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Do you have comments or concerns about your Medicare coverage? Issues regarding getting your needed prescriptions from your Part D plan, or a Medicare Advantage plan representative's marketing practices? Let us know at .

We are dedicated to making Medicare's program work well for all beneficiaries. Your feedback from your own or your client's concerns and experiences with Medicare, will guide our Medicare advocacy efforts with key policy and decision-makers in both California and nationally with the Centers for Medicare and Medicaid Services (CMS) and Congress.

  • 24Jun

    Thank you to all who have contacted your Congress people, sharing the valuable and essential work of our State Health Insurance Assistance Programs (SHIPs) nationwide. We’ve received both local and national press, including articles in NPR and our own Board President, Tatiana Fassieux interviewed on CBS and NBC news. While local volunteers, staff, and state and national partners have done a great job highlighting and publicizing the important work of our volunteers, some in Congress have erroneously concluded that with so many volunteers doing tens of thousands of hours of free counseling there’s no need for the program! This could not be further from the truth.

    SHIPs provide the essential structure that allows our volunteers to do the excellent service they do. Without that structure, we have nothing. Some examples include, the SHIPs:

    • Recruit quality and dedicated volunteers,

    • Provide the initial 30+ hours of training for new volunteers, giving them the basic foundation to begin counseling others,

    • Provide on-going training for the over changing Medicare program,

    • Find and maintain public counseling sites throughout the community for volunteers to do their work,

    • Schedule the one-on-one counseling appointments for their volunteers,

    • Develop local venues for volunteers to do community education presentations and outreach,

    • Launch media campaigns to educate the public on Medicare issues and advertise their free services,

    • Develop and disseminate current, reliable counseling materials to use with clients, and

    • Provide technical information and assistance for tough cases.

    Please join us in contacting your Congress people. Urge them to Save our SHIPs and keep one-on-one Medicare counseling and advocacy!

  • 24Jun

    Below is a great account of one of our SMP Liaisons, Claire Pisching, and her quick and skilled advocacy work with a local resident at Sunnyside Glen Senior Apartments. Claire had given a presentation, spoke about Medicare fraud and was able to help one of the residents, Amy receive a very needed new wheelchair. Her past one was old, unreliable and often left her stranded. She had been in tears, not knowing who to turn to for help, and within 1 month Claire helped her receive her new one. Great job, Claire!!!

    Claire’s advocacy is one of many examples of the important work our Senior Medicare Patrol provides for beneficiaries throughout California. These volunteers educate, advocate for and empower their peers to receive the quality health care and services they’re entitled to, and help them prevent and detect fraud. A recent Office of Inspector General report reviews the work of 54 SMP programs nationwide.

    Below is a more detailed account of Claire’s advocacy written by the resident coordinator, Karen Cosio for her newsletter…



    NHE Resident Service Coordinator, Karen Cosio, teamed up with Claire Pisching, Senior Medicare Patrol representative, to assist a resident in getting her electric wheelchair.

    Amy’s old chair was worn and very slow. It often stalled for no reason leaving her stranded. Amy’s chair is her lifeline for mobility as she suffers from cerebral palsy. With multiple doctor’s appointments every week she needed a wheelchair that was reliable.

    Amy had been trying for six months to get her new wheelchair. She tried two different medical equipment companies but kept getting the run around.

    She came to the RSC office in tears asking for help. She explained her situation and stated, “I need my chair to get around. Please help me before the prescription runs out.”

    Karen recommended calling Claire for assistance. Amy asked Karen to help her contact Claire for an appointment as her speech is impaired due to her medical condition. A telephone call was placed and Amy had an appointment to meet with Claire the next week.

    Claire went to work and within 30 days Amy received her new wheelchair which was better quality and had features not available on her other chair. Amy was ecstatic! She kept saying, “I don’t know what I would have done without you. This is great. I was at my wits end. Thank you so much!”

    The team celebrated with Starbuck’s coffee provided by Claire. Karen recommends contacting your local Medicare Patrol with any problems regarding medical equipment and billing. They are a valuable resource!

  • 21Jun

    The Senate recently voted to eliminate our country’s only free, unbiased one-on-one Medicare counseling and advocacy program. Please join us in saying no and contacting your Congress people to keep funding for our nation’s State Health Insurance Assistance Programs (SHIPs) – known as HICAP – Health Insurance Counseling & Advocacy Program in California.

    Here’s a short clip of our Board Chair, Tatiana Fassieux speaking to this issue on CBS/NBC news! Great job Tatiana!

