitted to Medicare. A change in prescription and/or a change in your condition requires that an updated certificate be completed and submitted.

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What supplies require a certificate of medical necessity (CMN)?
The following items require a CMN:

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What is a "capped rental" item?
A capped rental category consists of any item which meets the following qualifications:

The capped rental program enables beneficiaries to spread their share of the rented item's cost (i.e. coinsurance) over an extended time period rather than paying in a lump sum. This also protects the beneficiary from making an incorrect purchase decision.

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What are some "capped rental" products?
Some examples of capped rental items include, but are not limited to, the following items:

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Information provided by Medicare and gathered from the Official U.S. Government Site for people with Medicare. All of the answers above can be found at www.medicare.gov.

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