Welcome Seniors-

Guide to Medicare Benefits (Download the Guide in PDF)

To our Patients on Medicare, welcome to Pronger Smith MedicalCare.

In an effort to assist our patients in maximizing the benefits to which they are entitled from Medicare, we have created Pronger Smith MedicalCare’s, “Guide to Medicare Benefits.” This guide is designed to assist you in understanding what services Medicare will pay for and how to access these healthcare services at Pronger Smith MedicalCare.

We are committed to providing the highest quality healthcare for you and your family. What Medicare will pay, and not pay, is often a source of great confusion to both patients and physician practices. Our primary concern is to always provide you with the best care possible.

As an added service to our patients, we created this packet of written materials to assist you in identifying and understanding the Medicare Part B benefits to which you are entitled under the current program. Medicare Part B covers outpatient, observation and professional services (ER physician and surgical Certified Registered Nurse Anesthetists/CRNA).

Our Medicare Financial Policy

As a service to our patients in Medicare, Pronger Smith MedicalCare made the decision to list all our physicians as participating in the Medicare program. As a result, we will bill Medicare for all charges. As a courtesy to you, we will also bill all Medicare supplemental plan(s). We accept assignment for the services provided to patients, which means that on covered services after your deductible is met, you are only responsible for the 20% not paid by Medicare.

As a general rule, Medicare will pay 80% of the allowed amount directly to the provider on any assigned charges that are covered. The patient is responsible for the 20% copayment in addition to any deductibles not met. When monies collected exceed the 20% you are obliged to pay, a refund is made.

A copy of your Medicare and supplemental insurance cards is required. In addition, please provide any information regarding employment status and retirement dates for yourself and your spouse, which is a requirement of the Federal Government. Secondary insurance information is important so we may submit any deductibles and copay/coinsurance amount to your secondary carrier to minimize your out-of-pocket expense.
You will be responsible for any remaining balance after Medicare. A statement will be mailed at that time indicating the amount due or you can take advantage of our Pre-Authorized Debit program by filling out the authorization form included in this packet.

Medicare will not pay for some services. There are several services, which may have health benefits, but are exempt from Medicare coverage. We will attempt to identify these non-covered services in this packet, but it is your responsibility to check coverage. To assist in finding answers to coverage questions, we have included additional resources (phone numbers and web sites) in this packet.

If you are unsure whether Medicare covers a diagnosis or procedure, our billing office is available to assist you. Call (708) 388-5500 or (708) 226-7000 and select the menu option for your Medicare Patient Account Rep.

Relevant Medicare Regulations

Medicare Secondary Payer Questionnaire– Medicare requires a series of questions to be asked of every registration of a Medicare patient to identify if another payment source may be primary to Medicare. These questions may have been asked of you at prior visits, but those answers cannot be used for new dates of service.

Advance Beneficiary Notice (ABN)– Medicare will only pay for services that Medicare itself determines are ‘medically necessary’ by their program guidelines’ definition (see the resource section for sources of these definitions). As a result, when a particular service is not ‘reasonable and necessary’ under the current governmental standards, Medicare will deny payment. Medicare does not pay for tests/procedures considered by their own written and published guidelines as “routine” (not performed to treat or diagnose a specific illness or injury), in addition to many of the disease screening services. The fact that Medicare asks you to pay for these services does not mean they provide no benefit, or that the service is not medically necessary.

Our physicians provide a detailed diagnosis (problem-oriented reason why the test, lab or screening or service is being ordered) with every test/procedure ordered. Often, patients may feel a test is ‘routine’ because it is performed frequently, but our physicians order these services for a specific medical reason. For example, when your physician orders a lab test for you, they will provide a diagnosis. Medicare will not pay for services they consider to be ‘preventive medicine’ by their own program’s definition, or for lab tests or screening without a problem oriented compliant or disease specific concern.

In addition, Medicare also has limits on the frequency of these screenings and exams. Medicare requires Pronger Smith MedicalCare to bill all patients for any denied or limited coverage services. The only exception to this is when an Advance Beneficiary Notice (ABN) was not provided, completed and collected prior to the exam, testing or screening. We are required to collect payment from patients for services deemed by Medicare to not be “reasonable and necessary” (by Medicare program guidelines). Requirements: The ABN must include the date of service, description of the service that Medicare may not cover. The ABN must be signed and dated by the patient beneficiary.

What Services Are Covered under Medicare?

