Good news for seniors who wish to stay in their home and community instead of going to a senior care facility. A new program offered by Medicare — Medicare PACE — will allow seniors to receive health care from the comfort of their homes and communities. This program is not available in all states.
Medicare PACE stands for Program of All-Inclusive Care for the Elderly. Currently roughly 40,000 seniors participate in Medicare PACE and receive in-home care. The program is optional but is turning out to be a really good support for elderly Americans in need of social services and more inclusive, personal, in-depth medical care.
The Medicare PACE program is designed to allow seniors to continue to live at home and in their communities instead of senior facilities. Seniors may qualify be eligible for the PACE program if they are in need of nursing home-level care, are able to live safely in the community, are 55 or older and are living in a PACE service area.
Those participating in the program have a medical team dedicated to them and their health care needs. Each team features a primary care doctor, occupational therapist, recreational therapist, nurse, social worker, physical therapist, activity coordinator, home care liaison, dietician and various other medical professionals.
With a team working with you, you get personalized, one-to-one care. You may need use a PACE-preferred doctor, but that is to your advantage as the physicians are trained in a multi-disciplinary approach to senior care. There is no deductible/co-payment for medications, services or care approved by your health care team. It is covered under the program for eligible beneficiaries.
What does PACE cover? Currently, it covers a wide variety of services that may change over time or be added to as it grows. The services covered include:
- Physical therapy
- Occupational/recreational therapy
- Laboratory
- X-ray services
- Home/Hospital care
- Emergency services
- Meals
- Medical specialty services
- Nursing home care
- Adult day primary care
- Mental health services
- Dentistry
- Prescription drugs (partially covered under program)
It is important to note that you may choose to get your medications through the PACE program and can still enroll in Medicare Part D. However, if you do enroll in a prescription drug plan, you are disenrolled from PACE.
What do you pay for PACE? If you have or qualify for Medicaid, you do not pay the premium for long-term care. However, if you do not qualify for Medicaid but have Medicare, you do pay the monthly premium and a premium for prescription drug coverage.
Posted on Friday, November 30th, 2018. Filed under
Medicare.
Recently Washington, D.C. hinted that changes to Medicare are coming. Medicare is the federal health program for people 65 and older.
Medicare Advantage plans are becoming made available through private health insurers and include Medicare Part A, for hospital/catastrophic care, and Part B, doctor visits/routine medical care. They can address dental and vision insurance and prescription drug coverage. Currently, one in three Medicare beneficiaries out of a total of 19 million seniors has a Medicare Advantage plan. Between 2016 and 2017 enrollment in Medicare increased by approximately 1.4 million people.
The Chronic Care Act, one of the most welcome new acts affecting medical care for seniors, will boosts Medicare Advantage plans by adding more benefit flexibility for non-medical coverage — meaning items such as wheelchair ramps or grab bars for the bathroom. The act also makes more telehealth services available for seniors with Medicare Advantage.
Following the footsteps of the Chronic Care Act, the Centers for Medicare and Medicaid Services (CMS) announced the expansion of the definition of “health-related” supplemental benefits in Medicare Advantage to include compensation for physical impairments, reduce avoidable ER visits and reduce the impact of health conditions or injuries. That means the supplemental benefits in Medicare Advantage would include “additional service that increase health and improve quality of life.”
This is exciting news as it means Medicare Advantage would be able to offer services such as aides to help with daily living activities; home modifications; and home delivered, medically appropriate meals that are currently limited to a small number of conditions. Aging at home is something that a great number of seniors would prefer as opposed to living in a nursing home facility. Aging at home also means lower costs for Medicare and Medicaid. Medicare Advantage plans have 77 percent enrollment in the 65 to 84 age group compared to 71 percent for original Medicare.
Currently, Congress and the Trump administration support Medicare Advantage. With such support it appears that healthcare for seniors is not going anywhere.
According to a Congressional Budget Office study, 41 percent of Medicare enrollees are expected to choose Medicare Advantage by 2027 — a figure that looks like it may keep growing.
Posted on Tuesday, November 27th, 2018. Filed under
Medicare.
If you do not enroll in certain Medicare programs/plans when you are first eligible during the Medicare Initial Enrolment Period (IEP), you could increase your premiums. There are late-enrollment penalties for Medicare Part A, Part B and Part D plans.
The IEP begins three months before you turn 65 and lasts seven months in total.
The vast majority of Medicare beneficiaries automatically receive Part A premium-free provided they have worked for at least ten years and have paid Medicare taxes. If you already get Railroad Retirement benefits or Social Security, you are auto-enrolled in Medicare Part A.