    Click here to watch CHA on CBS/NBC News Urging Congress to Save our SHIPs!

    Here’s a simple letter written by NCOA to contact your Congress person:

    And here are some points you can include if you personalize your letter:

    • SHIP is only program that provides free, unbiased, one-on-one Medicare coverage and benefits counseling to older adults, people with disabilities, and their families.
    • Over the past decade, the number of Medicare beneficiaries receiving personal assistance has almost tripled. Last year, over 7 million people were helped and 98,000 public education presentations were given throughout the country.
    • To keep pace with the needs and the complexity of the Medicare program, SHIP needs an increase to at least $59.4 million/year. This is below the $66.6 million that would just be keeping up with inflation and the increased number of Medicare beneficiaries.
    • With a dizzying array of Medicare coverage options (Original Medicare, Medicare Advantage, Medigap plans, TRICARE, retirement plans, etc) and significant differences in premiums, cost-sharing, provider networks, and coverage rules, sorting through information is overwhelming, isolating and confusing. SHIPs’ one-on-one counseling services play an essential role in making sure beneficiaries make well-informed choices and receive the coverage that best meets their needs.
    • SHIPs offer increasingly critical services that cannot be provided by 1-800 Medicare, on-line or written materials, or other outreach activities. In fact, approximately one-third of all partner referrals to SHIP originate from Medicare Advantage and Part D prescription drug plans, local and state agencies, the Centers for Medicare and Medicaid Services, the Social Security Administration, and members of Congress and their staff.

    Thank you for your advocacy, and please share this post with others!

  • 15Jun

    Last week, the Senate Appropriations Committee approved the FY17 Labor, HHS, Education Appropriations bill with a nearly unanimous vote of 29-1. While it includes additional funding for some aging services, it also proposes to ELIMINATE all funding for the State Health Insurance Assistance Program (SHIP). SHIP’s annual budget is only $52 million, which is a relatively small drop in the bucket in terms of government funds. Yet, this dangerous bill aims to eliminate this important, effective program that helps millions of beneficiaries nationwide better understand and navigate the increasingly complex Medicare program.

    This is the only program that provides free, unbiased, one-on-one Medicare coverage and benefits counseling, and with 10,000 Americans becoming Medicare eligible each day and SHIP services are needed more than ever. We ask you to join us in contacting your Congress people and urging them to support SHIP!

    Here’s a link to the National Council on Aging’s form to send an email to your Representative. They provide sample text, but please take the time to personalize your message with your experiences as a SHIP counselor or as a recipient of valuable Medicare information.

    Thank you for your advocacy, and please share this alert with others!

  • 06Jun

    Can a nursing home deny needed therapy services? Evict a resident for being “difficult”? Limit family members and friends to specified “visiting hours”?

    These are all good questions and unfortunately point to many common nursing home practices that are, in fact, illegal. In order to receive the best possible quality of care, a resident or resident’s family member should be familiar with the protections of the federal Nursing Home Reform Law, and understand how to use the law effectively. That’s why Justice in Aging wrote this resourceful guide, “20 Common Nursing Home Problems and How to Resolve Them“. Please review and pass on to others who will benefit from this knowledge.

    Also, join our free webinar with Justice in Aging on this topic on Thursday June 23, 2016 at 10 a.m.

  • 31May

    Part of being a health advocate, is learning and knowing what healthy aging means. What does it mean to you? This article from Seattle’s National Public Radio highlights an important point…that depression is not a normal part of aging…

    At the Greenwood Senior Center in Seattle, about two dozen older adults are gathered around a large table.

    There’s homemade bread being passed around, and some handouts related to today’s discussion. The people in this group are mostly over age 65. Some are widowed, some are divorced, and some have never married. All live alone.

    Carin Mack, a geriatric social worker, starts the conversation. The topic: loneliness and isolation.

    The Living Alone group, as it’s called, meets twice a month. The topic today is loneliness and isolation. Julia Robinson knows about this first hand.

    “Anytime you have a medical procedure the issue of living alone crops up,” Robinson says. “You’re supposed to have someone stay with you the first night and all that nonsense. What I found is the phone works well if you keep it charged.”

    It’s not just the practical challenges of living solo that the group wanted to talk about. There are emotional ones, too, like how to deal with loneliness.

    Beatrice Dolf says she has phone numbers of friends in her book that she hadn’t called in ages.

    “I think the tendency is not to call somebody unless we have something to talk about,” Dolf says.

