Frequently Asked Questions
How do I get a new Medicare card?
Who do I notify to change my address for Medicare?
Where can I get general information about Medicare?
What does IFQHC have to do with Medicare?
How do I enroll in Medicare Part A?
How do I enroll in Medicare Part B?
What is the cost of Medicare Part B?
What are my rights under Medicare?
Does Medicare help pay for medications?
Does Medicare cover diabetes services?
Does Medicare pay for eyeglasses?
Does Medicare cover screening mammograms?
Does Medicare cover the cost of medical equipment?
Does Medicare cover flu shots and other vaccinations?
The hospital wants to release me, but I don't feel well enough yet. What do I do?
What is a Notice of Medicare Provider Non-Coverage?
What if I miss the deadline for an immediate review?
What happens after I call IFQHC?
What should I do if I am concerned about or not satisfied with the quality of care I received?
Who conducts the review and what does it include?
What is mediation, and how does it work?
Can IFQHC review my quality of care concern for health care I received in another state?
How do I get a new Medicare card?
New Medicare cards can be obtained by either calling the Social Security Administration at 1-800-772-1213, requesting a replacement card online at www.ssa.gov/medicarecard, or visiting your local Social Security office. You can locate the nearest office online at: www.ssa.gov/locator.
Who do I notify to change my address for Medicare?
To change your address for Medicare you must call the Social Security Administration at 1-800-772-1213.
Where can I get general info rmation about Medicare?
General Medicare information can be obtained via phone at 1-800-MEDICARE (1-800-633-4227) or online at www.medicare.gov.
What does IFQHC have to do with Medicare?
The Centers for Medicare & Medicaid Services (CMS) set up Medicare Quality Improvement Organizations (QIOs) to protect the rights of Medicare consumers and improve the quality of health care provided to them by expeditiously addressing individual complaints. QIOs also safeguard the integrity of the Medicare Trust Fund, by ensuring payment is made only for reasonable and medically necessary services.
The Illinois Foundation for Quality Health Care (IFQHC) is the Medicare QIO for Illinois.
What is Medicare Part A?
Part A is the Medicare program that helps pay for care while you are in a hospital, skilled nursing facility, critical access hospital, or if you are receiving certain home health care services.
How do I enroll in Medicare Part A?
Most people get Part A automatically when they turn age 65. You can call the Social Security Administration at 1-800-772-1213 to find out if you have Part A or to ask for information about purchasing Part A. If you have questions about Part A coverage, bills and services call 1-800-MEDICARE (1-800-633-4227), or visit www.medicare.gov.
What is Medicare Part B?
Medicare Part B is the program that helps pay for doctors, services, outpatient care, and some other medical services that Part A does not cover, including services of physical and occupational therapists, some medical equipment, and some home health care. Medicare Part B helps pay for these services and supplies when they are medically necessary.
How do I enroll in Medicare Part B?
You can sign up for Part B anytime during a 7-month period before you turn 65. For example, if your 65th birthday is June 1, you may enroll in Part B from March 1 to September 1. To sign up, visit your local Social Security office or call the Social Security Administration at 1-800-772-1213.
What is the cost of Medicare Part B?
For information on the current Part B monthly premium, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov.
What are my rights under Medicare?
As a Medicare consumer you have the right to receive quality health care, the right to be admitted to the hospital when medically necessary, the right to stay in the hospital until it is medically safe to leave, the right to have IFQHC review your medical case at no cost to you to determine whether or not Medicare will pay for your hospital stay, the right to appeal a hospital’s decision to tell you to leave the hospital before you feel well enough to do so, and the right to seek a review of care you received that you feel was of poor quality.
Does Medicare help pay for medications?
Medicare offers prescription drug coverage for everyone with Medicare under Medicare Part D. To find the actual costs of the Medicare drug and health plans in your area, visit www.medicare.gov and select “Compare Medicare Prescription Drug Plans”, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
Does Medicare cover diabetes services?
Yes, all Medicare consumers with diabetes (insulin users and non-users) are covered for services, supplies and resources including glucose monitors, test strips, lancets, and self-management training. You will pay 20 percent of the Medicare approved cost for these services after the annual Part B deductible.
