Protect Yourself, Your Family and Your TribeMedicare offers peace of mind and protection for elders

Sponsored by: (Sponsor / partner)

Presented by: (Presenter name, SMP agency name)

Funded by: (grant / funding language)

Today we will talk about…

• The Senior Medicare Patrol program

• Medicare

• How Medicare helps your tribal health providers

• How to protect yourself from fraud and scams

• How to get help with questions

Trained volunteers that help elders prevent health care fraud and assist people if they feel they have been scammed.

What is the Senior Medicare Patrol or SMP?

Q: A:

What is Medicare?

Medicare is health insurance that helps pay for health care services and supplies.

Q: A:

How many of you have Medicare?

Why do you think Medicare is important for your Indian health

providers and tribe?

Q:

Medicare matters for you and your tribal community

• Indian Health Service (IHS) is not insurance

• Many elders need care they can’t get through Indian health care providers

• Medicare is insurance that often covers more services than IHS or tribal health

• You can still use IHS

• Saves money for more tribal health care

Medicare vs Medicaid

Medicare

• Federal health insurance

• Eligible by age or disability

Medicaid

• Health insurance through your state

• Eligible by income

You can have BOTH!

Who is eligible for Medicare?

• Most people 65 or older• Disabled at any age• People with end stage

kidney disease• People with Lou Gehrig’s

disease (ALS)

Q: A:

9

Prescription Drugs

Part A + Part Band sometimes Part

D

Part AHospital

Insurance

Part BMedical

Insurance

Part CMedical

Advantage

Part DPrescription

Drugs

Medigap or Medicare Supplements

10

• Helps pay some costs after Medicare

• Not required

• Not Medicare plans

• Private insurance

• Must have Part A & B

• Plans have different costs and cover different things

Part A: Hospital Insurance

11

Helps cover:• Inpatient care

• Inpatient skilled nursing

• Hospice care

• Home health services

Part B: Medical Insurance

Helps cover:• Doctor visits

• Emergency room visits

• Durable Medical Equipment (DME) i.e. wheelchair, walker

• X-rays, lab tests

• Outpatient services

• Outpatient mental health

• Ambulance

• Preventive health services

What’s not covered by parts A & B?

Original Medicare doesn’t cover:

• Long-term care • Routine dental care • Dentures • Acupuncture • Hearing aids • Cosmetic surgery • Care not medically

necessary

Q:A:

Part C: Medicare Advantage

14

Part A + Part B and sometimes Part D

Hospital Insurance

Medical Insurance

Prescription Drugs

• Replaces A and B

• Don’t need Medigap / supplemental insurance

• Some extra benefits

• Compare plans carefully

• Run by private companies – not Medicare

Part D: Prescription Drugs• Must have Part A or Part

B

• Run by private companies

• Drugs and costs vary

• No cost to you if IHS approved pharmacy

• Medicare pays the tribal provider

IHS doesn’t pay for all prescriptions

What Does it Cost?

Part A is free for most.

Part B, Part C or Part D may have a monthly fee.

If you use a Tribal provider or IHS, you pay no out-of-pocket costs.

Q: A:

Things to think about when choosing a plan…

ConvenienceCost

• Review and compare

• Ask your family for help

• Find out how your tribal or employer benefits work with Medicare

• Get free help from your local SHIP program

• Take your time, get good info

https://www.medicare.gov/find-a-plan

Tips for choosing plansTake your time, and ask for

help!

How does Medicare work with IHS, Tribal and Urban Clinics?

+

=

• When you use Medicare at an Indian hospital or clinic, Medicare pays them

• That saves your tribe’s health care money

• You can also use non-Indian providers and use Medicare to help pay for care - may have costs!

More About Tribal Health & Medicare

• Each tribe decides what health care services they offer.

• Medicare may cover services that tribes or IHS do not.

• Indian providers may cover some services Medicare does not: dental, vision, hearing.

• Some tribes may pay Medicare premiums for their members.