Medicare has two Parts (Part A and Part B):
Medicare Part A (Hospital Insurance) helps cover your inpatient care in hospitals, critical access hospitals, and skilled nursing facilities. It also covers hospice care and some home health care.
Medicare Part B (Medical Insurance) helps cover physician services, outpatient hospital care, and some other medical services which Part A does not currently cover, such as some services provided by physical and occupational therapists, and home health care. Medicare patients currently pay a Medicare Part B premium of $54.00 per month.
- Medical and Other Services: Doctors’ services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also covers second surgical opinions, outpatient mental health care, outpatient physical and occupational therapy, including speech-language therapy.
- Clinical Laboratory Services: Blood tests, urinalysis, etc.
- Home Health Care: Part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen and walkers) and medical supplies and other services.
- Outpatient Hospital Services: Hospital services and supplies received as an outpatient as part of a doctor’s care.
- Blood: Pints of blood you get as an outpatient or as part of a Part B covered service.

Medigap Insurance may include extra benefits such as prescription drugs, dental care, routine physical & vision services. To learn more about Medigap insurance plans that are available in your area call AARP at 1-888-AARPNOW

Remember, if you elect to join a Medicare HMO, traditional Medicare Benefits as described here are relinquished.

Medicare Also Helps Cover:
- Ambulance services (when other transportation would endanger your health)
- Artificial eyes
- Artificial limbs that are prosthetic devices, and their replacement parts
- Braces - arm, leg, back, and neck
- Chiropractic services (limited) for manipulation of the spine to correct a subluxation
- Emergency care.
- Eyeglasses - one pair of standard frames after cataract surgery with an intraocular lens.
- Immunosuppressive drug therapy for transplant patients as long as you are covered by Medicare (transplant must have been paid for by Medicare).
- Kidney dialysis
- Macular eye degeneration (age- related) treatment
- Medical nutrition therapy services for people with diabetes or kidney disease with a doctor’s referral.
- Medical supplies - items such as ostomy bags, surgical dressings, splints, casts, and some diabetic supplies.
- Outpatient prescription drugs (very limited, i.e., some oral drugs for cancer)
- Preventive services
- Prosthetic devices, including breast prosthesis after mastectomy
- Second opinion by a doctor (in some cases)
- Services of practitioners such as clinical social workers, physician assistants, and nurse practitioners
- Therapeutic shoes for people with diabetes (in some cases)
- Transplants - heart, lung, kidney, pancreas, intestine, bone marrow, cornea, and liver (under certain conditions when performed at approved facilities)
- X-rays, MRIs, CAT scans, EKGs, and some other diagnostic tests

What is not paid for by Original Medicare Part A and Part B?
- Acupuncture
- Deductibles, coinsurance, or co-payments when you get health care services
- Dental care and dentures (in most cases)
- Cosmetic surgery
- Custodial care (help bathing, dressing, using the bathroom and eating) at home or in a nursing home
- Healthcare while traveling outside of the US (except in limited cases)
- Hearing aids and hearing exams
- Orthopedic shoes
- Outpatient prescription drugs (with only a few exceptions)
- Routine foot care (with only a few exceptions)
- Routine eye care and most eyeglasses (see exception above for one pair of standard frames after cataract surgery with an introcular lens)
- Routine physical exams, certain types of screen tests, some vaccinations
Medicare FAQs

What does “participating” mean? Pronger Smith MedicalCare has decided, as a service to our patients on Medicare, to participate in Medicare. Each year, Medicare asks physicians to decide if they want to be a “participating” or “non participating” provider. Once a medical practice chooses to participate, there are specific rules that must be followed by both physicians and patients in the Medicare program.

What does “accept assignment” mean? Accepting assignment means accepting the Medicare allowed amount as the total charge for any given procedure. As participating physicians, we accept assignment on all Medicare-covered services.

What is a deductible? Each calendar year (January 1 - December 31) you are responsible for paying a specific amount of money for all Part B services received before Medicare will begin to pay for any health care services. This deductible may be met by one medical bill or by a combination of medical bills from several different physicians. Once the total deductible is paid, it will not be collected again for that calendar year.

What is the coinsurance/copayment? If Medicare feels the services billed are covered under its policy, it will pay 80% of the allowed amount of that bill. For example, if $50 is allowed, Medicare will pay $40 (80% of $50). You are responsible for the $10 balance, or coinsurance. The coinsurance/copay applies to any kind of Part B service (office visit, surgery, etc.) and goes into effect after you have paid your yearly (annual) deductible.

