Life After 50 Expo

Medicare Update!

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All Medicare Advantage plans must offer the same benefits as Original Medicare, but are allowed to have different costs and restrictions. Certain Medicare Advantage plans offer additional limited benefits, such as vision or dental coverage.

The two most common types of Medicare Advantage plans are health maintenance organizations (HMOs) and preferred provider organizations (PPOs). HMOs generally only cover care from providers who are within their networks. If you go out-of-network, you will usually be responsible for the full cost of your care. They also often require referrals to see specialists. On the other hand, you will pay the least if you see a provider within a PPO’s network, but it provides limited coverage for out-of-network providers. Additionally, PPOs do not require referrals to see specialists. Due to this additional freedom, the premiums for a PPO are generally higher than that of an HMO.

Health Tip !

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The US Centers for Disease Control and Prevention (CDC) has found that the number of older adults in the US who die from fall-related injuries has nearly doubled since 2000. The report examined information from the National Vital Statistics System between 2000 and 2013. The CDC found that about 30 in every 100,000 older adults died following a fall in the year 2000. By the year 2013, about 57 in every 100,000 older adults died following a fall, nearly a 50 percent increase. Falls are often a triggering event that signal larger health issues, such as balance issues, poor nutrition, or poorly controlled diabetes that results in foot numbness. Researchers have found that the study highlights the importance of coordinated fall-prevention efforts, such as home assessments and balance exercises.

Dear Marci,

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Dear Marci,

I was recently hospitalized after breaking my hip, and my doctor recommended that I go to a skilled nursing facility for continued therapy treatments. My doctor told me that Medicare will only cover this care in certain circumstances. When does Medicare cover care received in a SNF?

– Alex (Tampa, FL)

Dear Alex,

Medicare may help pay for skilled nursing facility (SNF) care if you meet the following requirements:

  • You need skilled nursing care seven days a week or skilled therapy services at least five days a week. Skilled nursing services include wound care, tube feedings, and IV drug administration. Skilled therapy services include physical, occupational, and speech therapy;
  • You were formally admitted as an inpatient to a hospital for at least three consecutive days. You must enter a Medicare-certified SNF within 30 days of leaving the hospital;
  • You have Medicare Part A before you are discharged from the hospital; and
  • You need care that can only be provided in a SNF.

If you meet these requirements, Medicare should cover the SNF care needed to improve your condition or maintain your ability to function. It is important to note that if you are admitted to the hospital underobservation or only receive emergency room services, this time does not count toward meeting the three-day prior hospital requirement for SNF coverage.

When you qualify for a Medicare-covered SNF stay,Medicare covers a semiprivate room, meals, nursing care, therapy services, medical social services, mental health services from clinical social workers, dietary counseling, medications, medical equipment and supplies, and ambulance transportation (when other transportation would be dangerous to your health) to the nearest supplier of needed services that are not available at the SNF.

Original Medicare will pay the full cost of the first 20 days and part of the cost of another 80 days of care in a Medicare-certified SNF each benefit period as long as it is medically necessary. A benefit period is how Original Medicare measures hospital stays. It begins the day you start getting inpatient care and ends when you’ve been out of the hospital or SNF for 60 days in a row. If you have a Medicare Advantage plan, your plan’s coverage of SNF stays may be different. Contact your plan directly to confirm costs and coverage of SNF stays.

In order to find a SNF that meets your needs, you should speak to your doctor and the hospital discharge planner about your SNF care needs. Ask them to find a Medicare-certified SNF in your area that will best meet your needs after you leave the hospital. If you are in a Medicare Advantage plan, you should contact your plan to find out which SNFs are in their network. A network is a group of doctors, hospitals and pharmacies that contract with a managed care plan to provide health care services to plan members.

-Marci

 

May is Skin Cancer Detection & Prevention Month!

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Skin cancer is the most common cancer in the United States. Melanoma, the most dangerous type of skin cancer, is typically caused by exposure to ultraviolet (UV) light. Skin cancer can usually be cured when it’s found and treated early. Talk with your doctor about skin cancer screenings and detection. Protecting yourself from UV light is an important part of reducing your risk for skin cancer. The U.S. Centers for Disease Control and Prevention (CDC) recommends the following precautions:

  • Stay in the shade, especially during midday hours.
  • Wear clothing that covers your arms and legs.
  • Wear a hat with a wide brim to shade your face, head, ears, and neck.
  • Wear sunglasses that wrap around and block both UVA and UVB rays.
  • Use sunscreen with sun protection factor (SPF) 15 or higher, and both UVA and UVB protection.

Dear Marci,

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Dear Marci,

My mother has several serious health complications, and her condition has deteriorated in the past few weeks. Her doctor has diagnosed her as terminally ill and recommended that we consider transitioning her to hospice care, but I am concerned about the costs and coverage. How does Medicare cover hospice care and what are the costs?

– William (Trenton, NJ)

Dear William,

Medicare covers hospice care if you meet certain criteria. Hospice care is comprehensive care for people who are terminally ill that includes pain management, counseling, respite care, prescription drugs, inpatient and outpatient care, and services for the terminally ill person’s family.

In order to qualify for the hospice benefit, you must meet the following criteria:

  • Have Medicare Part A;
  • The hospice medical director (and your doctor, if you have one) must certify that you have a terminal illness, meaning that your life expectancy is six months or less;
  • You sign a statement electing to have Medicare pay for palliative care, such as pain management, rather than care to try to cure your condition;
  • Your terminal condition is documented in your medical record; and
  • You receive care from a Medicare-certified hospice agency.

If you are considering hospice care, speak with your doctor about finding a Medicare-certified hospice agency. The hospice medical director and your doctor will certify your eligibility. You must sign a statement electing hospice care and waiving curative treatments for your terminal illness. The hospice team of providers must consult with you to develop a plan of care. The team includes a hospice doctor, a registered nurse, a social worker and a counselor.

Hospice can be provided in the home or in an inpatient facility; you do not have to be homebound to qualify for the hospice benefit. The hospice benefit covers the following services related to your terminal condition:

  • Nursing services
  • Skilled therapy services
  • Home health aide services
  • Durable medical equipment and medical supplies
  • Short-term inpatient care to give relief to your caregivers
  • Short term inpatient care to manage symptoms and control pain
  • Medical social services
  • Some prescription drugs
  • Spiritual or religious counseling care
  • Nutrition and dietary counseling

The hospice benefit is always covered under Original Medicare. Even if you have a Medicare Advantage plan, Original Medicare Part A will cover your hospice care. Your Medicare Advantage plan will continue to pay for your care that is unrelated to your terminal condition.

Original Medicare covers most costs associated with hospice care. You will be responsible for paying up to $5 for outpatient prescription drugs covered through the hospice benefit (prescription drugs related to pain relief and symptom control). You also will pay a copay of no more than 5 percent of the Medicare approved amount for each day of inpatient respite care.

While you have hospice, you can still get Medicare coverage for treatment of all illnesses and injuries unrelated to your terminal condition. However, the costs you usually pay for services will apply.

Medicare will cover the hospice benefit as long as you continue to qualify for hospice care. If you receive 180 days of hospice care, you must have a face-to-face meeting with a hospice doctor or nurse practitioner to confirm that you still qualify for hospice care. You also can end hospice care at any time and elect to receive curative treatments for an illness.

-Marci