Home » Medicare » Page 2
Tag:

Medicare

Medicare 101
Health Insurance

Medicare 101

by Jagger Esch
written by Jagger Esch

While most individuals embrace the aging process, Medicare is excellent coverage that many seniors look forward to obtaining. Medicare has been providing health insurance coverage since 1965 for individuals 65 and older as well as certain disabled Americans.

Over 15% of the country is currently enrolled in Medicare today and that’s a definite bonus after having worked for most of our lives. Being on Medicare means having Hospital and outpatient coverage for many services.

Although, many seniors are unaware of the coverage they have and what expenses they’re responsible for paying. Having a Medicare Supplement could help you plan your health care expenses better.

Traditional Medicare Benefits

Medicare consists of two main parts:

  • Part A (Hospitalization)
  • Part B (Outpatient and DME supplies)

 

Medicare Part A is typically premium-free and provides coverage for your hospitalizations and skilled nursing facility stays. Additionally, Part A benefits provide coverage for home health and hospice care.

Part B premiums are ever-changing, typically they go up annually based on inflation. However, the government takes into consideration individual incomes, paid taxes and annual expenses. Many people with Part B don’t pay the full Part B premium.

Extra Help is available to those that qualify.

Part B benefits cover your outpatient costs for doctors’ visits, lab work, diagnostic testing, physical therapy, and outpatient surgeries.

Regardless of whether Medicare Part A or Medicare Part B is being used, each plan only covers at 80%. The remaining 20% leftover is the Medicare beneficiary’s responsibility to pay.

Both Plan policies only take effect after the Part A and Part B deductibles have been met. Each year the deductible cost changes so you can log onto Medicare.gov to see the exact rate for each deductible.

How to Qualify for Medicare

To become eligible for Traditional Medicare benefits, individuals must be at least 65 years of age.

When enrolling in Traditional Medicare you have a seven-month Open Enrollment Period (OEP). The OEP begins the three months leading up to your 65thbirthday, continues through your birthday month, and the remaining three months after turning 65.

Failing to enroll for Medicare Part A or Medicare Part B during the Open Enrollment Period can result in penalty fees.

Medicare Part A Penalty:

If you have Part A premium, an extra 10% is added for each year gone without Part A benefits. Based on how long one goes without Part A benefits will determine the number of penalty fees.

Medicare Part B Penalty:

With the Medicare Part B penalty, the monthly premium is increased an extra 10% for every year without Part B benefits. With the Part B penalty, the increased premium rates are paid for the entirety of having part B benefits.

Medicare is also available for certain individuals with end-stage renal failure and certain other disabilities. For those individuals who also receive social security benefits or certain Railroad Retirement Benefits, you’re automatically eligible and enrolled in Medicare Parts A and Part B after two years.

Part C Medicare Advantage Plans

Medicare Advantage Plans are provided by private insurance companies within your area. Premiums are based on the individual plans offered.

Part C Plans are oftentimes referred to as Medicare Supplement Plans as their benefits will take over coverage for that of Traditional Medicare Part A and Part B.

Oftentimes, Medicare Advantage Plans come with cheaper premium costs. So, those living on a fixed income find the sound of these policies appealing.

However, with the cheaper premium prices come at a price.

Medicare Advantage shortcomings include:

  • Restrictions
  • Referral requirements to see a specialist
  • Coverage limitations
  • Limited doctor, pharmacy and hospital networks
  • Limited coverage areas.

 

What seems like being more valuable, can end up costing more for the individual when it comes to their out of pocket cost. Coinsurance, deductibles and copayments are commonly discussed when you enroll in these plans.

Medicare Part D

Traditional Medicare offers no insurance benefits for prescription medications. With medications, especially brand name, the out of pocket costs at the pharmacy can be downright astronomical!

By obtaining a Medicare Part D Plan, AKA, a Medicare Prescription Drug Plan (PDP), you can get those medically necessary prescriptions at a lower price. In some cases, you can get them at no cost whatsoever.

Offered by the individual health insurance companies, you can pick the best Part D Plan to suit your prescription medication needs. Depending on the policy will depend on your premium prices.

Another bonus of enrolling in a Medicare Part D Plan is you will avoid the penalty fees.

Like the penalty fees of Original Medicare, failing to enroll during your 7-month initial enrollment period will result in an increase in the Part D premium charge.

Depending on how long one went without drug coverage will determine the additional premium fees each month.

Medicare Supplement Plans

There are also Medicare Supplement Plans, that like Advantage Plans, are purchasable through your local private insurance carriers.

With Medigap Plans, they work alongside the already excellent Traditional Medicare benefits. These plans provide extra coverage for those items not originally covered by straight Medicare.

Pending on which Plan is chosen, items like deductibles, coinsurance, copayments and other items not covered by Medicare can cost less for the beneficiary. In some cases, there are plans that offer complete coverage.

There are ten letter plans available to choose from and depending on your individual healthcare needs will depend on which plan best suits you.

