Medicare Corner
Medicare Fraud, Errors, and Abuse Medicare fraud can occur when a provider or facility bills for services you did not receive or were not medically necessary. Examples of potential skilled nursing facility (SNF) fraud: • Learning that your Medicare was charged for: Services that your doctor did not deem medically necessary. Services that you never received. More expensive services than what you received. A greater quantity of services than what you received. SNF services for dates after you were released from the SNF. • Being forced to stay in a SNF until your benefits have expired, even though your condition has improved, and you wish to transition to home health care services. You can stop fraud by: • Reading your Medicare statements to compare the services you received with the services Medicare was charged. • Reporting any charges on your Medicare statements that are not accurate to your local Senior Medicare Patrol (SMP). • Working with your doctor to enroll in SNF services. • Not accepting gifts or money in return for choosing a SNF. • Signing forms only once you have understood them. • Reporting potential fraud to your local Senior Medicare Patrol (SMP). • Reporting quality-of-care complaints to the BFCC-QIO (visit www.qioprogram.org to find your BFCC-QIO). Contact your local Senior Medicare Patrol (SMP) to report Medicare fraud, errors, or abuse. PCOA is your local SHIP/SMP. Contact us at (520) 546-2011. These projects were supported in part by grant number 90MPPG0022, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects with government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official ACL policy.
Getting help paying your health and drug costs The Center for Medicare and Medicaid Services (CMS) recently released the 2024 income standards to qualify for the Medicare Savings Programs (MSP). These income limits are based on the percentage of the Federal Poverty Level. If you have limited income and resources, you may be able to get help through MSPs to pay your Medicare costs if you meet certain conditions. Arizona has three levels of Medicare Savings Programs: 1. Qualified Medicare Beneficiary (QMB) Program: If you are eligible, the QMB Program pays for Part A and Part B premiums. In addition, Medicare providers aren’t allowed to bill you for services and items Medicare covers, including deductibles, coinsurance, and copayments. QMB is for beneficiaries with monthly incomes of up to $1,275 for a single person and, $1,724 for a married couple. 2. Specified Low-Income Medicare Beneficiary (SLMB) Program: Pays Part B premiums only. To be eligible, beneficiaries’ income must not exceed $1,526 for a single person, and $2,064 for a married couple. 3. Qualifying Individual (QI-1) Program: Helps pay Part B premiums only. Beneficiary monthly income: $1,715 for a single person, and $2,320 for a married couple. Once you are approved for the Medicare Savings Program, you are automatically approved for Full Extra Help or Limited- Income Subsidy (LIS) program through Social Security. Extra Help/LIS pays your Part D premium and deductible. Additionally, it reduces your Part D co-pays for generic drugs ($4.50) and brand-name drugs ($11.20). However, if your income exceeds the limits listed in this article, you may still qualify for Full Extra Help/LIS to help reduce co- pays for your medications. You will still be responsible for your Part B premiums. For more information and application assistance, please contact us at (520) 546-2011.
Page 12 | March/April 2024, Never Too Late
Pima Council on Aging
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