Not qualified? Then you are not enrolled and may end up paying a 10 percent higher monthly premium if you do not enroll during the IEP period. You would also be paying this increased premium for twice the number of years that you could have had Part A but were not enrolled. As an example, the Part A premium can be as high as $422, without the penalty, in 2018.
Part B may also come with a late enrolment penalty if you do not enroll when you are first eligible. That may send your monthly premium up 10 percent for each year you were without Part B after your IEP closed. This penalty may be with you for the remainder of the time you are enrolled in Medicare.
Part D may have a penalty as well if you go 63 or more consecutive days without a creditable drug plan after you IEP closes.
It is definitely confusing trying to keep track of all the ins and outs and if you need more information before you make Medicare choices, contact a knowledgeable health insurance agent. They are your best friends when it comes to helping you choose what you need and what suits your lifestyle.
Posted on Friday, November 23rd, 2018. Filed under
Medicare.
You may find yourself wondering if you qualify for both the Medicare and Medicaid programs. If you are a senior with medical needs and are living on a small income, you may qualify.
Qualifying for both Medicare and Medicaid is called dual eligibility. Those that are eligible for both programs are usually low-income adults over the age of 65, or a low-income individual with a disability. This dual eligibility can be quite confusing and for that reason, the Centers for Medicare & Medicaid Services (CMS) try to ensure that each program works with the other efficiently and effectively.
CMS offers an extensive collection of resources for those searching for information on how to co-ordinate their benefits. You can find that collection here.
If you still have more questions about your eligibility contact an insurance agent. They are trained in helping individuals like you.
Posted on Wednesday, November 21st, 2018. Filed under
Medicare.
Medicaid is not to be confused with Medicare, although the two often get mixed up. Medicaid is funded by federal and state governments, helps low-income individuals and families and is really an assistance program. Also, it is for all individuals of all ages.
Each state has different qualifications for Medicaid eligibility, but one thing is constant, income levels do determine eligibility. For seniors to be eligible for Medicaid, they must pass an income, medical necessity and asset test. Should they qualify, they find that Medicaid may actually offer some benefits that Medicare does not, such as routine hearing, dental and vision care, and prescription drug coverage. There are no extra supplement plans needed if you quality for Medicaid.
If at any time you are not certain which program is for you ask a qualified insurance agent, check with the Medicaid and Medicare government websites if you are computer savvy and ask your friends. The more information you have, the better informed your health insurance choices.
Right now it is more important than ever to understand the differences between Medicare and Medicaid. Under the new administration, things are changing so rapidly, it is hard to keep track. It may be necessary for you speak to an insurance agent to understand what are the changes may affect you.
Medicare is a federal program for all seniors 65 years of age or over. Medicaid is jointly funded at federal and state levels and is usually intended to serve lower income individuals and families.
To find out what program is right for you, you will need to speak to a highly trained health insurance agent who knows the industry, as well as their products. An insurance agent can help you choose what best suits your needs. While it is confusing, with the help of a qualified insurance agent, the choices are much easier to understand.
Posted on Tuesday, November 13th, 2018. Filed under
Medicare.
Although Medicare does offer beneficiaries a great deal, there are gaps in the coverage. In order to fill those gaps, seniors will have the opportunity to take advantage of Medicare supplement plans. While Medicare pays 80 percent of all medical costs, patients pay the other 20 percent. The 20 percent can easily be covered by supplemental Medicare plans. These plans can also cover all deductibles, co-insurance and co-payments associated with your Medicare coverage.
It is important to note that Medicare does not offer coverage for hearing, vision or dental. You would need additional coverage for those specific services.
Given that the whole process of getting enrolled in Medicare and choosing Medicare supplement plans is time-consuming, it is best that you make sure you do get enrolled on time. Waiting until the last minute to try and sort out what you need and what is best for your particular situation can cause undue stress and you stand the chance of ending up with something you did not want or need. Always ask a qualified health insurance agent for help if you are struggling with the process of getting enrolled. They are there to help you find what suits your needs and your budget.
Posted on Wednesday, October 31st, 2018. Filed under
Medicare.
Medicare, the federal program, offers health insurance to adults 65-years-old and older. With this program, most people who paid Medicare taxes while working for at least 10 years, are automatically enrolled when they turn 65. If you have not worked for 10 years, then you could possibly be eligible for Medicare through your spouse.