For example:

Plan F

This plan provides 100% coverage of both your Medicare Part A and Medicare Part B deductibles.

It has the added benefit of paying for:

  • Medicare Part B’s copayments
  • Foreign travel emergency coverage
  • The remaining 20% coinsurance for your Part A and Part B fees

 

While Plan F is the most popular due to the great additional benefits, it also comes with a higher premium price tag.

High Deductible Plan F

There is also a Medicare Supplement Plan F High Deductible version that provides the exact same benefits, just with a deductible. The added bonus of this specific plan is there is a lower monthly premium so it’s cheaper for those on fixed incomes.

Plan G

This plan is another great Supplement Plan that’s also comparable to Plan F, however, there is no Medicare Part B deductible coverage.

Many times, the savings in Plan F premiums is more than the Part B deductible, meaning you get comprehensive coverage at a great price. Besides, Plan G typically has lower annual rate increases when compared to other plans.

Plan N

With this specific policy, it’s considered, “cost-sharing”. While the Medicare Part A deductible is completely covered, the beneficiary will be required to pay a small copayment for ER and doctor’s office visits.

It’s important to research all Medicare plans available, prior to picking your “perfect” plan. What works for one individual, may not work for another.

There’s plenty of information available regarding not only Traditional Medicare benefits, but also Medicare Advantage as well as Medicare Supplement Plans.

Medicare low Income Plans

While Medicare offers good healthcare coverage, those living on a fixed income may find it hard to afford monthly premiums, deductibles, coinsurance and copayments.

Even with lower premiums associated with Medicare Advantage plans or more coverage with Medicare Supplement Plans, the out of pocket costs can still be quite burdensome.

Those still struggling with healthcare costs there are Medicare Savings Programs that you may qualify for, applying is highly recommended when you meet the income requirements.

Additionally, each individual state has their own State Health Insurance Program, also known as SHIP. SHIP can provide financial assistance and relieve some of the stress associated with out of pocket costs for health insurance.

Changes in Medicare as of 2020

In the upcoming years there’s always the chance of change when it comes to not only premium and deductible prices, but also changes in policies.

The most major upcoming change will be the doing away with First-dollar coverage plans. What this means is that any of the Medicare Supplement Plans that leave a Medicare beneficiary without any out of pocket costs, will no longer be available.

This affects the 3 major first-dollar coverage Supplement Plans:

  • Medicare Supplement Plan C
  • Medigap F
  • High Deductible F policy

 

This change in 2020 is mainly due to congress feeling as though Medicare beneficiaries who have no deductibles or out of pocket costs, will then no longer overuse healthcare services they don’t necessarily need.

This upcoming change will only affect those eligible for Medicare benefits after 2020. Luckily for those who currently carry or are eligible prior to 2020, will be, “grandfathered in.” This means you may still reap the benefits of those first-dollar plans!

There will be other options available for those looking to enroll after 2020. You can still enroll in Medicare Supplement Plans with just some slight changes and a small overall increase in your out of pocket costs.

Getting good health insurance to converge should be simple. Traditional Medicare benefits, a Supplemental insurance plan as well as a Prescription Drug Plan can provide individuals with optimal healthcare coverage.

Medicare is readily available, easy to obtain and most providers take the insurance. Regardless of what you may have heard about Medicare in the past, take action and enroll in Medicare as soon as you become eligible.

The sooner you do the sooner you too can start benefiting from our government appointed healthcare!

0 comment
0 FacebookTwitterPinterestEmail
Post-Acute Care Advice after a Hospital Stay
Caregiving

Post-Acute Care Advice after a Hospital Stay

by Guest Blogger
written by Guest Blogger

One of the most challenging experiences for seniors and caregivers can be managing the recovery process after a hospital stay. Often, it’s not the hospitalization that is most difficult, but the specialized follow-up care that many seniors require to avoid complications or readmission into the hospital.

This follow-up care, called post-acute care, is one of the most important parts of the recovery process. It’s also one of the most misunderstood and difficult to navigate parts of our healthcare system. Seniors who receive high-quality post-acute care after an injury or illness experience better, faster recoveries and have lower out-of-pocket healthcare. Post-Acute Care Advice after a Hospital Stay

Usually, your healthcare provider will inform you of the follow-up care you or your loved one will need upon admission to the hospital. Sometimes, however, you may not find out what services are needed until it’s time to leave the hospital. For these time-constrained and stressful situations, it’s important that you make an informed decision for optimal recovery. Patients are often assigned a case manager who can guide you through the post-acute care process and coordinate recovery as you or your loved one transitions from the hospital back to their home. The case manager can be a great resource to discuss post-acute care options.

To ensure that you select the best post-acute care for your condition, it’s important to understand the different options and identify what best suits your personal needs. There are four main types of post-acute care – each provides unique services in different settings.

