Day 1SHINE Program

Certification Training

Welcome! SHINE = Serving the Health Insurance Needs

of Everyone…..on Medicare

Started in Massachusetts 1985

Partially federally funded since 1992

Part of national SHIP= State Health Insurance Assistance Programs

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State Organization

Executive Office of Elder Affairs

• State SHINE Director: Cindy Phillips

• Assistant State Director:

• State Field Operations Manager/Training Coordinator: Annie Toth

• State Program Coordinator: Jessica Gutierrez-Dutra

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Regional Organization

Regional SHINE Office:

Regional SHINE Director:

SHINE Program Assistant:

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Overall Goal

To ensure that Medicare beneficiaries have access to accurate, unbiased information regarding health insurance and health care options

To help people help themselves

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Examples Of What We Do Assist people in understanding their Medicare

and MassHealth rights and benefits Educate people about all of their health

insurance options Screen for public benefits (State and Federal) Assist with applications Resolve problems with insurances; Medicare,

MassHealth6

Training

Certification training

Mentoring

Monthly training meetings

October: Review and training for Medicare’s annual Open Enrollment

Recertification review every spring

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We’re Here To Support You Regional Office Staff

•Director: name and phone number•Assistant Director: name and phone number

SHINE Counselor Website•shinecounselor.800ageinfo.com

Common ResourcesSHINE newsletter: The Beacon

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Medicare Part A & Part B

Medicare Federal health insurance program for:

• Individuals over age 65 • Individuals under age 65 with a disability

Enacted into law 1965, Title XVIII of the Social Security Act; Effective July 1st , 1966

• Entitlement program

Never intended to cover 100% of healthcare costs• NOT a comprehensive health insurance program

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Medicare

Medicare only pays for services which are reasonable and medically necessary for the treatment and diagnosis of an accident or illness

Even when “medically necessary”, there are gaps in Medicare coverage and the beneficiary must pay a portion of the medical expenses

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Federal Agencies Involved With Medicare

Department of Health and Human Services (DHHS)

Administers Medicare through its divisions, CMS and SSA

Centers for Medicare & Medicaid Services (CMS)Determines policyBudgets for MedicareIssues regulationsSets provider feesEstablishes agreements with contractors

Social Security Administration (SSA)

Processes Medicare applicationsIssues Medicare cardsProvides public informationDetermines entitlement to Medicare benefits

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Medicare Card Each Medicare Claim Number is unique to the

beneficiary The number has nine digits and a letter Card lists effective dates for Part A & Part B

Medicare Claim #.Letter attached to

the claim # indicates how the individual qualifies

for Medicare

Part A & B Effective

Dates

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Four Parts of Medicare

FYI: Part A & B called “Original Medicare”

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Part A Hospital

Insurance

Part B Medical

Insurance

Part C Medicare

Advantage Plans This

includes Part A, Part B , &

sometimes Part D

Part D Medicare

Prescription Drug

Coverage

Original Medicare Health care option run by the federal government Provides Part A and/or Part B coverage See any doctor or hospital that accepts Medicare

Beneficiary pay’s: • Part B premium (Part A is usually premium free)• Deductibles, coinsurance, or copayments

Can join a Part D plan to add drug coverage

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Eligibility: 65+ Age 65 +

• Must be a citizen/lawfully permitted resident for 5 years AND• Qualify under ONE of the following 3 conditions:

Be entitled to receive Social Security benefits and contributed to the Medicare Tax (having earned 40 credits from about 10 years of work)

Be entitled to receive Railroad Retirement Act retiree benefits Be a spouse or ex-spouse (marriage lasted at least 10 years), widow or

widower (age 65+) of a person who qualifies for Social Security or Medicare benefits

FYI: Increase in age for full Social Security benefits does NOT affect Medicare

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Eligibility: Under 65 Under 65

•Individuals of any age entitled to Social Security (SSDI) or Railroad Retirement Disability Insurance benefits for 24 months

•Individuals with ESRD (End Stage Renal Disease)

•Individuals with ALS (Amyotrophic Lateral Sclerosis, aka “Lou Gehrig’s Disease”)

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Enrolling In Medicare Social Security processes Medicare

applications

Common myth that Medicare will know when a person turns 65. This is NOT TRUE

A person must notify Social Security of their intent to enroll in Medicare•Medicare and Social Security are two

entirely separate entitlement programs18

Medicare Premiums Individuals or their spouses who have paid into the Medicare

Program and worked at least 40 quarters DO NOT pay a Part A premium • This is called premium-free Part A