    She learned it pays to take the first step and reaching out to them.

    “I found it takes loneliness away,” she says. “I do this frequently on the weekend, because the weekend is the time I feel it would be fun to do something, and I just call these people even if I haven’t seen them for years.”


    Carin Mack leads the Living Alone group.

    The group starts sharing ideas on how to spend their free time and ways to meet people.

    Mack, the social worker, started the Living Alone group 15 years ago. It was a small group, initially, but over the years, more people started coming.

    “People have lost that sense of community,” she says.

    Communities and activities give people reason to get out of the house. Mack says they anchor our lives. But for many older adults, there aren’t many anchors left.

    “The family might be gone, or they’re too busy,” Mack says. “They’re not in the workplace anymore; they haven’t developed maybe some kind of a passion either for community service or quilting or anything that you can think of that will be an anchor. And I think it definitely makes them vulnerable.”

    Mack says older adults living in isolation are vulnerable to elder abuse. It puts them at risk for cognitive decline or depression, which could lead to other medical problems requiring doctor visits or hospitalization.

    Public health officials are taking note. In Washington, elderly men have the highest suicide rate. And according to the Centers for Disease Control and Prevention, depression is a common problem among older adults, but it’s not a normal part of aging.


    James Hyde, who jokingly calls himself “Sir James”, attends the Living Alone group at Greenwood Senior Center.

    Back at the Living Alone meeting, the group talks about pets that keep them company. But if that’s not an option, James Hyde offered this suggestion: houseplants.  Hyde says his plants are like buddies. The group chuckles.

    “I know it’s strange,” he says, “but I don’t know much about plants other than I love them.”

    Hyde says his ex-wife and a good friend coach him on how to care for the plants. So far, he says, it’s working. “I talk to them and they’re doing super well! When I see a new sprout, I’m like, wow! They keep me company.”

    Someone then mentions she has a bunch of baby jade plants that are rooting. Would anybody like some? Immediately, hands went up.

    After the meeting, a few people linger to chat. Rose Hublitz is 64 and new to the group. Her friend suggested that she come to the senior center.

    “I tend to self-isolate,” Hublitz says, “and I’m looking for a place to meet and chat with people.”

    Hublitz says there are times when she wants to be alone, but other times, being alone hits her harder.

    “It’s evenings for me, where you want to share the day’s events with someone and there’s no one there,” she says.

    Thinking back to the discussion, she chuckles. “I am going to get a plant. I have no plants, and I am going to get one.”

    Hublitz says coming to the meetings has helped her. She felt welcomed.


  • 24May

    While we wish it was as simple as telling apples from oranges, Medicare Part B and Medicare Part D coverage is quite different in how they cover outpatient drugs. It depends on the drug, where you receive it, and whether you are in Original Medicare or have a Medicare Advantage plan. Understanding how Medicare covers drugs can help you address denials and avoid unnecessary expenses. Below are a few points to help in understanding this difference, summarized by the Medicare Rights Center in one of their Medicare Minute publications.

    Point 1: Understand how you get Medicare prescription drug coverage. You can get Medicare prescription drug coverage through a Part D stand-alone prescription drug plan or through a Medicare Advantage Plan that includes prescription drug coverage. The Part B benefit also covers certain prescriptions. You have the Part B benefit regardless of whether you have Original Medicare or a Medicare Advantage Plan.

    Point 2: Understand which part of Medicare covers which outpatient prescription drugs. Most outpatient prescription drugs are covered under Part D, as long as they’re on your plan’s formulary, which is the list of drugs they cover. Certain outpatient drugs are covered by Part B, however. For example, Part B should cover your flu shot. Antigens – a type of prescription drug often used to treat allergies – are also covered by Part B, not Part D. The general rule is that Part B covers drugs that usually can’t be self-administered, meaning you need a provider’s help to take or inject them. Part B also covers a limited number of prescriptions from the pharmacy (mainly oral anti-cancer drugs).

    Some drugs may be covered by either Part B or by Part D, depending on the situation. For example, if you use an insulin pump, you probably get your insulin and pump from a durable medical equipment supplier, and Part B will cover it. If you inject insulin using a needle, Part D will cover it. If you are a hospital outpatient, Part B should cover all medications that relate to the reason for your hospital visit; however, Part D will cover medications that you administer yourself and do not relate to the hospital visit.

    Your pharmacist, your provider, or your plan (when applicable) can help you understand your prescription coverage. For objective counseling and assistance, you can also contact your local Health Insurance Counseling and Advocacy Program (HICAP). HICAP can explain which part of Medicare should cover your drugs, depending upon your circumstances.