4 Types of Acute Care:

  1. Home health care agencies send medical professionals to patients’ homes to receive skilled nursing and rehabilitation services without having to go to a separate facility. Common services provided through home health care are wound care, physical therapy, and help with medicines, such as injections.
  2. Skilled nursing facilities are residential healthcare facilities for patients who no longer need to be in a hospital but who require a higher level of medical care than can be provided at home. Common services provided include physical/occupational rehabilitation, speech and language therapy, and complex wound care.
  3. Inpatient rehabilitation facilities are residential healthcare locations that provide intensive hospital-level care for patients with complex conditions such as spinal cord diseases or traumatic brain injuries. Common services provided through inpatient rehabilitation facilities include intensive physical therapy and stroke rehabilitation.
  4. Long term care hospitals offer the same level of round-the-clock care as traditional hospitals or intensive care units, but over a longer period of time (usually a month). Common services provided at long term care hospitals include ventilator care, intravenous therapy, and dialysis.

 

After determining the type of post-acute care provider best fits your needs, there are some other important factors to consider before making a decision.

  • Meet with a medical professional to understand medical needs and determine the best post-acute care options. If you have a specific medical condition (diabetes, chronic disease, Alzheimer’s), you can narrow down your search based on specialty services offered through the provider.
  • Verify insurance coverage to make sure that the post-acute care facility is within your insurance network and that the treatment is covered under the insurance policy.
  • When evaluating healthcare providers, it’s important to compare Medicare quality data and other key information such as patient/family reviews and health inspection reports.
  • Talk to staff members at the provider to discuss patient care plans, how patient needs will be addressed, and how they handle different situations. If possible, visit the location and talk to current employees and residents about their experiences. Evaluate the facility’s cleanliness, amenity options, and medical specializations.

 

Navigating follow-up care is a challenging and emotional process, especially for seniors who have just gone through a major medical operation or hospitalization. If you’re a caregiver or family member supporting your loved one in the transition, be patient and understanding throughout the decision-making process. There are many online communities and discussion forums to find out more about post-acute care and learn from others’ experiences to make the most of the recovery journey. Remember, leaving the hospital is just the first part of the road to a happy and healthy recovery!

Ryan Miller is a recovering healthcare policy wonk and co-founder of repisodic, a health technology company that helps seniors, families, caregivers and healthcare professionals find the highest quality, personalized post-acute care. He was previously Director of Policy and Strategy for Siemens Healthcare, one of the largest medical device companies the world, but now enjoys building up and providing free profiles of health providers as well as guides and articles on a variety of senior healthcare topics. He lives in Washington, DC with his wife and dog. www.repisodic.com

Post-Acute Care Advice after a Hospital Stay

Post-Acute Care Advice after a Hospital Stay Post-Acute Care Advice after a Hospital Stay Post-Acute Care Advice after a Hospital Stay Post-Acute Care Advice after a Hospital Stay Post-Acute Care Advice after a Hospital Stay Post-Acute Care Advice after a Hospital Stay Post-Acute Care Advice after a Hospital Stay Post-Acute Care Advice after a Hospital Stay Post-Acute Care Advice after a Hospital Stay Post-Acute Care Advice after a Hospital Stay Post-Acute Care Advice after a Hospital Stay Post-Acute Care Advice after a Hospital Stay

0 comment
0 FacebookTwitterPinterestEmail
Portrait of an aged woman outdoors
Medicare Plans

Do You Really Have to Wait Five Years to Access Medicaid Benefits?

by Guest Blogger
written by Guest Blogger

If you or someone you love is trying to qualify for Medicaid, you may have heard people talking about—or in most cases, complaining about—having to wait five years to access benefits. If you don’t have access to professional guidance, you could easily fall victim to this common misconception about Medicaid.

When people complain about waiting for Medicaid to kick in, what are they talking about? It’s what Medicaid calls its five-year lookback period.

How does this work? Let’s say you’re applying for Medicaid. As part of the application process, you may be required to provide financial information for the previous five years. This includes bank statements, brokerage statements, 401(k) statements, IRA statements, life insurance policies, deeds, and more for you—and your spouse, if you have one. The Medicaid office scrutinizes all transfers made by the individual during the preceding five years to determine if any of those transfers should trigger a penalty.

A penalty-triggering transfer can take a number of forms including a cash gift, a real estate gift, a gift of valuable personal property, such as a vehicle, and the sale of an asset at below fair market value. If the Medicaid applicant made any penalty-triggering transfers during the preceding five years, it results in a period of ineligibility for Medicaid benefits. Medicaid determines the period of ineligibility by taking the sum of all penalty-triggering transfers and dividing it by a “transfer of asset divisor,” which is intended to approximate the monthly cost of a skilled nursing facility. As of July 1, 2018, the “transfer of asset divisor” is equal to $9,171. The penalty period will start once you apply for Medicaid and are otherwise eligible.

For example, if your mom, a Medicaid applicant, transferred $200,000 to you within five years of applying, it would result in a period of ineligibility of about 20 months. This is meant to disincentivize Medicaid applicants from gifting their assets away in order to become “poor on paper.” The intention of the penalty period is to force the Medicaid applicant to use up those transferred funds before Medicaid will provide any benefits.