EVERYONE pays a Part B premium

Part B premiums are often deducted from the Social Security check • If not collecting Social Security, will be billed every 3 months

Part A & B premiums may change annually

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2014 Part A and B Premiums Part A

• People that don’t qualify for premium-free Medicare may enroll voluntarily and pay a monthly premium for Parts A & B

• Part A Premiums 0-29 work quarters= $426/month 30-39 work quarters= $234/month

Part B• Premiums based on annual income (past 2 years tax returns)• Part B Premiums

Ind < $85,000 & married < $170,000= $104.90/month Increases with higher income

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Three Enrollment Types

Automatic Enrollment

Standard Enrollment

Voluntary Enrollment

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Automatic Enrollment For individuals already receiving Social Security benefits

Beneficiary receives automatic enrollment notice 3 months before 65th birthday month (4 months before if birthday on 1st of month - Medicare begins 1st of month prior to birthday month)

Individuals with a disability receive notice 24 months after Social Security Disability payments began

Individual must sign and return card if she/he does NOT want Part B

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Standard Enrollment Individuals not yet collecting Social Security benefits prior to age

65 MUST NOTIFY Social Security of intent to enroll in Medicare (enrollment is NOT automatic)

Initial Enrollment Period (IEP): 7 month period encompassing the full 3 months preceding person’s 65th birthday, the month of the 65th birthday, and the full 3 months following the 65th birthday• Must sign up during the first 3 months of IEP to get Part B

coverage effective 1st of birthday month

If individual waits to sign up until last four months of IEP, Part B start date will be delayed

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Voluntary Enrollment For individuals who don’t have sufficient Social Security work credits (40

quarters/10 yrs)

Can purchase Part A

Must be an American citizen OR an alien lawfully admitted for permanent residence and resided in US for 5 consecutive years

Can purchase Part A AND Part B OR Part B only

• CANNOT have Part A alone as a voluntary enrollee

• Having Part B only does NOT meet the minimum essential coverage requirement under the Affordable Care Act and beneficiary may have to pay a penalty

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Three Enrollment Periods Initial Enrollment Period (IEP): 7 months surrounding 65th

birthday month (month earlier if birthday on 1st of month)• Date of enrollment determines effective date of Medicare

Special Enrollment Period (SEP): 8 months following loss of coverage from “active” employment

General Enrollment Period (GEP): Jan 1st – Mar 31st of each year • July 1st effective date

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Initial Enrollment Period

Enrollment Period

JAN

FEB MAR APR

MAY

JUNE

JULY AUG

SEP OCT NOV

DEC

If you enroll during:

3 months before

the birthday month

Month of b-day

 

3 months after the birthday

month

   

MEDICARE STARTS:

JULY 1

AUG 1

OCT 1

DEC 1

JAN 1

   

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Initial Enrollment Period: When Part B Starts

If beneficiary enrolls in this month of IEP:

Medicare Part B Coverage Starts:

1 The month beneficiary becomes eligible for Medicare

2 The month beneficiary becomes eligible for Medicare

3 The month beneficiary becomes eligible for Medicare

4 One month after beneficiary enrolls

5 Two months after beneficiary enrolls

6 Three months after beneficiary enrolls

7 Three months after beneficiary enrolls27

Delaying Part B Enrollment Individuals may choose to have just Medicare Part A while they are

ACTIVELY working or are covered under a spouse who is ACTIVELY working

Once ACTIVE employment coverage has ended, must take Part B coverage within 8 months to avoid a penalty (there is no 8 month period for retiree coverage)

If the employer has <20 employees or <100 employees if the beneficiary has a disability, then the individual may need Part B because Medicare should pay first and Employer Group Health Plan (EGHP) second• Beneficiaries should confirm with their employer if Part B is

needed28

Consolidated Omnibus Budget Reconciliation Act (COBRA)

When employment and/or EGHP ends, individual can elect COBRA coverage which continues health coverage through employer’s plan (in most cases for only 18 months) and probably at a higher cost

If elect COBRA, should NOT wait until COBRA ends to enroll in Part B or will pay a late enrollment penalty and will have to wait until the next General Enrollment Period to enroll• Must sign up for B within the first 8 months (SEP after ACTIVE

work) of COBRA to avoid penalty

Should enroll in Part B because Medicare pays first and COBRA pays second

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Late Enrollment Penalty Penalty for Part A: Capped at 10% of premium and goes away

after penalized for twice the length of time the person delayed enrollment• Only for voluntary enrollees (paying for A) who don’t enroll in