    Point 3: Understand the costs and coverage for your prescription drugs. Your costs and coverage depend upon which part of Medicare covers your drug. It also depends upon whether you are in Original Medicare or have Medicare Advantage. If you are in a Medicare Advantage Plan, your coverage and costs will depend upon what plan you have. If Part D covers your drug, make sure it is included in your plan’s formulary and that you use a preferred network pharmacy. Under Part D, you typically pay a set co-payment for your medications, after you meet a deductible. However, these amounts will vary depending on your plan and how much you have spent on prescriptions so far this calendar year.

    If Part B covers your drug and you are in Original Medicare, you or your supplemental insurance typically pay a 20 percent coinsurance, after meeting the Part B deductible. If you have a Medicare Advantage Plan, your out-of-pocket cost will vary based upon your plan. Those costs may also be higher than the 20 percent coinsurance under Original Medicare. If you get your medications from a pharmacy, make sure the pharmacy will submit claims for your Part B covered drugs to avoid unnecessary expenses.

    If Medicare denies coverage for a drug taken as a hospital outpatient, it may be that you can submit the charges to your Part D plan. Contact your plan to find out what steps to follow. You can also contact your SHIP for help understanding your coverage and addressing denials.

    If charges for medicines you didn’t receive show up on your Medicare statements, your Medicare number may have been used in a scheme to falsely bill Medicare. If you receive calls offering you a prescription drug discount card and requesting your bank account number, it is a scheme aimed at stealing your money. Contact our California Senior Medicare Patrol program (SMP) for help at 1-855-613-7080.

    Action steps to take:

    1) Make sure you understand which part of Medicare covers your prescription drugs.

    2) If you were denied coverage because your drug was billed to the wrong part of Medicare, contact your plan to find out what steps to follow.

    3) If you need help understanding Medicare’s prescription drug coverage or addressing denials, contact your local Health Insurance Counseling and Advocacy Program to discuss your options.

    4) If you receive suspicious offers or charges, contact our California Senior Medicare Patrol at 1-855-613-7080 to discuss and report potential abuse or fraud.

  • 10May

    Did you know that 1 in 10 Americans is affected by elder abuse? And that elders who have experienced abuse, even modest abuse, have a 300% higher risk of death when compared to those who had not been abused? (See NCEA data.) These are some very sobering statistics, yet they are not widely known! That’s why it’s important to spread awareness of this growing public health problem, that could affect any one of us if we’re blessed to live a long life into older adulthood. One way to do this is to promote the upcoming World Elder Abuse Awareness Day (WEAAD) on June 15.

    The National Center on Elder Abuse has a blog with several contributing writers on this topic and on spreading awareness for this day. One of the recent writers had the following suggestions on big and small ways to get involved and acknowledge the day:

    • Wear purple or a purple ribbon (and be prepared to talk about elder abuse if someone asks about your sartorial choices)
    • Post on Facebook or Tweet (#WEAAD2016) about elder abuse
    • Join the National Center on Elder Abuse’s “Finish this Sentence” campaign (“Together we can fight elder abuse by…”)
    • Ask your elected officials to sign a proclamation acknowledging WEAAD (here’s a great resource for a proclamation: Elder Abuse: What You Must Know)
    • Write a letter to the editor of your local newspaper (even if it doesn’t get published, you’ve probably educated the editor about the issue)
    • Host an event that brings people together – it can be educational, fun, inspiring, and awareness-raising. For ideas, check out our WEAAD Event map and be sure to add your event!

    Together our efforts can raise awareness and educate the public, professionals, policy makers, and the press about elder abuse. Thank you for your participation in #WEAAD2016!

    NOTE:  You can also join Administraion for Community Living for a webinar on “Getting the Word Out: Creating Compelling Communications for WEAAD” tomorrow, Wednesday, May 11, 11:00 AM (Pacific). Learn about working with the press, how to use social media, and what the research says about effective messages about elder abuse. No registration required just join at the time of the webinar.

  • 05May

    Fraudsters are! The article below takes a close, shocking look at the rising fraud specific to Medicare’s Part D prescription drug program, and the devastating effects it has on Medicare AND beneficiaries. Spending in the Part D program has more than doubled in 8 years, from $51 billion in 2006 to $121 billion in 2014, and that’s not all due to a legitimate increase in use of the benefit and is a significant tax on the financial health of the program. Part D fraud can also have direct harmful effects on beneficiaries as noted in some of the Office of Inspector General’s recent convictions. For example, several providers have actually harmed beneficiaries through false diagnoses and giving them unnecessary drugs, many of them high cost and high risk drugs for cancer or HIV.