When people hear this, they usually panic. And if they don’t get professional advice from an attorney experienced in Medicaid Planning, that panic will often result in some very bad decisions.

Even if someone you love will need Medicaid right away, in most cases, at least some of those assets can be preserved. In the elder law world, we call that Crisis Planning. Depending on the language in your loved one’s Durable Power of Attorney, we can usually get them qualified for Medicaid immediately.

However, if you start planning earlier, before the nursing home crisis happens, we can save even more. The secret is what we call Pre-Crisis Planning. This often involves creating an Irrevocable Trust and transferring ownership of the elder’s assets into that trust. But not all seniors are thrilled about this powerful asset protection tool because it means giving up dominion and control of their assets. But those who are willing to follow the guidance of an elder law attorney experienced in Medicaid Planning will usually be able to save more of their hard-earned assets than those who wait. It may feel like the nuclear option to a senior who doesn’t need nursing home care—YET—but it will feel like a blessing to the family members who are looking out for the elder’s legal and financial well-being when the time comes.

You don’t have to wait five years for Medicaid benefits to kick in, even if you didn’t plan.

Written by Kathleen Flammia, Attorney at Law, one of Florida’s TOP Elder Law & Estate Planning Attorneys. Attorney Flammia is a Member of the National ElderCare Matters Alliance, and she and her firm are Featured in ElderCareMatters.com – America’s National Directory of Elde

0 comment
0 FacebookTwitterPinterestEmail
Retirement Planning

4 Questions to Ask Before Buying Long-Term Care Insurance

by Carol Marak
written by Carol Marak

My wife, Gina, and I are in year five of owning and running a home care agency, and we’ve experienced firsthand the pain of families struggling to pay for it.

After Gina and I helped managed care for my mother, Emily, as she transitioned into an assisted living facility near our home, we knew we couldn’t afford NOT to have a LTC plan. There are so many options, riders, qualifications and all of this was completely overwhelming.

Ultimately, the entire process took us about eighteen months, but we did finally choose a long-term care insurance policy that was right for us. Here are the 4 questions we’d encourage you to consider as you begin the research.

What is long-term care insurance and what do you need to know?

An excellent resource to get started is a Shopper’s Guide to Long Term Care Insurance. This is a great resource from the National Association of Insurance Commissioners that gives you all the basic information you need.

Do you need it and is it right for you?

After reading the guide, sit down with your spouse and discuss your feelings.

How much do you need?

This is a very tough question. A good financial planner would probably recommend looking at a two to three-year period of long-term care. If you plan to stay at home, personal care now costs an average of $25/hr. If you needed care 7 days a week for 8 hours a day over the course of 3 years, that’s $219,000. For one person. It’s a very realistic – and expensive – scenario.

What are your goals and what’s important to you?

Since we deliver services, we understand the costs of care and the various options and that helped us to hone in on our goals for long-term care:

  • Avoid being a burden on our children and/or counting on support from others.
  • Stay at home.
  • Get a policy with no ceiling or cap. Many policies pay based on what you put in and once funds are gone, they are gone.
  • We did not want a “use it or lose it” policy. If we didn’t use it, we wanted the full or remaining balance go to heirs.
  • Have minimal or no elimination period.
  • Find one with clear triggers to start care.
  • Offer a variety of services.

 

The most important advice we can give is to find a trustworthy financial advisor. One of the biggest things we learned is planning and choosing long-term insurance is a commitment, and it should fit into your overall retirement plan. You’ll find that many financial planners and advisors are also experienced with this type of planning, or they have relationships with some great long-term care insurance agents.

Searching for the right long-term care insurance plan was a long process, but we feel we’ve found one that works well for us.

-Guest writer, Tim Murray, President and Co-Founder, Aware Senior Care.

0 comment
0 FacebookTwitterPinterestEmail
elderly woman isn't feeling well
Money Tips

Can I Get Medicaid if I Transfer All of My Assets to My Spouse?

by Guest Blogger
written by Guest Blogger

In the past, to avoid exceeding Medicaid’s income and asset limits, many individuals transferred their assets into the name of other relatives, particularly when nursing home care was immediately needed. Now, Medicaid takes into account all asset transfers made in the preceding five years prior to an application for Medicaid benefits (this period is called the “look-back” period). If such asset transfers were made, Medicaid may assess a penalty period, which will delay the commencement of Medicaid benefits.

However, as discussed below, it is crucial to understand that not all assets are counted for Medicaid benefits determination and that some asset transfers will not impact (or be included in) the “look-back” period.

As Florida Medicaid Planning Attorneys serving Orlando, Winter Park, and the surrounding communities, we are frequently asked about how Medicaid planning may benefit clients, often in the course of contemplating, entering, or even after being admitted to a nursing home. We invite you to contact us about your Medicaid planning concerns, questions, or needs.

