Medicare Corner
Medicare and Vaccines • Influenza (flu) shots, including both the seasonal flu vaccine and the H1N1 vaccine • Pneumococcal (pneumonia) shots
To avoid billing issues, it is usually best to make sure that your health care provider or pharmacy administering the vaccine will bill your Part D plan. When you get a vaccine at your doctor’s office, ask the provider to call your Part D plan first to find out if your provider can bill your Part D plan directly. Coverage may be different with Medicare Advantage. Contact your plan for more information. Contact PCOA Medicare at (520) 546-2011 for more information.
Since January 2023, all Medicare-covered vaccines have been administered at no cost to Medicare beneficiaries. This means that you should not owe any cost-sharing such as a copayment, coinsurance, or deductible for your covered vaccines. If your provider recommends that you get a vaccine, in most cases it will be covered by your Part D plan. Part D plans must include most commercially available vaccines in their formularies, including vaccine for shingles. However, there are certain vaccinations that are always covered by Part B such as:
• Hepatitis B shots • COVID-19 vaccine
Part B also covers vaccines after you have been exposed to a dangerous virus or disease. For example, Part B will cover a tetanus shot if you step on a rusty nail, or a rabies shot if you are bitten by a dog.
Your Medicare Statements • The amount approved by Medicare for payment. • How much Medicare paid.
Medicare statements outline payments made on a beneficiary’s behalf for Medicare covered services. There are two primary types of statements received by Medicare beneficiaries: Medicare Summary Notices (MSNs) and Explanations of Benefits (EOBs).
Tracker. If you notice any mistakes, or have questions, call your provider or plan with your questions. If you still have questions or need further help, contact your local SMP (select your state on the left and click "search"). • Medicare’s website, www.medicare. gov , allows beneficiaries enrolled in Original Medicare to create a secure Medicare account to view their most recent MSNs, track claims made on
• What the beneficiary may be billed. Detect Potential Fraud, Errors, or Abuse • Review yours or your loved ones' Medicare statements as soon as they arrive to ensure that all the services listed were received. • Keep a record of medical visits, tests, receipts for services, and equipment received. A My Health Care Tracker, available from your local SMP, can help you keep a record of these services. • Compare your statements to your receipts, records, and My Health Care
• Beneficiaries enrolled in Original Medicare receive quarterly MSNs. • Beneficiaries enrolled in Medicare Advantage (Part C) plans receive monthly EOBs. • Beneficiaries enrolled in Medicare prescription drug (Part D) plans receive monthly EOBs. MSNs and EOBs explain: • What services the health care provider billed for.
their behalf, and check payment status. You can also review all bills processed within the past 36 months. Contact PCOA Medicare at (520) 546-2011 for more information.
This project was 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.
Page 12 | July/August 2024, Never Too Late
Pima Council on Aging
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