Tue, 21 May 2024 15:08:44 -0700WeeblyWed, 08 May 2019 19:26:18 GMThttp://answersformedicare.com/blog/medicare-coverage-of-hospice-care
What is the Medicare hospice care benefit?
Hospice is a program of end-of-life pain management and comfort care for those with a terminal illness. Medicare’s hospice benefit offers end-of-life palliative treatment, including support for your physical, emotional, and other needs. It is important to remember that the goal of hospice is to help you live comfortably, not to cure an illness.

To elect hospice, you must:

• Be enrolled in Medicare Part A
• Have a hospice doctor certify that you have a terminal illness, meaning a life expectancy of six months or less
• Sign a statement electing to have Medicare pay for palliative care (pain management), rather than curative care (unless your provider is participating in a special demonstration program)
• And, receive care from a Medicare-certified hospice agency

Once you choose hospice, all of your hospice-related services are covered under Original Medicare, even if you are enrolled in a Medicare Advantage Plan. Your Medicare Advantage Plan will continue to pay for any care that is unrelated to your terminal condition. Hospice should also cover any prescription drugs you need for pain and symptom management for your terminal condition, while your Part D plan may cover medications that are unrelated to your terminal  condition.

How can I elect the hospice benefit?
If you are interested in Medicare’s hospice benefit, ask your doctor whether you meet the eligibility criteria for hospice care. If you do, ask your doctor to contact a Medicare-certified hospice on your behalf. There may be several Medicare-certified hospice agencies in your area.

Once you have found a Medicare-certified hospice, the hospice director (and your own doctor, if you have one) will certify that you are eligible for hospice care. Afterwards, you must sign a statement electing hospice care and waiving curative treatments for your terminal illness. Your hospice team must consult you—and your primary care provider, if you wish—to develop a plan of care.

What services are covered under Medicare’s hospice benefit?
If you qualify for the hospice benefit, Medicare covers:
Skilled nursing services: services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness.
Skilled therapy services: physical, speech, and occupational therapy services that are reasonable and necessary to manage your symptoms or help maintain your ability to function and carry out activities of daily living (like eating, dressing, or toileting).
Hospice aides and homemaker services: includes full coverage of a hospice aide to provide personal care services, including help with bathing, toileting, and dressing, as well as some homemaker services (changing the bed, light cleaning, laundry)
Medical supplies: full coverage of certain medical supplies, such as wound dressings and catheters.
Durable medical equipment (DME): full coverage of equipment needed to relieve pain or manage your terminal condition.
Respite care: short-term inpatient stays for you that allow your caregiver to rest. This coverage includes up to five consecutive inpatient days at a time.
Short-term inpatient care: care at a hospital, SNF, or hospice inpatient facility if your medical condition calls for a short-term stay for pain control or acute symptom management. This is only covered if care can not feasibly be provided in another setting.
Medical social services: full coverage of services ordered by your doctor to help you with social and emotional concerns related to your illness. This may include counseling and/or finding resources in your community.
Prescription drugs related to pain relief and symptom control. You pay a $5 copay.
Spiritual or religious counseling
Nutrition and dietary counseling
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These materials made possible by support from Jack Schroeder & Associates, Inc.]]>Tue, 30 Jan 2018 03:37:44 GMThttp://answersformedicare.com/blog/when-is-the-best-time-to-enroll-in-medicare-parts-a-and-bWhen is the best time to enroll in Medicare Part A and Part B? As you might be thinking, there is not always a simple answer to that question. When I sit down with someone who is approaching 65 I first ask about their current health insurance situation. I typically get one of two answers: “I am on an individual plan” or “I am on a plan through my (or my spouse’s) work.” That leads back to the original question - when is the best time to enroll in Medicare Part A and Part B?

“I am on an individual plan”
For those that are on an individual plan, typically the answer is pretty simple. We compare the monthly cost difference of Original Medicare and what they are currently paying and more often than not there is a significant savings by enrolling in Medicare Parts A and B. Many will then enroll in Medicare in the 7-month initial enrollment period.  The initial enrollment period spans the full 3 months prior to your birth month, the month you turn 65, and the full 3 months following your birth month. After that, the decision about whether to add a Medicare Advantage (also called Part C) or Medicare Supplemental and a Part D Prescription plan is next.

“I am on a plan through my (or my spouse’s) work”
When someone is on an employer plan, there are a few additional details to consider. Monthly cost difference is usually the first factor. If the monthly cost is not an issue, a number of other factors are considered. Some people like their doctor. Others are happy with the deductibles, copays, and co-insurance (the other half of cost). For a number of reasons, a person may decide they would like to continue on the employer plan. As long as the plan has 20 or more members enrolled, Medicare deems that plan “creditable” and you should avoid a potential penalty for delaying your enrollment in Part B.

So when is the best time to enroll in Parts A and B? I hope that this post has been beneficial to you, but the most effective way to know your answer is to sit down and start a conversation. I’d love to get to know you and get you the answers for your Medicare questions!