Part A when initially eligible

Penalty for Part B: 10% of premium for each full 12 month period the individual delayed enrollment

• Penalty for Part B not capped and is a lifetime penalty except: Under 65 beneficiaries with a penalty will have the

penalty removed and will have a “clean slate” when they turn 65

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Initial Enrollment Example

Mr. Kaplan is turning 65 on August 29th. His first opportunity to enroll in Medicare based on his age (not disability) is May 1st . His initial enrollment period lasts until November 30th. The month he enrolls determines the effective date of coverage

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Special Enrollment Example

Mrs. White continued working after age 65 and was covered by an employer-related group medical plan. She chose to enroll in Part A when she turned 65 (because she does not have to pay a premium) but delayed Part B enrollment. Her Special Enrollment Period will be the 8 month period following the month she is no longer covered by her employer’s plan or her employment ends, whichever comes first

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General Enrollment Example

Mr. Santos retires at age 65 and declines Medicare Part B. At age 70, Mr. Santos wants to purchase Part B. He must wait until the General Enrollment Period (January 1st - March 31st ) for coverage that begins the following July. Mr. Santos will have a 50% penalty added to his Part B premium (10% for each 12 month period he delayed Part B enrollment)

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Medicare Part A(Hospital Insurance)

Medicare Part A (Hospital Insurance)

Part A Covers:•Inpatient hospital care•Care in a skilled nursing facility (SNF)•Home health care•Hospice care•Blood

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2014 Part A Out-of-Pocket Costs Inpatient hospital care • Days 1-60: $1216 deductible (per benefit period)

• Days 61-90: $304 per day • Days 91-150 (Lifetime Reserve Days): $608 per day • All additional days: All costs Skilled Nursing Facility care• Days 1-20: Nothing• Days 21-100: $152 per day Durable Medical Equipment• 20% of approved amount Hospice Care• Small co-pays for inpatient respite care and drugs Home Health Care• Nothing

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Inpatient Hospital Coverage Covered days in a hospital

• 90 renewable days Medicare pays 100% for days 1-60 in a benefit period* AFTER

beneficiary pays Part A deductible Daily co-payment for days 61-90 in a benefit period

• 60 non-renewable days Daily co-payment for days 91-150 (lifetime reserve days)

A benefit period is a period of time that Medicare pays for a person’s care in a hospital or SNF. It begins when a beneficiary goes into the hospital and ends when she/he has been out of the hospital or skilled nursing facility for 60 consecutive days

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Inpatient Hospital Coverage

Inpatient hospital coverage requirements:

•Doctor determines it is medically necessary•Care requires being in a hospital•Hospital participates with Medicare •Utilization Review Committee of the

hospital approves the stay

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Inpatient Hospital Covered Services

Services covered during a hospital stay

•Semi-private room and all meals•Special care units•General nursing services•Drugs administered in the hospital•Lab tests •Radiology services

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Inpatient Hospital Covered Services, cont.

Services covered during a hospital stay

•Medical supplies (casts, surgical dressings)•Operating and recovery rooms•Rehabilitation services (physical therapy)•Use of appliances (wheelchairs)•Blood transfusion (after first 3 pints)

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Inpatient Hospital Services NOT Covered

Services NOT covered during a hospital stay

•Physician services (Part B)•Personal convenience items•Private room (unless medically necessary)•First three pints of blood•Private duty nursing

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Hospital Coverage

Other hospital coverage• Care in a psychiatric hospital

190 lifetime days for Inpatient care

• Care in a foreign hospital Medicare usually does NOT pay for care outside

the United States Medicare MAY pay for qualified care in a Mexican

or Canadian hospital under special conditions

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Skilled Nursing Facility (SNF) Coverage

Must be a Medicare participating facility

Physician must certify that patients needs and receives daily skilled care from RN or therapist

Prior Inpatient hospital stay of 3 days or more (72 hours as an admitted patient)• An overnight stay doesn’t always mean an Inpatient day (can be observation

day)• Break in skilled care that lasts more than 30 days will require a new 3 day

hospital stay to qualify for additional SNF care

Admitted to SNF within 30 days of discharge from hospital

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SNF Covered Days

100 renewable days

Days 1-20: Medicare pays 100% in a benefit period

• Except convenience items

Days 21 – 100: Daily co-payment

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SNF Covered Services

Services covered in a SNF

•Semi-private room•All meals (including special diets)•General nursing services•Rehabilitation services•Drugs furnished by the SNF during the stay•Use of medical equipment and supplies

