Life After 50 Expo

Dear Marci,

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Dear Marci,

I am new to Medicare. I have been receiving treatment for depression and anxiety for several years, and have gotten treatment in both inpatient and outpatient settings. Will these services be covered under Medicare? How much will they cost?

  • Beau (Baton Rouge, LA)

Dear Beau,

Medicare covers medically necessary mental health care—services and programs that are intended to help diagnose and treat mental health conditions.

If you have Original Medicare, Part A covers inpatient mental health services that you receive in either a psychiatric hospital (a hospital that only treats mental health patients) or a general hospital. Your provider should determine which hospital setting you need. If you receive care in a psychiatric hospital, Medicare covers up to 190 days of inpatient care in your lifetime. If you have used your lifetime days but need additional mental health care, Medicare may cover your additional inpatient care at a general hospital.

Be aware that you will have the same out-of-pocket costs with Original Medicare whether you receive care in a general or psychiatric hospital:

  • The Part A deductible: Before Medicare covers the cost of inpatient care, you have to meet the deductible for the benefit period. In 2018, the deductible is $1,340.
  • Days 1-60: After you meet the deductible, Medicare pays in full for the first 60 days of your care.
  • Days 61-90: Medicare pays part of the cost, and you are responsible for a daily coinsurance. In 2018, the coinsurance is $335.
  • Lifetime reserve days: For up to 60 lifetime reserve days, Medicare pays part of the cost, and you are responsible for a daily coinsurance. The coinsurance in 2018 is $670.

Medicare Part B covers outpatient mental health care, including the following services:

  • Individual and group therapy
  • Substance abuse treatment
  • Tests to make sure you are getting the right care
  • Occupational therapy
  • Activity therapies such as art, dance, or music therapy
  • Training and education (such as training on how to inject a needed medication or education about your condition)
  • Family counseling to help with your treatment
  • Laboratory tests
  • Prescription drugs that you cannot administer yourself, such as injections that a doctor must give you.
  • An annual depression screening that you receive in a primary care setting. Speak to your doctor or primary care provider for more information.
    • The depression screening is considered a preventive service, and Medicare covers depression screenings at 100% of the Medicare-approved amount.

Original Medicare covers these outpatient mental health services (with the exception of the annual depression screening) at 80% of the Medicare-approved amount. This means that as long as you receive services from a provider who accepts assignment (meaning they accept Medicare’s approved amount as full payment for a service), you will pay a 20% coinsurance after you meet your Part B deductible.

Medicare Part B also covers partial hospitalization for mental health treatment for people who meet coverage requirements. Partial hospitalization programs provide care that is more intensive than other forms of mental health care, but less intensive than inpatient care.

If you have a Medicare Advantage Plan, your plan must cover the same inpatient and outpatient mental health services as Original Medicare, but they may impose different rules, restrictions, and costs. If you need information about a plan’s costs and coverage rules, or if you are experiencing problems, contact your Medicare Advantage Plan.

-Marci
 

Healthy living tips !

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Here are a few tips for living a healthy lifestyle.

There’s no better place to start self-improvement than with your health. After all, health is one of the most important aspects of life. Taking care of your health is the first step on the road to self-improvement.

1. Eat breakfast- start the day off right with a quick morning breakfast. Fruit and yoghurt, granola and milk or whole-wheat toast and peanut butter will ensure you start on the right foot.

2. Relax in the morning- get up a couple minutes early and savour that extra time. Enjoy a cup of coffee while watching the sun rise; take a few extra minutes to yourself in the shower; or go for a quick brisk walk around the block to get your heart pumping. There’s nothing worse than starting your day in a rush. A few minutes in the morning can make a world of difference. [Read more…]

Dear Marci,

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Dear Marci,

With Fall Open Enrollment coming up, I am thinking about changing my Medicare coverage. I might keep Original Medicare and enroll in a new Part D prescription drug plan, or I might enroll in a Medicare Advantage Plan with prescription drug coverage. What factors should I consider when I am looking at different plans?