Asset Transfer Matters

How Are the Medicaid Look Back Penalty Periods Calculated in Florida?

The Deficit Reduction Act of 2005 made certain types of asset transfers more difficult to accomplish by creating a five-year “look back” period for all asset transfers. If applicable, penalty periods are calculated by dividing the transferred amount by the average price of Florida nursing home care.

For example, if an individual transfers $70,000 in assets, and the average nursing home cost in Florida is $7,000 per month, Medicaid assistance will be unavailable until the person pays the cost of the nursing home care for 10 months ($70,000 ÷ $7,000 = 10). These penalty periods are not capped, meaning that there is no limit to the number of months that the senior may be ineligible for benefits.

Are All Transfers Counted in the Medicaid “Look-Back” Period?

While the prospect of a penalty period may be cause for concern, an important caveat must be considered – not all transfers are counted in the look-back period. Assets not counted in the “look-back” period include transfers to:

  • A spouse (or to a person acting for a spouse’s benefit)
  • A child under the age of twenty-one
  • A permanently disabled or blind child
  • An adult child who lives in the home and who has provided care to the individual for at least two years prior to the submission of the Medicaid application
  • A brother or sister who has an equity interest in the home and who has been living in the home for one year prior to the submission of the Medicaid application

 

If you have extensive assets and do not have adequate financial planning mechanisms in place, qualifying for Medicaid can be problematic. If you anticipate needing Medicaid benefits, it is important to review your financial situation with an experienced Florida Medicaid attorney as soon as possible to help ensure that transfers are made in a manner that avoids the Medicaid look-back period or lessens its effects.

Article provided by Kathleen Flammia, Attorney at Law, one of Florida’s TOP Elder Law & Estate Planning Attorneys. Attorney Flammia is a Member of the National ElderCare Matters Alliance, and she and her firm are Featured in ElderCareMatters.com – America’s National Directory of Elder Care / Senior Care Resources to help families plan for and deal with the issues of Aging.

0 comment
0 FacebookTwitterPinterestEmail
US dollar bills with medicine pills
Medigap

Guide to Medicare Supplemental Insurance (Medigap)

by Carol Marak
written by Carol Marak

Medicare Supplement Insurance, also known as Medigap, is a private insurance policy that helps pay some of the health care costs that Original Medicare doesn’t cover, like copayments, co-insurance, and deductibles. Some Medigap policies offer coverage for services that the Original Medicare does not cover. Examples are the medical care when you travel outside the U.S or visit a doctor who does not accept Medicare, and charges an “excess charge.”

Medicare Supplement Insurance policies only work if you enroll in the Original Medicare Plan. You must have Medicare Part A and Part B but won’t pay any benefits if you’re in a Medicare HMO or another type of Medicare Plus plan.

First, Let’s Explain Medicare

Original Medicare is fee-for-service coverage under which the government pays the insured’s health care providers directly for the Part A and Part B benefits.

Medicare Supplement policies can minimize Medicare co-payments and deductibles for covered services, but do not offer expanded coverage of long-term care services or prescription drugs.

Medicare Part A covers hospital insurance and for most people it is free. You might be required to pay for Medicare Part A if you were self-employed or didn’t contribute to Medicare when you were younger. If you or your spouse paid Medicare taxes for less than ten years total, you would have to pay a monthly fee for Part A coverage.

Medicare Part B is not free. You have to pay a monthly Medicare premium, which comes out of your social security check. Medicare Part B (Medical Insurance) helps cover:

  • Services delivered by doctors and other health care providers,
  • Outpatient care,
  • Home health care,
  • Durable medical equipment,
  • Some preventive services like Pap tests, flu shots, and screening mammograms.

7 MUST KNOW FACTS about Medicare Supplemental Insurance (Medigap) Policies

  • If you have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins.
  • You pay the private insurance company a monthly premium for your Medigap policy also to the monthly Part B premium that you pay to Medicare.
  • A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you’ll each have to buy separate policies.
  • You can buy a Medigap policy from any insurance company that’s licensed by the state.
  • Any standardized Medigap policy guarantees renewable even if you have health problems. Therefore, the insurance company can’t cancel your Medigap policy as long as you pay the premium.
  • Some Medigap policies sold in the past cover prescription drugs, but Medigap policies sold after January 1, 2006 aren’t allowed to include prescription drug coverage. If you want prescription drug coverage, you can join a Medicare Prescription Drug Plan (Part D).
  • It’s illegal for anyone to sell you a Medigap policy if you have a Medicare Medical Savings Account (MSA) Plan.(Source: Medicare.gov)

 

Medigap policies don’t cover:

  1. Long-term care,
    Vision or dental care,
    Hearing aids,
    Eyeglasses,
    Private duty nursing like medical and non-medical care

 

Long-term supports and services provided at home, in the community, in an assisted living, or in a nursing home. Individuals may need long-term supports and services at any age. Medicare and most health insurance do not pay for long-term care.