What else might I have to pay for out-of-pocket? All you have to pay is the annual deductible as well as a 20% coinsurance for both participating and non-participating physicians on covered services. You will pay 100% of any non-covered services.

What about supplemental coverage/Medigap? Sometimes a supplemental insurance will cover your deductible and copayment/coinsurance amount.

Why can’t Pronger Smith MedicalCare just write off the balance that Medicare doesn’t cover? All doctors are required by Medicare to collect copayments. The exceptions to this rule are when either a state law or justifiable cost or a specific financial burden prohibits the collection of these monies.

I have more than one insurance. How do I know who pays first? Sometimes other insurance will pay your health care bills first and Medicare pays second. This is called Medicare Secondary Payer.
Other insurance that may have to pay first includes: employer group health plan insurance (under certain conditions), no-fault insurance, any liability insurance, black lung benefits, and workers’ compensation. It is important that you tell our registration staff that you have other insurance so they can determine how to handle your bills correctly. If you have questions about who pays first, call the Coordination of Benefits Contractor at 1-877-999-1118.

How Does Medicare Decide if a Service is Covered? Benefits available to you are called “covered” services. The first step is for you and your physician to determine whether a particular service or procedure would be beneficial or necessary in treating your condition. Items and services covered by Medicare are broadly defined in the Social Security Act (a law). Certain items are specifically excluded from coverage, while others are subject to interpretation. At times, even when your physician prescribes a specific item or service, Medicare may not pay for it. Requests for Medicare coverage are evaluated according to prescribed procedures. The first step is a determination that the law allows it to be covered. After that, Medicare will look at the scientific evidence to support the coverage of the item or service. Your physician could recommend a treatment that is new to the medical field, and as there may be little knowledge about its benefit, it may be considered ‘non-covered’ by Medicare guidelines.

Does Medicare cover ophthalmology services? Examples of non-covered ophthalmology services are refractions, routine annual examination (except with a medical diagnosis i.e. cataracts, glaucoma, infection, etc.), eyeglasses (except for post-cataract surgery), cosmetic surgery and low vision aids.

Has Medicare’s coverage for people with Alzheimer’s disease changed? The Centers for Medicare & Medicaid Services (CMS) has clarified the coverage for Alzheimer’s disease about how Medicare processes claims for patients with Alzheimer’s disease. On September 1, 2001 Medicare contractors were informed they can no longer automatically deny claims based solely on the Alzheimer’s diagnosis. This does not guarantee that all claims for Alzheimer’s patients will be paid. Instead, Medicare contractors are instructed to review these claims based on the beneficiary’s overall medical condition. This means that Medicare may pay for speech, occupational and rehabilitation therapies for people with Alzheimer’s, including mental health services. The instructions given to Medicare contractors about Alzheimer’s disease reflect the Center for Medicare & Medicaid Services’ commitment to ensure that people receive benefits they are entitled to under the program.

What is the new coverage for Ambulatory Blood Pressure Monitoring? Ambulatory Blood Pressure Monitoring (ABPM) involves the use of a device, which is used to measure your blood pressure on a 24-hour cycle. This service is covered for people with Medicare who are suspected of having “white coat hypertension.” White Coat Hypertension is a term that is used when an individual’s blood pressure is raised simply by going to the doctor’s office. The Ambulatory Blood Pressure Monitoring cuff is not covered for any other use than suspected “white coat hypertension.”

The Ambulatory Blood Pressure Monitoring cuff is not a self-monitoring device. A clinician must transfer information from this cuff to a computer. This information is then studied and analyzed by a specially trained person to interpret the information received from the Ambulatory Blood Pressure Monitor. This device belongs to the provider and Medicare does not cover the purchase of this item for private use.

Will Medicare pay for ambulance service for patient to go to the doctor’s office? No, ambulance service to a doctor’s office is not covered.

When does Medicare cover ambulance trips? When medically necessary and the patient is confined to a bed and unable to be taken any other way.

What medical supplies and equipment does Medicare Part B cover? Medicare Part B helps pay for durable medical equipment such as oxygen equipment, wheelchairs, walkers, and other medically necessary equipment that your doctor prescribes to use in your home.