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SNF Services NOT Covered

Services NOT covered in a SNF

•Physician services (Part B)•Personal convenience items•Private room (unless medically necessary)

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Medicare Part A: Benefit Period Example

Benefit period Example 1: Mr. Jones is hospitalized as an Inpatient on January 5th and remains in the hospital until January 12th. Mr. Jones has used 8 of his hospital days in the benefit period. (Day of discharge counts.) Mr. Jones has 82 hospital days left in the benefit period

• How much would Mr. Jones have to pay for his hospital stay?

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Medicare Part A: Benefit Period Example

Benefit period Example 2: Mr. Jones is discharged from the hospital on

January 12th and transferred to a SNF where he remains until February 9th. Mr. Jones used 29 days of his SNF benefit. He has 71 days left

• How much would Mr. Jones have to pay for his Skilled Nursing Facility care?

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Home Health Benefit

Home health benefit coverage requirements:• Must need skilled care on intermittent basis• Home health agency must be Medicare-approved• Physician must authorize treatment and have face-to-face

meeting with beneficiary prior to start• Beneficiary must be “homebound” (see next slide)• Medicare pays 100% for all covered and medically

necessary home health servicesEXCEPTION: Medicare pays 80% of durable equipment

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Homebound Homebound means normally unable to leave home or that

leaving home is a major effort and must:• Require a supportive device, or• Use of special transportation, or• Require the assistance of another person

Can leave home, but it must be infrequent and for a short time.

• Examples: Leave to get medical care (may include adult day care), attend a religious service, get a haircut

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Home Health Benefit: Covered Services

Services covered by home health benefit

•Skilled nursing care•Physical, occupational, or speech therapy•Medical social services (dietary counseling)•Care by home health aide (bathing, changing

dressing)•Medical supplies•Equipment (20% co-insurance)

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Home Health Benefit: Services NOT covered

Services NOT covered by home health benefit

•Drugs•Homemaker services•Home delivered meals•Personal care (without skilled care)

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Hospice Hospice Coverage

•Physician must certify that beneficiary is terminally ill and expected to live 6 months or less

•Beneficiary has elected to receive comfort and pain relief care from Hospice instead of medical treatment for cure

•Care is provided by Medicare certified hospice program

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Hospice

Covered “benefit period” for Hospice Care•Two 90-day periods•Then unlimited 60-day periods•Face-to-face meeting with doctor required

While receiving Hospice Care•Medicare pays 100% of most services•Beneficiary only pays small co-pays ($5 or less) for

outpatient drugs and respite care54

Blood

Coverage of blood

•Medicare pays 100% after the first 3 pints of blood

•The 3 pint blood deductible can be met under Part A or Part B Won’t have to pay for it or replace blood if hospital

gets it free from a blood bank

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Utilization Review Committee Reviews patient stays in hospitals and SNF’s to determine if

patient meets Medicare standard for needing care in hospital setting

• Each patient’s doctor must satisfy the Utilization Review Committee (URC) that patient meets admission criteria and continues to need acute hospital level of care

Has authority to terminate Medicare’s obligation to pay for medical services in hospital or SNF

Determines patient time of discharge

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Hospital Discharge Discharge Plan

• Beneficiaries should be an active part of their discharge plan

• Beneficiary should be given written discharge plan at least 24 hours prior to discharge

• Beneficiary signs plan to acknowledge receipt (Signature does not mean beneficiary agrees the plan is appropriate)

• If unsatisfied with plan, the beneficiary can appeal Beneficiary should ask for written “Notice of Non-

Coverage” and appeal if appropriate to Dept. of Public Health

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Medicare Part A Review Review

1.What are the two major federal agencies involved with the Medicare Program and what is each of their roles?

2.Who can enroll in Medicare?

3.When can someone enroll in Medicare?

4.Does someone have to enroll in both parts of Medicare (A & B)?

5.What is a benefit period?

