Troubleshooting when your provider refuses to file a claim

…sign an Advance Beneficiary Notice (ABN). Before signing an ABN, ask additional questions to find out whether your provider considers the service to be medically necessary, and whether they will…

MSA plan basics

…and B to join an HDHP and an MSA, and generally you will continue paying your Medicare Part B premium. Some MSA plans charge an additional premium, on top of…

SNP basics

…rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs. Some SNPs offer additional benefits, such as vision and hearing care. Eligibility and…

Explanation of Benefits (EOB)

…only receive an EOB if you have Medicare Advantage or Part D. An EOB is not the same as a Medicare Summary Notice. It is also important to remember that…

Care coordination after a hospital or skilled nursing facility (SNF) stay

…coordination after a hospital or SNF stay at 80% of the Medicare-approved amount if you receive the service from a participating provider. You pay a 20% coinsurance after you meet…

Maximum out-of-pocket limit

…such as a PPO, your plan will set two annual limits on your out-of-pocket costs. One limit is for in-network costs and the other is for combined in-network and out-of-network…

VA drug coverage and Part D

…pay at VA pharmacies and facilities, and Part D will only pay at pharmacies in your plan’s network. If you have questions about VA benefits and coverage, contact the Department…

Appeal basics

…level of appeal, and you have the right to continue appealing if you are not successful at the first level. Be aware that at each level there is a separate…

PFFS basics

…service from an out-of-network provider, requesting an advance organization determination can help you avoid unexpected denials. Contact your plan for information about requesting an advance organization determination. Medicare PFFS plans…

PPO basics

…rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs. Some PPOs offer additional benefits, such as vision and hearing care. Eligibility and…