Medicare pays for different kinds of durable medical equipment in different ways. Some equipment must be rented, other equipment must be purchased. Your Durable Medical Equipment Regional Carrier can provide more specific information. Check the Helpful Contacts section of Official US Government Medicare Website for the phone number for your Durable Medical Equipment Regional Carrier.

Other Durable Medical Equipment covered by Medicare include:
- arm, leg, back and neck braces
- medical supplies such as ostomy bags, surgical dressings, splints and casts
- breast prostheses following a mastectomy
- one pair of eyeglasses with an intraocular lens after cataract surgery

Just because Medicare will not cover a specific service or treatment does not mean the service is ‘medically unnecessary’ or lacks benefit. It is important for you and your family to base decisions on the specific health issues being addressed by the services provided and treatments recommended.
Medicare Health Care Fraud Prevention

Pronger Smith MedicalCare is committed to reducing waste, fraud and abuse in the delivery of, and reimbursement for, healthcare services. We ask our patients to join us in the effort to identify those organizations and individuals who intentionally or unintentionally add costs to our healthcare system. The following is a brief overview of what to look for:

Fraud: an intentional deception or misrepresentation that an individual makes, knowing it to be false and that could result in some unauthorized benefit.

False Claims Act § 287 of Title 18 of the U.S. Code (31 U.S.C. 3729-3733) imposes criminal liability and civil prosecution on persons making false claims against the government. A physician that ignores or disregards other potential payment sources before billing Medicare is guilty of “billing fraud” under the False Claims Act. Insurance policies have a “medical payment” portion that pays for injuries without filing of a lawsuit. It is considered filing a “false claim” if we do not bill the following prior to Medicare:
- Auto insurance (medical payment for injuries obtained in or around, going to or from an automobile) or,
- Homeowners/Business liability insurance (medical payment for any injuries obtained outside of your own property).
If the name and address of the location where a patient was at the time of an injury are not reported on claims submitted to Medicare, the government will investigate the details of the injury.

What is Fraud?
Pronger Smith MedicalCare and Medicare are working hard together along with other government agencies to protect patients, honest providers and the integrity of the current Medicare program. Pronger Smith MedicalCare published our own Healthcare Provider Compliance Program in 2001 to assure continued compliance to Federal and State Guidelines and to maintain the highest level of integrity among our physicians and other providers of care.

Most doctors and health care providers who work with Medicare are honest, but fraud still drains a lot of money every year from the Medicare program. Honest physicians and beneficiaries pay for this fraud and abuse with higher premiums. Fraud schemes may be carried out by individuals, companies or groups of individuals.

Medicare fraud is purposefully billing Medicare for services you never received. Some examples of Medicare fraud:
- Billing Medicare or another insurer for services or items you never got.
- Billing Medicare for services or equipment different from what you got.
- Use of another person’s Medicare card to get medical care, supplies or equipment.
- Billing Medicare for home medical equipment after it has been returned.

When you receive services under the Original Medicare Plan, you receive an Explanation of Medicare Benefits (EOMB) or a Medicare Summary Notice (MSN) from a company that handles bills for Medicare. The notice shows what was charged for services or supplies and how much Medicare paid. You should check the notice to make sure you received the services/supplies listed.

If you see services/supplies billed for which you did not receive (or do not understand), call us at (708) 388-5500 or (708) 226-7000 and select the menu option for the billing office or for your Medicare Patient Account Rep. The bill may be correct and the person you speak to may help you to better understand the services or supplies you received. Other times, a simple billing error will be found, which can be corrected. This helps everyone who is dependent upon the Medicare program. Rarely will there be instances of actual fraud. If you are not satisfied after speaking to us, you should call or write the Medicare Carrier that sent you the payment notice. Their name, address and phone number is printed on the front of the notice.

Use the 3 Step approach if you suspect fraud:

1? Call your health care provider
2? Call your Medicare Carrier or Fiscal Intermediary
3? Call the Inspector General or your state representative.

Be Suspicious if any Provider Tells You...

-“The test is free, we only need your Medicare number for our records.”
-“Medicare wants you to have the item or service.”
-“We know how to get Medicare to pay for it.”
- "The more tests we provide, the cheaper they are.”
-“The equipment or service is free– it won’t cost you anything.”