Preserve your tribal resources…

Protect yourself and your tribe from health care fraud, errors and abuse.

Health care fraud hurts everyone

• Hurts the tribe by stealing health care dollars

• Steal money or benefits from you• Reduces quality of care• Leaves less money for care you

need• Leads to higher health care costs

What is fraud & abuse?

• Billing for services, supplies, or equipment that were not provided

• Billing for excessive medical supplies

• Obtaining or giving a Medicare number for “free” services

• Improper bill coding to obtain a higher payment

• Unneeded x‐rays and lab tests

• Providing services that are not medically necessary

• Using another person’s Medicare number, or letting someone else use your number, to obtain medical care, supplies or equipment

Q:

A:

What about Errors?

Medicare payment errors are simply mistakes and are not the result of intentional fraud.

Health care billing is complicated, which can lead to simple mistakes.

Must review and investigate.

Q:A:

Real Cases: Health care fraud & abuse in Indian Country

• South Dakota Man Charged With Pharmacy Fraud

• Montana Clinic Psychologist Guilty of Bribery and Tax Fraud

• Montana Home Health Care Agency Owners Indicted on Conspiracy to Commit Health Care Fraud, Money Laundering and Identity Theft

• Tribal Governor Convicted of 29 Counts of Fraud in Substance Abuse and HIV Prevention Programs

Consequences of fraud and abuse for YOU!

Your Medicare number can’t be cancelled or changed

Fraud with your Medicare number may mean:• Errors in medical

records • Medicare won’t pay• You receive the

wrong care

If someone steals your Medicare number they can:• Misuse the Social

Security number• Steal your identity• Get access to

banking and credit card info

Steps to prevent health care fraud

Report

ProtectDetect

If you have Medicare, you have a Medicare card.

The Medicare number on that card is a Social Security number.

Step 1: Protect yourself from Medicare fraud and abuse

DO

•Treat your Medicare card and number like your credit cards.•Watch out for identity theft.•Be aware that Medicare doesn’t call or visit to sell you anything.

DON’T

•Give out your Medicare number except to your doctor or other Medicare provider. •Carry your Medicare card unless you will need it.

“ If it smells like a fish…it probably is! ”

Step 2: Review to Detect signs of fraud & abuse

Use your Personal Health Care Journal or a calendar:

• Write doctor visits, tests, and procedures in the journal & take it with you to appointments

• Ask questions about your health care. Write the answers in your journal

• Compare billing statementsand Medicare Summary Notices to your journal

Medicare Summary Notices or MSN

Explains:

• What the health care provider billed Medicare for

• The amount Medicare approved for payment

• How much Medicare paid

• What you may be billed for (have to pay)

Step 2: Review to Detect signs of fraud & abuse

Review Medicare Summary Notices and other health insurance statements for:

1. Services you didn’t receive2. Double-billing 3. Services not ordered by your doctor

Step 2: Review to Detect signs of fraud & abuse

Access your Medicare information online at: www.MyMedicare.gov.

• View most recent Medicare Summary Notices

• Check Part B deductible status• View benefit eligibility information• Look at preventive services available to

you• Find Medicare health or prescription drug

plans • Use the “Blue Button” to download health

information

Step 3: Report possible Medicare fraud and abuse

• Call the doctor, pharmacy or hospital first

• Gather information and paperwork

• Contact your SMP

This is a free and confidential service!

SMP volunteersWould you like to:

• Learn more about Medicare

• Help other elders learn to protect themselves from health care frauds and scams?

• Give back to your tribal community…

Join the SMP program as a volunteer!

Questions?

Q:Ask questions or get help:• Right now!

• Talk to your tribal benefits coordinator or community health representative

• Contact the SHIP program in this area for help with Medicare

• Call your SMP program

Contact your State SMP: (Your SMP Name)

Visit us online: (Your website)

• For more information

Call Toll-free: (Your SMP phone #)

• To report suspected fraud/abuse

• For training, speakers, and/or materials

• To volunteer with the SMP program