INDEX [umassmed.typepad.com]



A

Accepting Assignment, Medicare, 62, 137

Acronyms, List of, 233

Activities of Daily Living (ADL’s), 166, 195

Acupuncture, 65

Adult Day Health, 196, 201

Adult Foster Care, 201

Advance Beneficiary Notice of

Noncoverage (ABN), 65

Affordable Care Act, 21, 101

Aged Eligibility Criteria: Income and Asset Guidelines, MassHealth, 152

Ambulance Coverage, 71

Amyotrophic Lateral Sclerosis (ALS), 26

Annual Deductible, Part A, 36,

Part B, 61

Annual Open Enrollment Period - Federal, Medigap, 123

Appeal of a Hospital Discharge Plan, Medicare, 51, 57

Approved Amount, Medicare Part B,

61, 138

ASAP (Aging Service Access Point),

14, 199

Asset Eligibility, MassHealth, 159

Assignment, Medicare, 62, 137

Assisted Living, 15, 196, 201

Assisted Living, Ombudsman

Program, 15

Automatic Enrollment, Medicare, 26

B

Balanced Budget Act of 1997 (BBA),

71, 77

Ban on Balance Billing, 62, 139

Basic Benefits, Medigap, 116

Benefit Period, Medicare, 35, 42

Blood, Medicare, 52

Burial Account, MassHealth, 160

Burial/Funeral Contract, 160

Buy-In, MassHealth/Medicare, 163

C

Calculating a Spend-down, MassHealth, 160

Caretaker Relative, MassHealth,

166

Catastrophic Coverage, Part D, 102

Centers for Medicare and Medicaid Services (CMS), 23, 186

Chair Car, Medicare Coverage, 71

CHAMPVA, 191

CHAMPVA For Life, 191

Chiropractors’ Services, 63

Chore Services, 200

Christian Science Sanitarium, Care

In, 40

Claims Processing, Medicare, 137

Client Contact, 215

COBRA, 27, 180, 184

Coinsurance, Part B, 61

Coinsurance, Part D, 102

CommonHealth, 164

Community Care Ombudsman

Program, 15

Community MassHealth Programs, 156

Completing a Medicaid/MassHealth Application, 162

Confidentiality, 213

Congregate Housing Program, 15

Connector, Massachusetts Health,

209

Consolidated Omnibus Budget

Reconciliation Act, (COBRA), 180

Continuing Care Retirement Communities (CCRC), 201

Continuous Open Enrollment in Massachusetts, Medigap, 120

Conversion Privilege, Employer Group Health Plan, 186

Coordination of Benefits, Medicare, 192

Coordination of Benefits Contractor, Medicare, 24 & 144

Coordination of Care Unit of an Aging Service Access Point (ASAP), 199

Coordination with Medicare, Medigap, 125

Co-payment, Part D, 102

Core, Medigap, 116

Cosmetic Surgery, Medicare, 65

Councils on Aging, 14

Counseling Guidelines, 211

Counseling Process, 215

Counseling Session, 212

Counseling Skills, 211

Counseling Tools, 217

Counselor Role, 214

Counselor Tips, LTC Insurance, 205

Counselor Tips, MassHealth, 176

Coverage for Physician Services, 63

Coverage Gap, Part D, 101

Covered Days for Medicare SNF Care, 42

Covered Days Under Medicare Part A, 35

Covered Services During Hospital

Stay, 38

Creditable Coverage, Part D, 102

Crossover Billing, Medigap, 141

Cultural Competency, 225

Cultural Diversity, 225

Custodial Care, SNF, 45

D

Deductibles, Part D, 102

Deductibles & Coinsurance, Medicare

Part B, 61

Deemed Eligible, Part D 105

Deemed Provider, Medicare Advantage, 96

Definitions of Levels of Care, Medicare, 44

Demand Billing, Medicare, 54

Dementia Day Care, 201

VA Medical Centers, 194

Dentists’ Services, Medicare, 64

Department of Health and Human Services, 23

Discharge, Steps for Appeal of

Hospital, 57

Discharge Plan, 55

Appeal of, Information Required,

56

Discounts and Surcharges, Medigap, 127

Division of Insurance, 179

Dual Eligibles, Part D, 105, 110, 169, 170

Durable Medical Equipment (DME),72

Examples, 73