Medicare Supplemental Insurance Plan Details

Medicare Supplement Insurance offers twelve (12) plans. These programs must follow Federal and State laws. Each plan has different benefits. The twelve labeled A – N, lists below. The percentage shows how much each plan covers. The co-insurance is active after reaching the deductible. This PDF offers a quick look at the standardized Medigap Plans A through N and their benefits. Note: Plans E, H, I, and J are no longer for sale, but you can keep these programs if you already have one.

  • Plans A through N, (with the exceptions of E, H, I, and J which are no longer for sale) pay 100% on Medicare Part A Coinsurance and hospital costs up to an additional 365 days after Medicare benefits.
  • Plans A through N pay 100% on Medicare Part B Coinsurance or Copayment with the exceptions of Plan K pays 50%, and Plan L pays 75%.
  • Plans A through N pay 100% of Blood (First 3 Pints) with the exceptions of Plan K pays 50%, and Plan L pays 75%.
  • Plans A through N pay 100% of Part A Hospice Care Coinsurance or Copayment with the exceptions of Plan K pays 50% and Plan L pays 75%.
  • Plans C through N pay 100% of Skilled Nursing Facility Care Coinsurance with the exceptions of Plan K pays 50%, and Plan L pays 75%. Medicare Part A (Hospital Insurance) covers skilled nursing care in a skilled nursing facility under certain conditions for a limited time.
  • Plans B through N pay 100% of Medicare Part A Deductible with the exceptions of Plan K pays 50%; Plan L pays 75%, and Plan M pays 50%.
  • Plans C and F pay 100% of Medicare Part B Deductible with no other exceptions.
  • Plans F and G only pay 100% of Medicare Part B Excess Charges as it relates to Medicare medical services. If you are on Medicare and go to a doctor who does not accept Medicare assignment (receive full payment by Medicare), s/he’s allowed to have an “excess charge”. This excess charge would be an amount above and beyond what Medicare approves for a particular procedure/doctor office visit.
  • Plans C through G, M and N, pay 100% of Foreign Travel Emergency (Up to Plan Limits).
  • Other Medigap Plans information to know:
  • Plan F offers a high-deductible policy plan. If you choose the high-deductible option, you pay for Medicare-covered costs up to the deductible amount of $2,110 in 2013 before your Medigap plan pays anything.
  • Plans K and L, after paying out-of-pocket limit ($4,800 for K and $2,400 for L) and the Part B deductible ($147 in 2013), the Medigap plan pays 100% of covered services for the rest of the calendar year.
  • Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don’t result in an inpatient admission.

7 Things that Medicare and Medigap do Not Cover but You May Need

  • Long-term care such as assisted living (for recovery purposes)
  • Dental and eye care
  • Dentures
  • Hearing aids and exams
  • Cosmetic surgery
  • Acupuncture
  • Routine foot care

8 Insurance Plans that are not Medigap

  • Medicare Advantage Plans (like a HMO, PPO, or Private Fee-for-Service Plan)
  • Medicare Prescription Drug Plans
  • Medicaid
  • Employer or union plans, including the Federal Employees Health Benefits Program
  • TRICARE
  • Veterans’ benefits
  • Long-term care insurance policies
  • Indian Health Service, Tribal, and Urban Indian Health plans

COMPARE THE COSTS of Medigap Plans

Insurance companies may charge different premiums for the same policy. As you shop for a policy, be sure you’re comparing the same policy (for example, compare Plan A from one company with Plan A from another company).

In some states, you are able to buy another type of Medigap policy called Medicare SELECT. (If you buy a Medigap SELECT policy, you have rights to change your mind within 12 months and switch to a standard Medigap policy. A great resource is the 2013 Guide to Choosing a Medigap Policy.

0 comment
0 FacebookTwitterPinterestEmail
Durable Medical Equipment & Medicare
Medicare Plans

Durable Medical Equipment & Medicare

by Jagger Esch
written by Jagger Esch

Many baby boomers rely on Durable Medical Equipment (DME) supplies for their daily activities. Medicare covers medically necessary supplies such as a wheelchair, CPAP machine, or oxygen tank.

So, if you’re wondering about Medicare coverage on your Durable Medical Equipment; ask yourself this; is this medically necessary and is my doctor going to write a prescription for this?

If you can answer yes, then coverage will be likely.

Will My Medicare Coverage Pay for Durable Medical Equipment?

Durable medical equipment is covered under Medicare Part B. The yearly Part B deductible is applicable and then Medicare pays an 80% coinsurance.

That means the Medicare Beneficiary is responsible for the remaining 20%.

If you’ve purchased secondary coverage through a private insurance company, they may pay the remaining 20% of the equipment costs.

Of course, that is provided you have met the Medicare requirements; like paying any applicable deductibles or premiums.

How Do I Get Medicare To Cover My Durable Medical Equipment?

Medicare requires standard information to be included with all prescriptions for durable medical equipment.

Typically, a face to face office note detailing medical necessity and a prescription.