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Medicare Part B (Medical Insurance)

Medicare Part B (Medical Insurance)

Physicians’ Services Outpatient hospital services Durable medical equipment Prosthetics, orthotics, and supplies Ambulance Home health care (if not Part A) Blood (if not Part A)

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Medicare Part B: Important Terms

Medicare approved amount: Fee Medicare sets for Medicare covered service

Excess charges: Amount owed by beneficiary above the Medicare approved amount. In other states, there is a limit on excess charges of 15%

Ban on Balanced Billing: Massachusetts has a law prohibiting excess charges by physicians

Accepting Assignment: Accepting the Medicare approved amount as payment in full

Participating Provider: Signing an agreement saying you agree to accept assignment for all beneficiaries in all cases (non-participating – less important in MA)

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2014 Part B Out-of-Pocket Costs

Monthly Part B Standard Premium• $104.90/monthPremiums based on modified adjusted gross income for an

individual; those with higher annual incomes pay higher Part B premiums

Annual Deductible• $147

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2014 Part B Out-of-Pocket Costs, cont.

After the yearly deductible is met, beneficiary pays:• Doctor office visits: 20% co-payment • Diagnostic tests: Nothing• Outpatient therapy: 20% co-payment• Outpatient mental health: 20% co-payment• DME: 20% co-payment PLUS balance on bill

DME is sole area in which the provider can bill over and above the Medicare-approved amount (“Balance Billing”)

• Emergency Ambulance: 20% co-payment• Outpatient Hospital Services: Fixed amount determined by

Medicare

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Physician Services Physicians’ services covered

• Exams DOES NOT include routine annual physicalsWelcome to Medicare Exam

1x only exam within first 12 months of joining Part BAnnual Wellness Visit

Discussion with doctor to develop prevention plan to improve health, routine measurements height, weight, blood pressure

• Medical and surgical procedures, anesthesia, diagnostic tests and procedures

• Radiology and pathology services (in or out of the hospital)

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Physician Services, cont. Physicians’ services covered, cont.

• Drugs that cannot be self administered• Blood transfusions• Second opinion about recommended surgery

Physicians’ services which may be partially covered:• Chiropractor’s services• Podiatrist’s services• Optometrist’s services• Dentist’s services

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Physician Services

Physicians’ services NOT covered:

•Most routine physical exams and tests related to such exams

•Most routine foot care

•Exams for the fitting of hearing aids

•Exams for eyeglasses (except cataract related)

•Most routine dental care or false teeth

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Physician Services Physicians’ services NOT covered, cont.

• Acupuncture

• Cosmetic surgery (unless related to a degenerative disease or accident)

• Experimental medical procedures

• Any other service not considered by Medicare to be medically reasonable or necessary

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Sample of Medicare’s Preventive Benefits

Bone mass density testing Annual prostate cancer screening test Colorectal cancer screening Blood sugar testing equipment and training for managing

diabetes Immunization (flu, pneumonia and hepatitis B) Annual Screening Glaucoma Screening for people at high risk Cardiovascular Screening Blood Tests Diabetes Screening Tests

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Outpatient Services Outpatient hospital services:

•Partial hospitalization services, day surgery, radiology, stitches, cast application

•Clinical diagnostic lab services

•Orthotics, prosthetics, take home surgical dressings

•Chronic dialysis

•Outpatient rehab services (physical therapy, speech therapy, pathology, occupational therapy)

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Outpatient Mental Health Services

Medicare covers treatment by following providers:• Doctor, clinical psychologist, clinical social worker, clinical

nurse specialist, nurse practitioner, physician’s assistant

Medicare covers Outpatient mental health services at the following settings: • Clinic, doctor’s office, other therapist’s office, Outpatient

hospital department (partial hospitalization), community mental health centers

Partial Hospitalization:• Structured program of active treatment more intense than

care in a therapist’s or doctor’s office70

Ambulance Coverage Medicare covers ambulance service when

transport in another vehicle would endanger health

Will pay for transport from home to hospital/SNF or from hospital/SNF to home

Medicare will NOT pay for ambulance used as routine transportation

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Durable Medical Equipment (DME)

Medicare helps pay for DME if:

•It is prescribed by a physician•It is medically necessary•It fills a medical need (more than

convenience)•It is appropriate for use in the home•It can be used over and over again

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Durable Medical Equipment

What Medicare pays for DME:

•Medicare pays 80% of Medicare approved amount

• If the supplier accepts assignment, beneficiary pays 20%

• If supplier does NOT accept assignment, beneficiary pays 20% PLUS difference between what Medicare approves and supplier charges