Durable Medical Equipment Regional Contractor (DMERC), 76, 142

E

Elders At Risk Program, 16

Eligibility, Medicare, 22

Eligibility, Medicare Advantage, 78

Eligibility, Part D, 100

Emergency/Urgent Care, Medicare Advantage, 84

Employer Group Health Plans and Medicare, 179

Employer Group Retiree Plans, 179

Employer Options, Part D, 103

End Stage Renal Disease, ESRD,

Medicare Enrollment, 26

Enrollment, LIS, 105

Enrollment, Medicare, 26

Enrollment, Medicare Advantage, 79

Enrollment, Part D, 108

Enrollment Periods, Medigap, 120

ESRD & Medicare Advantage

Coverage, 78

ESRD Medicare Enrollment, 26

ESRD/Medigap, 121, 124

ESRD Network, 26

Estate Recovery, Exempt Home, 204

Examples of Durable Medical

Equipment, 73

Examples of Medicare & Medicaid Fraud or Abuse, 145

Excluded Drugs, Part D, 105

Executive Office of Elder Affairs

(EOEA), 2

Programs and Services, 14

Exempt, Estate Recovery, Home,

204

Extra Help (LIS), Part D, 104

Eyeglasses, Medicare, 64

F

Federal Requirements for Standardized Medigap Policies, 114

Federally Tax-Qualified Policy, LTC Insurance, 205

Financial Eligibility, LTC Medicaid, 197

Five-Star SEP, MA Plans, 81

Five-Star SEP, Part D, 110

Foreign Hospital, Care In, 39

Formulary, Part D, 101

Four Parts of Medicare, 23

Frail Elder (Medicaid Waiver) Program, 167

Fraud & Abuse, Medicare, 144

Full Retirement Age, 22

Funeral Contract, MassHealth, 160

G

General Enrollment Period, Medicare, 32

General Information About Medicaid/MassHealth, 174

Guarantee Issue, Medigap, 125

Guarantee Issue Right, Medigap, 122

Guaranteed Renewability, Medigap, 126

Guardianship Program, 16

H

Health Maintenance Organizations (HMOs), 81

Eligibility For, HMO, 87

Health Maintenance Organizations (HMO) with Point-of-Service Option (POS), 91

Health Safety Net, MassHealth, 173

Health Underwriting, LTC Insurance, 204

Healthcare Quality Improvement Organizations (QIOs), 24

Hearing Aids, Medicare, 65

HMO Contracts, 86

Home Care, Long Term Care, 200

Home Care Program, 16

Home Health Care, Long Term Care, 200

Home Health Services, Medicare, 45

Services, Supplies Covered, 49

Homebound, Medicare, 46

Hospice Care, 50, 201

Medicare Covered Services, 51

Hospital Discharge, 55

How to Choose a Medigap Plan – Counseling Techniques, 134

I

Initial Enrollment Period, Part B, 29

Initial Enrollment Period (IEP), Medicare Advantage, 79

Initial Enrollment Period (IEP), Part

D, 108

Inpatient Hospital Care, 35

Inpatient Hospital Prospective Payment System (PPS), 52

Intergenerational Initiatives, 17

Internet Basics, 207

Intermediate Care, SNF, 44

L

Late Enrollment Penalty, Part A, 28

Late Enrollment Penalty, Part B, 31

Late Enrollment Penalty, Part D, 104

Legal Services for Elders, 17

Levels of Care (SNF), Definitions of, 44

Lifetime Reserve Days, 37

Limitation of Liability, Medicare, 53

Limited/Low Income Subsidy (LIS), 104

Limiting Charge, Medicare, 139

LI NET, 109

Long-Term Care, 195

Medicare/Medicaid Coverage, 196

Paying For, 201

Personal Care, 200

Long-Term Care Insurance, 202

Federally Tax-Qualified Policy, 205

Medicaid/MassHealth Qualified

Policy, 204

Long-Term Care Medicaid, 197

Long-Term Care Medicaid Qualified

Policy, 202

Long-Term Care Ombudsman

Program, 17

Long-Term Care Options, 195

Long-Term Care Services, 200

M

Major Services Covered In a Skilled Nursing Facility, 43

Massachusetts Ban on Balance Billing Law, 62, 139

Massachusetts Board of Registration

in Medicine, 139

Massachusetts Executive Office of Elder Affairs, 2