    If you hear of or experience any such fraud as described below, please report it to our California Senior Medicare Patrol at 855-613-7080. See our fraud section for more info on other types of Medicare fraud and prevention tips.

    Fraudsters Cash in on Medicare Prescription Drugs: HHS Inspector General Takes Aim

    –By Jolie Crowder, MSN, RN, CCM with Health Benefits ABCs

    According to the Centers for Medicare and Medicaid Services’ (CMS) Fast Facts, the Medicare Part D program, which provides coverage for prescription drugs, spent $78.1 billion on 1.4 billion prescriptions for over 37 million people in 2014. The Health & Human Services Office of Inspector General (OIG) puts total Part D costs for 2014 in the neighborhood of $121 billion. (See Figure 1, below.) That’s a lot of zeros. That’s also a juicy opportunity that Medicare scam artists can’t seem to pass up.

    Nuritsa Grigoryan, an OIG fugitive convicted of five different health care fraud-related charges, worked with coconspirators to generate thousands of prescriptions for expensive antipsychotic medications. Patient recruiters working for Grigoryan lured Medicare beneficiaries with cash payments, had them fill phony prescriptions, and then returned them to Grigoryan’s company. The outfit also stole Medicare identities to fill unneeded prescriptions. The “pill mill” scheme was estimated at $20 million.

    Fraud is not only costly, it can hurt. In 2015, Detroit oncologist (cancer specialist) Dr. Farid Fata was convicted of providing unnecessary cancer treatments, iron infusions, and other injections and infusions to 553 patients who never needed them. Fata also set up an in-house pharmacy, Vital Pharmacare, and required all of his patients to fill their prescriptions with him instead of using other retail pharmacies. While most injected and infused drugs for cancer are billed to Medicare Part B, many drugs taken by cancer patients for treatment or to control side effects are covered under Part D. Many of Fata’s patients suffered serious, life-altering side effects as a result of unnecessary treatments. The estimated cost to Medicare and other insurers was approximately $34 million.

    A big Medicare prescription drug fraud conviction in 2015 was against a Michigan pharmacy. Six convicted pharmacists took unused patient drugs from 800 nursing and adult foster homes, returned them to the pharmacy supply, then redispensed the medications to other patients. They billed insurers over $79 million for the misbranded and adulterated drugs, some of which were the wrong dose or wrong drug.

    According to testimony from Ann Maxwell, an OIG assistant inspector general, to the U.S. House of Representatives on July 14, 2015, Part D investigations marked $720 million for return to Medicare. This is the result of 370 criminal and civil actions from fiscal years 2012-2014. A related report noted that as of May 2015 the OIG had 540 pending Part D complaints and cases and had seen an increase of 134 percent since 2010. These civil and criminal actions are likely just the tip of the iceberg.

    As a result, the OIG FY 2017 budget justification listed Medicare prescription drug diversion and fraud among its priorities. The budget includes a request for an additional $68 million. These funds would help pay for an additional 172 more full-time equivalent employees to assist with Medicare and Medicaid oversight. The OIG uses funds to investigate and prosecute criminal and civil cases, conduct audits and evaluations, and offer legal guidance and recommendations on Medicare and Medicaid programs.

    Examples of past OIG findings include:

    • Identification of 1,600 Medicare beneficiaries who received $32 million in prescriptions for HIV drugs who didn’t have an HIV diagnosis in their medical records, received an excessive supply of drugs, or obtained drugs from a large number of pharmacies.
    • Over $1 billion in Part D plan payments made even though evidence of a legitimate Medicare provider identifier didn’t exist, including prescriptions written for medications by massage therapists and athletic trainers who aren’t licensed to write drug prescriptions.
    • Medicare beneficiaries are often the victims but can also be the perpetrators of fraud. Cases include beneficiaries who took cash payments or incentives in exchange for filling prescriptions they didn’t need or let doctors perform unnecessary medical procedures in exchange for narcotics.
    • While federal law doesn’t allow refills for schedule II drugs (like narcotic medications), Medicare was billed for $25 million in refills for these drugs.
    • Inadequate systems are in place to prevent payments for prescriptions that continue to be filled after Medicare beneficiaries have died.

    These findings, and others, were accompanied by recommendations to CMS to strengthen program integrity and fraud detection efforts.