Be suspicious of providers that:
- Do not charge copayments without checking on your ability to pay.
- Advertise “free” consultations to Medicare beneficiaries.
- Claim they represent Medicare.
- Use pressure or scare tactics to sell you high-priced medical services or diagnostic tests.
- Bill Medicare for services you did not receive.
- Use telemarketing and door-to-door selling as marketing tools.
- Offer non-medical transportation or housekeeping as Medicare approved services.
- Put the wrong diagnosis on the claim so Medicare will pay.
- Bill home health services for patients who are not confined to their home, or for Medicare patients who still drive a car.
- Bill Medicare for medical equipment for beneficiaries in a nursing home.
- Ask you to contact your doctor and ask for a service or supplies that you do not need.
- Bill Medicare for tests you received as a hospital inpatient or within 72 hours of admission or discharge.


The following is a list of tips to help prevent fraud:

- Do not give your Medicare or Medicaid number over the telephone or to people you do not know, except to your doctor or other Medicare provider.

- Do not allow anyone, except appropriate medical professionals, to review your medical records or recommend services.

- Avoid a provider of health care services or items who tells you that the service or item is not usually covered, but they know how to bill Medicare to get it paid.

- Do not ask your doctor to make false entries on certificates, bills or records in order to get Medicare to pay.

- Beware of health care providers and suppliers that use telephone calls and door-to-door selling as a way to sell you goods or services.

- Be suspicious of companies who offer free medical equipment or offer to waive your copayment without first asking about your ability to pay.

- Beware of health care providers who say they represent Medicare or a branch of the federal government, or providers who use pressure tactics to get you to accept a service or product.

If you have a question about a specific claim, you will need to contact the Medicare contractor that processed the claim. Their contact number can be found on your Medicare Summary Notice (MSN) or you can visit the Helpful Contacts section of the official US Government Medicare website.

Preventive Medicine Services

In recent years, Medicare has expanded coverage of preventive services to encourage beneficiaries to stay healthy. Although Medicare does not pay for routine physical examinations, you’re likely to qualify for a number of important benefits– including critical preventive services, which could help prevent life- threatening illnesses. These services are designed to help you stay healthy and prevent or identify for early treatment some of the major conditions affecting older Americans. Here is a summary of some of the benefits Medicare covers at least in part. In some cases, you might be required to pay a portion of the charges after meeting your annual deductible.

Bone Mass Measurements: Loss of bone mass can make you susceptible to osteoporosis and painful, sometimes disabling fractures. Medicare covers part of the cost of bone density screening tests for people at risk. These tests scan the heel, the wrists, the spine, or even the whole body to find weakened points or hairline fractures that might otherwise be undetectable. If you are eligible for this benefit, you are responsible for paying 20 percent of the Medicare -approved amount after the yearly Part B deductible.

Colorectal Cancer Screening: Colorectal cancer – cancer of the colon or rectum – is the second-leading cause of cancer-related deaths in the United States. Screening tests can find polyps, tiny growths that can become cancerous. Removing polyps early can prevent cancer. Screening tests also can find colorectal cancer early, when there may not be any symptoms and when treatment can be most effective. Medicare will pay for colorectal cancer screenings for all people with Medicare who are age 50 and older. Medicare covers an annual fecal occult blood test and a sigmoidoscopy once every two years. If you are at high risk for colorectal cancer, Medicare covers a colonoscopy every 24 months. If you are not at high risk, Medicare covers a colonoscopy every 10 years. If your doctor decides to use a barium enema instead of a sigmoidoscopy or colonoscopy, Medicare covers that procedure.

Diabetes Services: Nearly 1 of 5 people over the age of 65 has diabetes, putting them at higher risk for stroke, blindness, kidney disease and lower-limb amputations. These adverse consequences can be decreased with good diabetic management. Medicare covers both insulin users and non-users, as well as those whose doctor or other provider determines are at risk for complications from diabetes. Glucose monitors, test strips and lancets are covered, as is diabetes self-management training. Diabetes monitoring includes coverage for glucose monitors, test strips, lancets, and self-management training. If you are eligible for this benefit, you are responsible for paying 20 percent of the Medicare-approved amount after the annual Part B deductible.

Glaucoma Screening: Glaucoma, a leading cause of blindness, affects about 3 million Americans, half of whom don’t know they have this eye disease. Medicare pays for annual glaucoma screening (dilated eye examination) for all people with Medicare at high risk for glaucoma (those with diabetes, those with a family history of glaucoma and African Americans 50 and older). The screening must be done or supervised by an eye doctor who is legally allowed to do this service in your state. Medicare covers 80% of the Medicare-approved amount for glaucoma screening after the individual has paid the $100 deductible for Part B services. You should check with your local Medicare Carrier for specific coverage information for glaucoma screening.

