Using Medicare

Medicare is a federally funded health insurance program for patients who are disabled or over age 65.

Medicare has two parts that may cover your care at Stanford:

  • Part A
    Part A is hospital insurance that covers hospitalization, hospice and skilled nursing facility services. Learn more about Medicare Part A.
  • Part B
    Part B covers doctors' services (including office visits), medical supplies and clinic care. Learn more about Medicare Part B.

CONTACT INFORMATION

If you are concerned about your ability to pay for treatment, financial assistance is available. Contact Patient Financial Services at 1-800-549-3720.

You may also have a "Medicare Supplement Plan" purchased through a third party. If so, your policy may cover medical services that Medicare does not.

Forms for Medicare patients

Certain forms are specific to Medicare patients and may be new to you. These include: 

  • Medicare Secondary Payer Questionnaire—all patients
  • Hospital discharge information (called "An Important Message from Medicare")—inpatients only
  • Advance Beneficiary Notice of Non-payment (ABN)—outpatients only

Medicare secondary payer questionnaire

For many people, Medicare is their only insurance policy that covers medical services. However, sometimes more than one insurer is responsible for medical bills. In this case, the "primary" insurer is the insurer who is billed first, and the "secondary" insurer is billed next. For example, if you are injured in a car accident, auto insurance pays first, then health insurance.

Medicare uses the Medicare Secondary Payer Questionnaire to decide if they are the primary or secondary insurer. You will fill out this form at each visit.

Health care providers who accept Medicare are required to use this questionnaire.

Questions about Medicare secondary payer

For any additional questions you may have, please contact

  • Medicare: 1-800-Medicare (633-4227)
  • Coordination of Benefits (COB): 1-800-999-1118

Your rights at hospital discharge ("Important Message from Medicare")

This form explains your rights, as a Medicare patient, at hospital discharge. It includes information about the appeals process if you feel you are being discharged too soon.

You will receive this form twice, at admission and discharge. The Centers for Medicaid and Medicare Services (CMS) require hospitals to notify you of these rights.

Advance beneficiary notice of non-payment (ABN)

Medicare only covers services it considers reasonable and medically necessary for someone with your diagnosis. Your doctor's office does not always know in advance what services Medicare will cover.

The Advance Beneficiary Notice of Non-Payment (ABN) form notifies you Medicare may not pay for certain services. It will list any tests that may (or may not) be covered. It will also inform you of your responsibility to pay for services if Medicare denies payment.

Signing an ABN will not affect Medicare's decision to pay for a test.

Options when an ABN is required

In some cases, you must sign an ABN before services are performed. In this case, you have two options:

  1. Sign the ABN, agree to pay for the service if Medicare will not, and receive the service
  2. Refuse financial responsibility if Medicare will not pay for the service, and do not receive the service

Signing the ABN simply indicates that you were informed of your responsibility to pay for services if Medicare refuses. Refusing to sign it does not change your options.

If you refuse to sign the ABN but accept the service, a witness will sign it, noting that you refused. If Medicare does not pay for the service, you will be billed.

What to do if you have questions

Your doctor's office can provide information about what is likely to be covered by Medicare.

Your doctor can help you make informed decisions about the necessity of tests and procedures, as well as alternatives.