Massachusetts State Prescription

Assistance Program (SPAP/PA), 111

Massachusetts Waiver, Medigap, 115

MassHealth, 154

Applying for, 162

Asset Eligibility, 159

Burial Account, Setting Up, 160

Burial/Funeral Contract, Setting

Up, 160

Buy-In Programs, 163

Buy-In & Medicare Late

Enrollment, 32, 164

Caretaker Relative, 166

CommonHealth, 164

Community MassHealth

Programs, 156

Completing an Application, 162

Coverage for People Leaving a

Nursing Home, 175

Disabled Working Adults, 164

Dual Eligible, 154

Financial Criteria, 156

Frail Elder Waiver Program, 167

Funeral Contract, 160

General Information About, 174

Health Safety Net, 173

Income Eligibility, 173

Medical Hardship, 173

MassHealth Programs, 163

PACE, 170

QI 1, MassHealth/Medicare Buy-

In, 163

Senior Buy-In, (Also Known as the

Qualified Medicare Beneficiary

Program [QMB] Program, 163

Senior Care Options (SCO), 168

SLMB, MassHealth/Medicare Buy-

In, 163

Spend-Down, 160

Calculating Spend-Down, 160

Standard, 156, 161

MassPRO, 24, 54, 149

Mediation, Medicare, 59

Medicaid Community-Based Waiver

Program (Frail Elder), 67

Medicaid/MassHealth Coverage for

People Leaving a Nursing Home,

175

Medicaid/MassHealth, General

Information, 174

Medicaid/MassHealth (Massachusetts) Program, 154

Medicaid/MassHealth and Medigap, 174

Medicaid/MassHealth Qualified LTC Insurance Policy, 204

Medical Benefits, Part B, 63

Medical Eligibility, LTC Medicaid, 199

Medical Hardship, 173

Medical Review, Medicare, 58

Medical Savings Account, Medicare

Advantage, 96

Medically Necessary, 35

Medicare

Eligibility, 24

Enrollment, 26

Four Parts Of, 23

Limiting Charge, 139

Non-Participating Provider, 138

Reimbursement, 138

Under Age 65, 25

Medicare A & B, 21

Medicare Administrative Contractors (MACs), 141

Medicare Advantage Disenrollment

Period (MAPD), 81, 89, 110

Medicare Advantage Plans (Part C), 77

Annual Open Enrollment Period, 79

Disenrollment Period, 81, 89, 110

Drug Coverage, 78

Eligibility, 78

Enrollment, 79

ESRD, 78

Fee-For-Service/Private Fee-For-

Service (PFFS), 93

Health Maintenance Organizations

(HMOs), 81

Initial Enrollment Period

(IEP), 79

Medical Savings Accounts (MSA),

96

Point of Service Option, HMO, 91

Preferred Provider Organization

(PPO), 92

Provider Sponsored Organization

(PSO), 93

Religious Fraternal Benefit Society

(RFBS), 92

Special Election Period (SEP), 80

Special Needs Plans, 97

Medicare Advantage Emergency/

Urgent Care, 84

Medicare Advantage Patient Rights, 148

Medicare Advantage Plan Options, 77

Medicare Advocacy Project (MAP),

149

Medicare Approved Amount, 61, 137

Medicare and Medicaid Fraud and Abuse, 144

Medicare as Secondary Payer, 143

Medicare Beneficiaries with Mental

Health Issues, 220

Medicare Card, 33

Medicare Claims Processing, Appeals, Fraud and Abuse, 137

Medicare Coordination of Benefits,

144

Medicare Covered Services Provided by Hospice, 51

Medicare Eligibility, 24

Medicare Fraud & Abuse, 144

Examples, 145

Medicare Limiting Charge, 139

Medicare Modernization Act of 2003 (MMA), 99

Medicare Part A Hospital Insurance, 35

Benefit Period, 35, 42

Christian Science Sanitarium, Care

In, 40

Claims Processing, 137

Covered Days, SNF Care, 41

Covered Days Under Medicare

Part A, 35

Covered Services During Hospital

Stay, 38

Deductible, 36

Enrollment, 26

Foreign Hospital, Care In, 39

Hospital Insurance, 34

Lifetime Reserve Days, 37

Premium, 27, 36

Psychiatric Hospital, Care In, 39