Occasionally, Medicare may require additional testing or documentation. The DME provider should be able to guide Medicare Beneficiaries through the process.

You can expect equipment to be covered if it provides a therapeutic benefit for a condition or illness and will be used in the home.

Keep in mind that Medicare will cover the base model, any upgrades will be billed to the Medicare Beneficiary.

What If I need Durable Medical Equipment To Be Discharged From The Hospital?

When being sent home from the hospital, most people need a few supplies to make the transition smoother.

The most common prescribed items at the time of hospital discharge are hospital beds, wheelchairs, and bedside commodes.

The items that are necessary for Medicare Beneficiaries to continue recovery in the comfort of their own home, are typically covered.

These items will be covered by your Medicare Part B when the prescription is submitted along with the provider’s progress note detailing your condition and the medical necessity of the equipment.

Depending on the length of need, Medicare may rent or buy the equipment being ordered.

What If I Can’t Get Around My Home?

In some cases, a Medicare Beneficiary may have a long-term need for mobility. This could be due to a disability that is classified as temporary or permanent.

In either event, Medicare will cover a Power Mobility Device (PMD) provided specific criteria have been met.

For example, Medicare will require a face to face office note detailing the disability along with the doctor’s recommendation the patient will benefit from the device.

Provided the PMD is primarily used in the home, it will be considered a covered expense. Just to be clear, the Power Mobility Device can used outside the home.

Other items that improve mobility are:

 

There are numerous types of walkers and your practitioner will be able to assist you in determining which one would best meet your needs.

What If I Have A Need for Supplemental Oxygen, A Nebulizer or A Ventilator?

These items are all considered durable medical equipment and are covered under your Medicare Part B coverage.

As you know, anything considered a covered expense by Medicare will be considered payable by your Medicare Supplement Plan.

Oxygen is covered when the doctor details in the face to face office note the specific reason for supplemental oxygen. Oxygen is prescribed for persons with conditions such as COPD, also known as emphysema.

Nebulizers are used to atomize liquid medicine so the beneficiary can inhale a mist that will help open the alveoli, or air sacs. Nebulizers are commonly used by persons with asthma and infants.

Ventilators come in many forms and offer different treatment options. Medicare Part B will require a prescription, a face to face office note from the doctor detailing the condition, and the reason this DME is being ordered.

Ventilators can be either invasive or noninvasive.

  • An invasive ventilator does require an endotracheal tube which is inserted either through the nose or mouth.
  • A noninvasive ventilator requires only a mask.

 

Both types of ventilation therapy provide a volume and pressure to assist the user and provide support breathing.

What Is the Most Common Durable Medical Equipment Ordered?

Diabetic equipment is the most common equipment prescribed under Medicare Part B. Monitors and strips are covered.

Prosthetics and orthotic equipment that supports the lumbar or cervical spine are frequently prescribed. Personal care items such as bath chairs and dressing aids are also commonly prescribed.

What About My Sleep Apnea?

Medicare Part B does provide coverage for machines that correct obstructive sleep apnea.

These items are called CPAP and BiPAP machine. Depending on the type of sleep apnea, a doctor would allow the machine to correct the Medicare Beneficiaries condition.

Diagnosing sleep apnea is a quick process, but most people don’t know what symptoms should be cause for concern.

Sleep apnea is caused by either a physiological condition where the weight of the neck closes making the person stop breathing or breathe very slow, or a condition where the brain forgets to breathe.

Both are cause for concern because they put added strain on your heart and brain.

Signs to report to your doctor are snoring, insomnia, morning headaches or persistent daytime sleepiness.

What About the Monthly Supplies I Need for Upkeep?

Recurring supply needs are covered by your Medicare Part B coverage. Your DME company will be able to advise the frequency with which you can replace any durable medical equipment supplies.

0 comment
0 FacebookTwitterPinterestEmail
Aging

Find Senior Care on Limited Budget

by Carol Marak
written by Carol Marak

Recently, a reader asked, “If you can’t afford to live in a senior care facility, or have family to take care of you what other options does a person have when they can’t take care of yourself?”

For many seniors, they survive on Social Security from month to month. The retirement years is challenging and enjoying the golden years and living comfortably is only a dream. And once they retire, they struggle. They are in survival mode. Others, like the 10,000 Americans who turn 65 every day, are just now facing the reality.

When seeking care on the limited income of Social Security, there are a few options available for the personal help you need or for additional income to pay for care. Here are a few ways to make that happen.

Supplemental Security Income (SSI)

If you are receiving Social Security alone, consider applying for SSI. This federal benefit is available to those 65 and older, the disabled and the blind who have limited income and resources.

The average monthly benefit for an individual is $710 (2013) and $1,066 for a couple. Some states add small supplement to these amounts.

Medicaid

In addition to Medicare, qualifying people 65 and older with limited resources can receive Medicaid. It provides coverage for inpatient and outpatient care, including costs that Medicare does not cover such as nursing home care and personal care services.