    Tom O’Donnell, an assistant inspector general, stated that OIG concerns related to Part D are aimed at costs to taxpayers, medical identity theft, patient harm, and rising opioid (narcotic) deaths. Opioid abuse and diversion was also listed as a priority in the FY 2017 budget report.

    According to the OIG budget justification, CMS is the single largest health insurance program in the country, accounting for $836 billion in spending for the Medicare and Medicaid programs in 2015. These numbers will rise as baby boomers continue to age into Medicare and Medicaid programs continue to expand. The OIG predicted an additional 18 million people enrolled in Medicaid by 2018. CMS predicts the number of Medicare beneficiaries will hit 57 million by the end of 2016, with 41 million of those people taking advantage of Medicare Part D insurance.

    As Medicare enrollment numbers swell, so, too, will the cost of the Medicare Part D program. Fraud fighters need to be poised to thwart crooked providers looking to take advantage of unsuspecting beneficiaries and steal from the Medicare Trust Fund.

  • 26Apr

    Knowing about and using Medicare’s covered preventive care and screening services can protect your health and save you money. Below is a review from the Medicare Minute program.

    Point 1: Know which preventive and screening services Medicare covers.

    For those new to Medicare, Medicare covers a one-time Welcome to Medicare visit within the first 12 months you have Part B. You are also eligible for an Annual Wellness Visit to manage your health care. Medicare’s more specific preventive services that help detect potentially serious conditions include exams, shots (such as flu shots), lab tests, and screenings (such as HIV screenings). To help you take care of your own health, it also covers programs for health counseling (such as nutrition and smoking cessation counseling), and education (such as diabetes self-management training).

    Some preventive care services are covered once every few years, while others may be covered more frequently if they are needed to diagnose an illness or condition. Speak to your provider about scheduling times to receive preventive services. It is important to know that Medicare covers preventive care services only if they are truly preventive in nature. If your doctor identifies a health issue during your preventive care visit and needs to provide care to address it, you may be responsible for certain costs, such as the Part B deductible and coinsurance. For more information on Medicare’s preventive care services, contact your State Health Insurance Assistance Program (SHIP).You can also call 1-800-MEDICARE (1-800-633-4227), or visit to find out if Medicare covers your test, service, or item.

    Point 2: Know how to prepare for your Welcome to Medicare and Annual Wellness Visits.

    Medicare covers a one-time, initial examination (also known as the Welcome to Medicare preventive visit) within the first 12 months you enroll in Part B. All people new to Medicare qualify for this visit. After you’ve had Part B for longer than 12 months, you can begin receiving Annual Wellness Visits. During each visit your provider will ask you to fill out a questionnaire, called a “Health Risk Assessment.” Answering these questions can help you and your provider develop a personalized prevention plan to help you stay healthy and get the most out of your visit. Note that you cannot receive your Annual Wellness Visit within the first year you are enrolled in Medicare or within the same year you have your Welcome to Medicare exam.

    Before your visit, make a list of illnesses that run in your family, surgeries, medical problems, treatments, injuries, allergies, and vaccines you’ve had, especially if you’re seeing a new provider. You should also make a list of all the medicines, vitamins, and supplements you use, including the doses and how often you take them. Remember to bring your lists with you and discuss them with your provider during your visit. Speaking with your provider is one of the best ways to make sure you receive the preventive and screening services you need.

    Point 3: Know the type of providers you should see.

    Original Medicare, you should receive preventive care services from providers who accept assignment. Assignment is an agreement by your provider to accept the payment amount Medicare approves for your health service or item, and not to bill you for any more than the Medicare- approved deductible and coinsurance. Part B now pays for most covered preventive and screening services at 100 percent of Medicare’s approved amount, so if you receive these services from a provider who accepts assignment, you will have no out-of-pocket costs. If you are in a Medicare Advantage Plan, your plan should not charge you for preventive care services that are free for people with Original Medicare, as long as you see in-network providers. In-network providers accept your Medicare Advantage Plan as insurance. If you do not see a Medicare-participating provider who accepts assignment or an in-network provider, charges will typically apply to your preventive care service.

    Note: You play a vital role in protecting the integrity of Medicare and can help detect fraud by carefully reviewing your summary of claims from Medicare or your plan. Always call your provider’s office to ensure they did not make a billing mistake. If your call is unsuccessful or if your provider is uncooperative, call our California Senior Medicare Patrol (SMP) at 1-855-613-7080.


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