Mammograms: Breast cancer, like most cancers, is most effectively treated when caught early. Despite recent debate, mammography remains the best available tool for detecting breast cancer. Studies have consistently shown a decrease in mortality of about one-third among women over 50 who regularly undergo screening mammography. Medicare covers this examination for breast cancer once a year. It also covers new digital technologies for mammogram screenings. All women 40 and older with Medicare coverage are eligible.

If you are between 35 and 39, you can also have one baseline mammogram.
You are responsible for paying 20 percent of the Medicare-approved amount for the test, without first having to pay the Part B deductible. For diagnostic mammograms, however, women must pay both 20 percent of the Medicare-approved amount and the Part B deductible. While Medicare pays for routine screenings only once a year, the program covers diagnostic screenings as often as are medically necessary.

Pap Smear and Pelvic Examination: Most cervical cancers can be caught early with regular screening. However, the early stages of cervical cancer have no detectable symptoms, which is why a Pap smear that checks for changes in the cells of your cervix can help find cancer at an early stage. A Pap smear and pelvic exam with a clinical breast exam are covered by Medicare once every two years. If you are a woman of childbearing age and have had an abnormal Pap smear within the preceding 36 months, or you are at high risk for cervical or vaginal cancer, Medicare will cover a Pap smear and pelvic exam every 12 months.

Prostate Cancer Screening: Prostate cancer is the most commonly diagnosed form of cancer, other than skin cancer, among men in the United States; it is second only to lung cancer as a cause of cancer-related death among men. Many physicians recommend an annual digital rectal examination and a Prostate Specific Antigen (PSA) screening test. All men age 50 and older with Medicare qualify for these annual tests. Men with Medicare age 50 and older, who qualify for the benefit and for the digital rectal examination, pay 20 % of the Medicare-approved amount after the Part B deductible. There is no deductible or coinsurance for the PSA test.

Vaccinations: Flu and pneumonia infections can be life-threatening for elderly people. Health professionals recommend that all adults age 65 and older receive a flu vaccination every fall. Medicare covers these annual flu shots.
Also covered is a pneumococcal pneumonia shot; for many people one shot confers lifetime coverage. Those at high risk for hepatitis, such as those with end-stage renal disease or hemophilia, should be vaccinated against hepatitis B, which Medicare covers. Those eligible pay 20 percent of the Medicare-approved amount after the Part B deductible.

Medicare Managed Care Plans & Supplemental Coverage
People with Medicare who are enrolled in Medicare managed care plans receive all of the preventive services covered under the original fee-for-service Medicare program. You may also be entitled to additional preventive services, such as physical exams.

Talk to your doctor about prevention. Together, you can make sure that you are doing everything possible to stay healthy longer.

Additional Resources

Medicare coverage decisions are either “national” (applicable to everyone) or “local” (established by the company (carrier) that processes Medicare claims for Illinois). Information on national coverage decisions can be found at http://www.hcfa.gov/coverage. Information on Illinois policies may be obtained from the Medicare carrier, http://www.wpsic.com.

You can find the phone number for additional assistance in understanding Medicare in the Helpful Contacts section of the official US Government Medicare website. A special Medicare handbook, “Medicare and You” provides a complete listing of covered preventive services, who is eligible, how much you need to pay, your rights as a patient, and new, available Medicare health plan options. You can order the handbook by calling 1-800-MEDICARE (1-800-633-4227), or view it online at Medicare’s website: www.medicare.gov. While you are there, be sure to check out the Wellness and Publications sections.

Agency for Health Care Policy and Research’s “Personal Health Guide” that can help you and your health care provider make sure you get the tests, immunizations, and guidance you need to stay healthy, is available by calling 1-800-358-9295, or visit www.ahcpr.gov/ppip/ppadult.htm.

The Office of Disease Prevention and Health Promotion
View online publications, including the Prevention Report, and the Clinician’s Handbook of Preventive Services which outlines the immunizations, screening tests for early detection of diseases, treatments to prevent disease, and counseling to modify risk factors: www.odphp.osophs.dhhs.gov

The U.S. Administration on Aging has programs in many communities that train volunteers to detect and report fraud. Information on these programs can be found at www.aoa.gov on the Internet.

If you do not have a computer, your local library or senior center may be able to help you get this information using their computer.