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A non-government Medicare community resource

HIPAA

HIPAA is the Health Insurance Portability and Accountability Act of 1996 and is defined as: "[a]n Act to amend the Internal Revenue Code of 1986 to improve portability and continuity of health insurance coverage in the group and individual markets, to combat waste, fraud, and abuse in health insurance and health care delivery, to promote the use of medical savings accounts, to improve access to long-term care services and coverage, to simplify the administration of Health Insurance, and for other purposes." Public Law 104-191


As noted by CMS: "On April 14, 2003, new Federal rules governing the use and disclosure of certain individually identifiable health information by health Plans, health care clearinghouses, certain health care providers ("covered entities"), became enforceable. Medicare Prescription Discount Drug Card Sponsors were added as covered entities by the Medicare Prescription Drug Improvement and Modernization Act of 2003.

The regulatory text of the final rule "Standards for Privacy of Individually Identifiable Health Information" (the "HIPAA Privacy Rule"), as modified, can be found at 45 CFR Parts 160 and 164, Subparts A and E. Part D Plans may use or disclose their members' protected health information as permitted by these regulations and any other applicable privacy laws (for example, more stringent state laws governing the use and disclosure of health information).

The HIPAA Privacy Rule generally allows covered entities to use or disclose this information without beneficiary authorization for treatment, payment, or health care operations (as those terms are defined by the rule) and for a number of public interest or benefit purposes, such as public health activities and research subject to certain requirements. Organizations are not required to obtain authorizations prior to using their Medicare beneficiary members' data to provide information to such members regarding their benefit packages. For additional information regarding the HIPAA Privacy Rule, go to the following:"


For more information, Please see also:


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  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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