Medicaid Waivers Program

State Medicaid plans or state plan amendments often indicate what types of services are covered under Medicaid. Contact your state’s Medicaid office and ask them about LTSS coverage – long-term care coverage. To find contact information for your state’s Medicaid office, visit the State Resources Map at https://www.cms.gov/, click on your state, and click the Medicaid agency link.

The program allows individuals to have active roles in the services they receive. Self-directed personal assistance services allow participants to:

  • Direct types of care that they receive and understand but cannot do (e.g., a person with a physical disability may wish to direct his or her own exercise program)
  • Choose who will provide the care
  • Include their own preferences, choices, and abilities in the service plan

States can target this program to people who already receive services under 1915(c) waivers and may want to direct their own care. States can limit the number of people who self-direct their care and can decide whether this program will be statewide or limited to certain areas.

Medicaid also offers nursing home stays for seniors on a limited income. For more information, contact your local Area Agency on Aging, Department on Aging, or the Ombudsman office in your city or community.

Carol Marak, aging advocate, syndicated columnist, and editor at Seniorcare.com. She earned the Fundamentals of Gerontology Certificate from UC Davis, School of Gerontology.

Get on the waitlist for my Facebook subscription group and learn how to plan for aging well. Send an email to carol@seniorcare.com and say you’re interested in the group.

0 comment
0 FacebookTwitterPinterestEmail
Senior man in hospice
Caregiving

If It’s Time for Hospice – Here’s some Help

by Guest Blogger
written by Guest Blogger

When someone tells you it’s time to call hospice for someone you love, it’s one of the toughest bits of news you’ll ever hear. However, when you do get that news, you’ll still need good information. Here are a few tips.

Find the Right Fit

First of all, you have a choice about which hospice agency or provider will give care to your loved one. You will often be given the names of one, sometimes up to three, agencies that provide hospice care. A doctor, a hospital social worker, your elder’s nurse practitioner or someone at your elder’s care facility usually gives hospice agency referrals.

You can call one of these agencies and/or you can do your own research on which agencies have the best reputation in your elder’s community. You have a choice. You don’t have to use one of the agencies that was referred to you. Remember this.

Sometimes it is very convenient to use a referral. Often, the person or organization referring the hospice agency to you has experience with that agency. They refer agencies that work well with the system that shares their name. That’s good in many ways.

How to identify the right fit –

  • The right hospice provider will understand your elder’s wishes, will work with the family as partners in care, will be very effective communicators and will be responsive to any changes needed or requested.
  • Interview each of the hospice agencies before you select one.
  • Ask neighbors, friends, coworkers (and even on social media) if they have had any experiences good or bad with hospice agencies. Who would they recommend?
  • Read this helpful list from the American Hospice Foundation. americanhospice.org/learning-about-hospice/choosing-a-hospice-16-questions-to-ask/
  • Check with your state hospice accreditation agency (search Internet for this in your state) on the reputation of each hospice group you’ve identified. Each state does this differently. You can find out if an agency has any complaints filed against them or if they are currently accredited.
  • A list of hospice associations by state can be found at https://hospicefoundation.org/Hospice-Directory
  • Remember you can change hospice agencies if you are not satisfied. Specifics at Medicare.gov – see next point.

Learn What Medicare Covers in Hospice Care

  • Visit Medicare.gov and use the Search box to find information on Hospice.
  • Download Medicare’s publication on Hospice Care. medicare.gov/Pubs/pdf/02154-Medicare-Hospice-Benefits
  • It is important to know what Medicare does and doesn’t cover in the hospice program. Don’t just rely on the hospice agency personnel to tell you. Verify any information you receive.

Read some Good Information

  • The best book that I’ve found on situations you’ll encounter in end-of-life care is Final Gifts by Maggie Callanan and Patricia Kelley. It is a must-read for families experiencing hospice for the first time. Take the time to read it.Please.
  • Visit hospicefoundation.org – the website of the Hospice Foundation of America. Good info available here on all sorts of topics.
  • National Association of Home Care and Hospice at nahc.org. They have a hospice patient’s bill of rights.

Have the Paperwork in order

  • Make sure your elder has an updated Advance Directive – delineating their wishes for end-of-life care (and that you and their providers have a copy of it)
  • Verify that their will is up-to-date and accessible to their attorneys and/or family members designated to be personal representatives.
  • Review Power of Attorney (POA) documents to make sure they match your elder’s wishes. Provide copies to care providers and anyone designated as POA.

Be a Good Advocate

  • Now is the time to speak out or speak for your elder. Their own voice may grow weaker but your advocacy should grow stronger. Find your most diplomatic voice and use it to make sure your elder’s wishes and your family’s wishes are respected and carried out.

You will make it through. You will. It’s hard, it may be long, but it may also bring some of the best, most touching moments you’ve spent with your elder.

By Suzanne Blankenship

0 comment
0 FacebookTwitterPinterestEmail
Newer Posts
Older Posts