Skilled Nursing Care, 41

Medicare Part B, 60

Accepting Assignment, 62

Ambulance Coverage, 71

Annual Deductible, 61

Approved Amount, 61, 137

Ban on Balance Billing

Law, 62

Claims Processing, 137

COBRA, 27, 180, 184

Co-insurance, 61

Crossover Billing, 141

Deductibles & Coinsurance,

61

Dentists, 64

DME (Durable Medical

Equipment), 72

Enrollment Periods, 29

Excess Fees, 62

General Enrollment Period, 32

Initial Enrollment Period, 29

Late Enrollment Penalty, 31

Medical Benefits, 63

Medical Insurance, 60

Mental Health Services Covered,

68

Monthly Premium, 27 &60

Non-Participating Providers, 62

Out-Patient Hospital Services, 65

Out-Patient Prospective Payment

System, 69

Out-Patient Rehabilitation

Therapy, 66

Out-Patient Treatment for Mental

Health Services, 67

Participating Providers, 62

Penalty, Late Enrollment, 32

Physicians Services, Coverage for,

63

Special Enrollment Period, 30

Medicare Participating Providers, 62

Medicare Patient Rights, 147

Medicare Prescription Drug Plans (Part D), 105

Affordable Care Act, 21, 101

Co-insurance, 102

Co-payments, 102

Coverage Gap, 101

Creditable Coverage, 102

Deductibles, 102

Dual Eligibles, 105

Eligibility, 100

Employer Options, 103

Enrollment, 108

IEP, 108

OEP, 109

SEP, 109

Disenrollment, MAPD, 110

Excluded Drugs, 105

Formulary, 101, 106

Late Enrollment Penalty, 104

LIS, 104

LIS Enrollment, 105

Out-of-Pocket Cap, 102

Overview, 99

Premium, 100

Prior Authorization, 102

Special Enrollment Period (SEP),

109

Standard Benefit, 106

Medicare Reimbursement, 138

Medicare Subrogation, 143

Medicare Summary Notice (MSN), 140

Medicare Supplement Insurance (Medigap), 113

Additional Benefits of a Supplement

One Plan, 117

Annual Open Enrollment Period,

123

Basics, 113

Basic Benefits, 116

Choosing a Medigap, 133

Continuous Open Enrollment in,

in Massachusetts, 124

Coordination with Medicare, 125

Core, 116

Counseling Techniques, How to

Choose a Medigap Plan, 134

Discounts & Surcharges 127

Disenrolling, 124

Enrollment Periods, 120

ESRD, 121, 124

Federal Requirements, 115

Foreign Travel, 117

Guarantee Issue Rights, 122, 125

Guarantee Renewable, 126

Massachusetts Waiver, 115

Outline of Coverage, 126

Pre-existing Condition, 122, 125

Special Enrollment Periods, 123

Standardized Policies, 114

Supplement One, 116

Supplement, Two, 104, 115

Suspension of Policy While

Covered by MassHealth,

127

Twelve-Month Rule, 122

Under Age 65 121

Medicare Websites, 207

Medicare/Medicaid Coverage, 196

Medicare’s Ambulance Coverage, 71

Medicare’s Requirements for Coverage of Hospice Care, 50

Medigap, 112

Mental Health Issues, Medicare

Beneficiaries With, 220

Mental Health, Outpatient Treatment

For, 67

Mental Health Services Covered, 68

Mini-COBRA, 182

MIPPA (Medicare Improvements for

Patients and Providers Act) 96

MSN (Medicare Summary Notice),

140

N

Non-Group Creditable Coverage,

Part D, 103

Non-Group Health Plans, 177

Non-Participating Providers, 62, 138

Notice of Non-Coverage, 65

Nursing Homes, 201

Nutrition Program, 18

O

OBRA 90 or the Medigap Reform Law, 114

Optometrists’ Services, 63

Orthotics, 73

Other Health Insurance Options, 177

Other Useful Websites, 208

Outline of Coverage, Medigap, 126

Outpatient Hospital Services Covered, 65

Outpatient Mental Health Coverage,

68

Outpatient Prospective Payment System, 69

Outpatient Rehabilitation Therapy, 66

Outpatient Treatment for Mental Health Services, 67

Oxygen, 73, 75

P