Medicare offers health coverage for basic needs and breaks down into Parts A through Part D. Hospital insurance is Part A and means you are covered for stays in hospitals and for medically necessary needs while there. Part B handles outpatient needs, such as doctor visits. Part C, also known as Medicare Advantage, allows those enrolled to get all the benefits of Parts A and B (there are some limitations). Part D handles prescription drugs.
If you do not know what you need to suit your lifestyle, ask your health insurance agent or broker. They are trained to know every detail you could possibly want to know.
Posted on Tuesday, October 16th, 2018. Filed under
Medicare.
Increasingly Americans travel to other states to visit relatives, take vacations and take care of family. As people move between states it is important to keep track of Medicare coverage. For instance what happens if your home state is South Dakota and you take up residence in Florida to care for a family member? Do you need to get a Medigap plan in Florida or one in South Dakota? Would there be any out-of-network expenses involved here? These are some of the questions many people ask.
Original Medicare offers coverage anywhere in the United States provided medical professionals accept Medicare and nearly all do. When you have Original Medicare, you should also consider Medigap plans which offer additional coverage for copayments, deductibles and coinsurance. For anyone traveling inside the country it is important to note that once you have a plan, you may retain that plan regardless of your location in the United States.
If you decide to move out of your home state, you can keep your current Medigap policy as long as you have Original Medicare. If you want to switch to a new Medigap policy, however, you will have to check with both your current and new insurance company to see the Medigap policy options they offer. There are 10 standardized Medigap plans, this means that you may be able to reaming with your plan. Therefore, you may get a Medigap policy in South Dakota or in Florida.
What if you decide to switch to a Medigap issuer in Florida? You can certainly do that once you have established residence there, but it is not required that you do so. If you do make the decision to switch, you might be charged more in Florida because you do not have “guaranteed first rights.” “Guaranteed first rights” are rights that you have in certain situations when insurance companies are required to offer certain Medigap policies.
Your situation may look different if you are enrolled in a Medicare Advantage plan or in Medicare Part D when you decide to move out of state. If your current Advantage plan is not available in the area you are moving to, your plan is required by Medicare to disenroll you. If this happens outside of the special election period (SEP) you will be returned to Original Medicare. However, if you notify your plan provider before you move, you SEP will be changed. The SEP will begin one month before the move and last three months. If you forget to notify your provider about your move, you can still do so the month of the move. In such a situation, you will also receive a three month SEP, which begins the same month of the move.
Always check with an experienced insurance agent if you have any questions about how changes in your situation may affect your Medicare coverage.
Posted on Friday, December 1st, 2017. Filed under
Medicare.
Recipients of Medicare, should have an understanding of how the system pays hospitals for an impatient claims. Understanding how Medicare works can demystify the process.
Here is an overview of Traditional Medicare. Traditional Medicare came into being in 1965 through the federal government. It covered approximately two-thirds of adult Americans over 65. Traditional Medicare was never created to and was never intended to cover all heath care expenses.
In 1997 the Balanced Budget Act created the Managed Medicare/Medicare Advantage option, meaning commercial insurance agencies sold traditional Medicare but with possible added services specific only to each insurance company selling them. Then in 1982, Congress changed how hospitals received reimbursement when a beneficiary was an inpatient.
With traditional Medicare, the hospital is paid based on the diagnosis of the patient treated during a stay as an inpatient. In other words, invoices indicating total time spent are submitted, but the hospital is paid for the diagnosis – not the charges. Furthermore, the payment system is different for every insurance plan, Medicaid (on a per state basis), traditional Medicare and managed Medicare Advantage.
Below is a hypothetical example:
Jane spent two weeks in ICU. The final bill was $130,000. Jane has traditional Medicare and a supplemental insurance plan that pays the inpatient deductible. (For 2017, the deductible is $1,316)
The hospital is paid one sum for the aggregate diagnosis. That one payment is referred to as a diagnosis-related group (DRG) payment.
The total hospital bill for Jane is $130,000
The diagnosis-related group payment from Medicare is $12,000
Medicare holds on to the deductible, which is $1,316 (due either from patient or supplemental insurance)
Total Medicare payment is $10,684
Anyone receiving that kind of a bill would likely have trouble finding the funds to pay it. However, here is the twist to this example. The “hospital” must write off the difference between the $130,000 ICU cost and the diagnosis-related group single payment of $12,000. That means there is no additional amount billed out to the patient other than the inpatient deductible.
Posted on Tuesday, October 31st, 2017. Filed under
Medicare.