Does Medicare pay for eyeglasses?
Yes, Medicare pays for one pair of eyeglasses with standard frames after cataract surgery.
Does Medicare cover screening mammograms?
Yes, Medicare covers a screening mammogram once per year for all female Medicare consumers age 40 or older. Medicare will pay for 80 percent of the approved amount with no Part B deductible.
Does Medicare cover the cost of medical equipment?
Yes, Medicare Part B covers some durable medical equipment (DME). DME is equipment that can withstand repeated use and is used primarily for medical purposes such as oxygen tanks, hospital beds, and walkers. For more information, and a list of approved suppliers, contact the Durable Medical Equipment Regional Carrier in your state, or call 1-800-MEDICARE (1-800-633-4227).
Does Medicare cover flu shots and other vaccinations?
Yes, Medicare pays for a flu shot each year for all Medicare consumers. Medicare also pays for a single pneumonia shot, which you get after you turn 65. In addition, a Hepatitis B vaccination is covered for those at high or intermediate risk for hepatitis. There is no coinsurance and no Part B deductible required for flu or pneumococcal vaccinations. However, Medicare consumers must pay 20 percent of the Medicare approved cost for the Hepatitis B vaccination.
The hospital wants to release me, but I don't feel well enough yet. What do I do?
If you are told that you must leave the hospital before you feel well enough, you have the right to appeal that decision. You may ask IFQHC to review your case at no cost to you. ALL Medicare consumers have the right to appeal their discharge decision, including those in HMOs or other managed care plans.
What is a Notice of Medicare Provider Non-Coverage?
This is the notice that is given to Medicare consumers when specific Medicare services are terminated. The services include: skilled nursing, home health, hospice and services provided in a comprehensive outpatient rehabilitative facility. This notice outlines the patient’s right to appeal.
Can I refuse to sign?
Yes, but the date of refusal will still be considered the date of receipt for the purpose of delivering the notice to the patient.
What if I miss the deadline for an immediate review?
You will still have appeal rights but the timeframes for completing the appeal review will change and the patient may become financially responsible if he/she remains in the facility.
What happens after I call IFQHC?
A nurse will obtain information from you regarding why you feel you need to continue your services. A nurse and physician will review your medical record to determine if services should continue. We will contact you with the outcome of our review.
What should I do if I am concerned about or not satisfied with the quality of care I received?
Contact IFQHC at 1-800-647-8089. A nurse will talk with you about your concerns and what you can expect when the full medical record review process begins. You will be asked to submit your quality of care concerns in writing to us.
Who conducts the review and what does it include?
Nurses and physicians, licensed in the state of Illinois, review your medical record based on the concerns you have shared with us. Your identity will be kept confidential unless you give us permission to release your name. Our review can take up to 280 days to complete and we keep you up-to-date on the progress of your review. At the conclusion of our review, you are sent a final letter summarizing our findings during the review of your case.
What is mediation, and how does it work?
Mediation is an option to resolve a quality of care complaint under Medicare. It is a voluntary dialogue between you and your doctor or hospital, facilitated by an impartial third person (the mediator). This is at no direct cost to you. It is an opportunity for you and your doctor or hospital to tell your story, respond to each other, and resolve your concerns about the way you were treated.
The confidential mediation session is facilitated by a professional, impartial third person, often in a face-to-face setting, but occasionally over the phone. If you are interested in using mediation, call IFQHC at 1-800-647-8089. You will be directed to an individual who will be able to walk you through the process that follows. Not all complaints are suitable for mediation and you and your doctor or hospital representative must agree to participate in mediation before moving forward. An IFQHC physician reviewer determines if the case is suitable to be resolved by both parties.
Can IFQHC review my quality of care concern for health care I received in another state?
No, Each state has an organization like IFQHC to handle similar issues in that state. To request a review or to file a complaint about the quality of care you received in another state, you must call the appropriate organization. To locate the organization for a particular state, call 1-800-MEDICARE (1-800-633-4227).