•Supplier is required to bill Medicare

•Beneficiary can buy or rent DME

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Medicare Part B Review

Review

1. What kinds of services does Part B cover?

2. What out of pocket expenses does a beneficiary have for Part B services?

3. What does accepting assignment mean?

4. What is a participating provider?

5. What are excess charges?

6. What is the Ban on Balanced Billing?

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Medicare A/B Quiz

1. Describe Medicare’s Enrollment Types

2. Mr. Hoover comes to ask about his mother’s hospitalization. His mother has been hospitalized for 62 days. His mother has no insurance other than Medicare.

a) After Medicare pays, what part of the bill is her responsibility?b) If she is discharged, but is readmitted 10 days later and stays

for 10 days, what additional amount of money will she owe?c) If she stays an additional 40 days instead of 10 days, what

additional amount of money will she owe?

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Medicare A/B Quiz

3. List the gaps in Medicare Part B coverage

4. Mr. Smith comes to see you at the Council on Aging (COA) office. He will be retiring soon and living on a limited income. His understanding is that he can get by with just Medicare A+B coverage.

• What would you tell him about having Medicare A+B coverage only?

3. What is the current monthly premium for Medicare Part B?

4. Medicare does cover an annual physical: True or False

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Case Study 1:Hal

Hal will celebrate his 65th birthday in a couple of months. He just received his Medicare Initial Enrollment Package from the Social Security Administration. While he has a general understanding of Medicare Part A, Hal doesn’t feel well informed about Medicare Part B. • What information would you provide Hal?

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Case Study 2:George Bell

George Bell is a 64 year old man who will soon be reaching his 65th birthday. George is so busy with a full-time career that his plans for retirement are far in the future. George will continue employment with a major corporation beyond his 65th birthday. • What should he do about Medicare enrollment

and his current group health insurance?

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Case Study 3:Agnus

Agnus is 64 years old and has been divorced for 15 years. Agnus married soon after high school and was a full-time homemaker. Until 5 years ago, Agnus had never worked outside the home. For the past 5 years she has worked for the Red Dye Company. She will be retiring in 4 months when she turns 65. The benefits administrator of the Red Dye Company told Agnus that she will not be eligible for Social Security or Medicare since she has not worked for a full 10 years.

• Is this true?• What would you tell Agnus?

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Case Study 4:Sam Pan

Sam calls for assistance with understanding Medicare. He tells you he is 59, has been on SSDI for 23 months and will be eligible for Medicare in a couple of months. From what he could figure out, he understands he can sign up for Part A but does not need to enroll in Part B at this time because he is covered under his spouse’s coverage. His spouse, John, works full-time and has excellent coverage for both of them through his employer plan. John is 63 and plans to retire in 3 years. They will then have the option of the company’s retiree coverage, so Sam plans to pick up Part B at that time. He wants confirmation that he’s correct in his understanding of Medicare.

• What information would you provide to Sam?

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Case Study 5:Leann Washington

Leann Washington lives in Massachusetts. She goes to see Dr. Franklin in her town who does not accept assignment. Ms. Washington is required to pay the entire bill of $150. When she receives the Medicare Summary Notice (MSN), she notices that the Medicare approved amount is $100. She wants to know what the exact amount is that Medicare will pay and the amount that is her responsibility? She explains that she has already met her Part B annual deductible.

• What would Ms. Washington owe if she lived in Florida?

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Case Study 6:Mrs. Joan Carroll

Mrs. Carroll called the SHINE office for help on June 1st for help with a problem. Mr. Carroll, much to his wife’s dismay, refused to sign up for Medicare Part B when he was initially eligible. He is very proud of the fact that he has only spent $1,000 for medical care in the last 3 years. As he repeatedly told his wife, that is cheaper than paying the Part B premium for the last 3 years.

Mr. Carroll now needs to have surgery. His wife is beginning to realize some of the problems involved as a result of an uninformed decision he made three years ago.

•List the problems he now will face

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Case Study 7:Ruth Rose

Ruth Rose comes to see you at the SHINE office. She says that she will be 65 in 5 months. She will continue to work and is covered by her employer group plan. She does not want to sign up for Medicare. However, her friend Rhoda told her that if he does not sign up now, she will not be able to get Medicare later.

• What information would you give her?

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Homework Assignment

Call Medicare (1-800-633-4227) with the following question:

“I (or my client) am having day surgery. What is my financial obligation/responsibility?”

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