PACE (Program of All-inclusive Care for the Elderly), 170

Part B Durable Medical Equipment Regional Contractor (DMERC), 72, 142

Participating Providers, Part B, 62

Paying for Long-Term Care, 201

PCP/HMO, 83

Penalty for Late Enrollment, Part B, 31

Personal Care, Long-Term Care, 200

Personal Care Attendant (PCA) Program, MassHealth, 166

PFFS, Medicare Advantage, 93

Physician Services, Coverage for, 63

Podiatrists’ Services, 64

POS Option, HMO, 91

Pre-existing Condition, 177

Pre-existing Condition, Medigap, 122, 125

Preferred Provider Organization (PPO), Medicare Advantage, 92

Premium, Part A, 27, 35

Premium, Part B, 27, 60

Premium, Part D, 100

Prescription Advantage, 19, 106

Primary Care Physician (PCP), 83

Prior Authorization, Part D, 102

Private Fee For Service, Medicare

Advantage, 93

Prospective Payment System,

Inpatient, 52

Prospective Payment System,

Outpatient, 69

Prosthetics, 73

Protective Services Program, 18

Provider Sponsored Organization (PSO), Medicare Advantage, 93

Psychiatric Hospital, Care In, 39

Public Benefits, 151

Q

QI 1, MassHealth/Medicare Buy-In, 163

QMB, MassHealth Senior Buy-In, 163

Qualifying Events, COBRA, 181

Qualifying Individual 1 (QI 1), MassHealth Buy-In, 163

Quality of Care Complaints, 58

R

Religious Fraternal Benefit Society (RFBS), Medicare Advantage, 92

Rehabilitation Therapy, Outpatient,

66

Reimbursement, Medicare, 138

Resources, 229

Respite Care, 201

Retirement, Full Age, 22

S

Second Opinion, 63

Secondary Payer, Medicare, 143

Senior Buy-In, 163

Senior Care Options (SCO), 168

Senior Community Services

Employment Program, 18

Services Covered During Hospital Stay, 38

Services/Supplies Medicare Pays for Under Home Health, 49

SHINE Program Description, 2

SHIP Programs, 2

Skilled Care, 42

Skilled Nursing Care, 41

Skilled Nursing Facility, Major

Services Covered, 43

SLMB (Specified Low-Income

Medicare Beneficiary), 163

Social Day Care, 196

Social Security Administration, 23

Social Security Disability Insurance (SSDI), 25

Social Security Full Retirement Age,

22

SPAP, State Prescription Assistance

Program, 111

Special Enrollment Period (SEP), Medicare, 80

Special Enrollment Period, Medicare Advantage, 80

Special Enrollment Period (SEP), Part D, 109

Special Enrollment Periods, Medigap 123

Special Needs Plans, Medicare Advantage, 97

Spend-down/Deductible for MassHealth Standard, 160

Spousal Impoverishment Protection Law, Medicaid/MassHealth, 197

SSI, 151

Eligibility, 152

Standard Benefit, Part D, 106

Standard Enrollment, Medicare, 28

Subrogation, Medicare, 143

Summary Notice, Medicare, 140

Supplement One, 116

Supplement Two, 116

Supplemental Security Income (SSI), 151

Supplies, Durable Medical Equipment, 72

Suspension of Medigap Policy While Covered by Medicaid/MassHealth Provision, 127

T

TRICARE, 189

TRICARE For Life (TFL), 190

Twelve-Month Rule, 122

U

U.S. Department of Labor and Treasury, 186

Uncompensated Care Pool (Health Safety Net) 173

Utilization Review Committee, 53

V

VA Health Plan and Part D, 188

VA Medical Centers, Dental Coverage, 194

Veteran’s Health Administration, 187

Voluntary Enrollment, Medicare, 27

W

Waiver, Late Enrollment Penalty,

Part D, 104

Websites, Medicare, 207

Websites, Other Useful, 208

Welcome to Medicare Routine Physical, 63

Wellness Exam, 63

Worker’s Compensation, 187

Working Disabled, MassHealth

CommonHealth Program, 164

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INDEX

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