]]>Wed, 11 Oct 2017 20:19:18 GMThttp://answersformedicare.com/blog/5-medicare-mistakesTurning 65 brings some difficult choices concerning your healthcare. Beyond making sure that the coverage you choose works for you, there are a number of rules that must be followed. You have probably received a number of flyers and letters in the mail and that can make the task more confusing. I would like to help you avoid some common Medicare mistakes. 

1. Misunderstanding enrollment periods

    You may have heard the term "Open Enrollment" and believe it is the only time to sign for Medicare. Open Enrollment (October 15th to December 7th) is for those already on Medicare who want to make changes to their coverage or plans for the next year. If you are new to Medicare, your enrollment period is a 7 month window around your 65th birthday. If you miss this window, you could have a late penalty added to your premiums, as well as a delay in coverage.

2. Failing to read your Annual Notice of Change
    If you are enrolled in a Medicare Advantage Plan, every September you will receive an Annual Notice of Change. This document informs you of the changes in coverage and costs for the following year. This is delivered just prior to Open Enrollment, giving you the opportunity to compare your plan with other options. If you fail to read this document, you could be in for bad surprise on January 1.

3. Failing to enroll in Part B when you should
    Signing up for Part B at the correct time is important. Signing up late can result in penalties - surcharges on your premium and also a delay in coverage. If you have employer coverage and that employer has more than 20 employees, you can delay signing up without penalty. The 3 months prior to your 65th birthday month, the month of your birthday, and the 3 months following your birthday month is the enrollment period to sign up for Part B without penalty.

​4. Not signing up for Part D because you don't take any prescription drugs
    Even if you currently have no prescriptions, it is recommended that you sign up for Part D. If you sign up late for a Part D plan, you may be subject to additional penalties in the form of higher premiums. You can avoid the penalty if are currently covered by a policy that Medicare approves as similar to a Part D plan. Some Medicare Advantage plans include a Part D plan which helps keep your costs lower.

​5. Assuming that your medical providers will always be covered by your Medicare Advantage plan

    Sometimes the providers that are part of a network change. Don't make the assumption
that the providers you used this year will be in-network next year. You are informed of
changes every September and provider changes should be included. It is worth your time
and effort to avoid out-of-network charges in the upcoming year.

Signing up for Medicare is no small task and making mistakes along the way can only make the ordeal more difficult. I hope that you find this list helpful and if you have any questions, please reach out to us. We are more than happy to sit down with you and answer your Medicare questions.
]]>Thu, 21 Sep 2017 21:45:04 GMThttp://answersformedicare.com/blog/5-medicare-scamsYou don't recognize the number calling your phone but you answer anyway. You are not sure to whom the voice belongs, but they make a compelling case as to why they need your Medicare number or bank information. What do you do?

Many seniors have found themselves in this situation. Many have been had personal information and money stolen during phone calls that start out just like this example. What can be done about this problem? The best way to protect ourselves from these criminals is to educate ourselves and know the signs of a scam. Here are 5 Medicare scams that I think you should be on the lookout for.

1. New Card Scam
In April 2018, Medicare will be issuing new Medicare cards with your updated number. Scammers will contact you asking for your current number in order to send you the new card. PLEASE KNOW: Medicare will NOT be contacting you, they will send the new card automatically.

2. Refund Scam
Scammers contact you to inform you of a "change" or "enhancement" that entitles you to a refund. They may also claim that a lawsuit was filed and you are owed money. Their goal is to get your Medicare number and your bank account for a "direct deposit". PLEASE KNOW: Medicare will automatically send you any refunds owed and likely already has your bank information (via Social Security).

3. Posers Scam
In this scam, people posing as representatives from health providers or government agencies will be seeking your personal information. They can manipulate the caller ID and use official sounding names. PLEASE KNOW: Health providers will not ask for your personal information. If you are concerned about a fake government agency, contact Medicare directly.

4. Fake Freebie Scam
Scammers offer a free health service or free medical supplies. Typically when they offer free supplies they'll ask for a credit card for "shipping charges". Free checkups can be a front to get your Medicare number. PLEASE KNOW: Getting a credit card number for "shipping charges" is a common scam. There are legitimate clinics that do free checkups, but do some research before you go.

5. Backdoor Billing
This is a scam that may not only steal personal information from someone on Medicare, it may also include them in the fraud. In some cases, a scammer will claim that there is a way to get a service or item covered by Medicare, they just need your Medicare number or credit card info to process it. In other cases, they will offer a "Free" service or medical equipment. In these instances, their goal is to defraud Medicare and use you as a way to bill Medicare for expensive and unnecessary equipment or services. PLEASE KNOW: Medicare fraud costs taxpayers $60 billion annually, so if it sounds like fraud, it probably is fraud. You should contact Medicare if you have any doubts.

As long as the opportunity to defraud seniors exists, there will be scammers. Keep yourself educated and keep yourself safe. And if you have any questions, please reach out to us. We're here to get you Answers for Medicare!

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