-Eva (Topeka, KS)

Dear Eva,

Fall Open Enrollment, which runs from October 15 through December 7, is the right time to review your current coverage, compare it with other options, and possibly make changes. The last change you make during Fall Open Enrollment will take effect on January 1, 2019. To avoid enrollment problems, it is best to call 1-800-MEDICARE when making changes to your health and drug coverage.

Here are some questions to ask about any Medicare Advantage Plan that you are considering enrolling in:

  • How much are the premium, deductible, and coinsurance/ copay amounts?
  • What is the annual maximum out-of-pocket cost for the plan? This amount might be high, but can help protect you if you have expensive health care costs.
  • What service area does this plan cover?
  • Are my doctors and hospitals in the plan’s network?
  • What are the rules I have to follow t access health care services and my drugs?
  • Does the plan cover additional health care benefits that are not covered by Original Medicare?
  • How will this plan affect any additional coverage I may have?

Ask yourself these questions before choosing a Part D prescription drug plan or a Medicare Advantage Plan with prescription drug coverage:

  • Does the plan cover all the medications I take?
  • Does the plan have restrictions on my drugs (like prior authorization, step therapy or quantity limits)?
    • Prior authorization means that you must get approval from your Part D plan before the plan will pay for the drug
    • Step therapy means that your plan requires you to trey a cheaper version of the drug before it will cover a more expensive one.
    • Quantity limits restrict the quantity of a drug you can get per prescription fill, such as 30 pills of Drug X per month.
  • How much will I pay for monthly premiums and the annual deductible?
  • How much will I pay at the pharmacy (copay/coinsurance) for each drug I take?
  • Is my pharmacy in the plan’s preferred network?
  • Can I fill my prescriptions by mail order?
  • If I have retiree coverage, will the Medicare drug plan work with this coverage?

For both Medicare Advantage Plans and Part D prescription drug plans, you may also want to consider a plan’s star rating. Star ratings are quality ratings that provide a measure of a plan’s performance. Medicare scores plans in several categories, including quality of care and customer service. Ratings range from one to five stars, with five being the highest.

Keep in mind that a plan’s star rating is only one factor to review when comparing plans in your area. Even though a plan has a high star rating, it may not be right for you. It is important to see whether the plan covers the health services and drugs you need and works with the pharmacies you use before considering its star rating. Also, note that the star ratings in the Medicare & You handbook are not necessarily the most recent. For the most up-to-date, comprehensive star ratings, you should call 1-800-MEDICARE or use the online Plan Finder tool at www.medicare.gov.

You may also find it helpful to use Medicare’s Plan Finder tool, which gives you a list of Medicare Advantage and Part D plans, the drugs they cover, and their estimated costs for the year. You can access Plan Finder by going online at www.medicare.gov or calling 1-800-MEDICARE.

-Marci
 

Dear Marci,

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Dear Marci,

I got Medicare in February of this year. My friend told me that people can change the way they get their Medicare benefits in the fall every year. Is this true? How will I know what changes to make?

-Rose (Cedar Rapids, IA)

Dear Rose,

You friend was referring to Fall Open Enrollment.Fall Open Enrollment runs from October 15 through December 7 each year. During this time, you can make changes to your health insurance coverage, including adding, dropping, or changing your Medicare coverage. Even if you are happy with your current health and drug coverage, Fall Open Enrollment is the time to review what you have, compare it with other options, and make sure that your current coverage still meets your needs for the coming year.

You can make as many changes as you need to your Medicare coverage during Fall Open Enrollment. The changes you can make include:

  1. Joining a new Medicare Advantage Plan
  2. Joining a new Part D prescription drug plan
  3. Switching from Original Medicare to a Medicare Advantage Plan
  4. Switching from a Medicare Advantage Plan to Original Medicare (with or without a Part D plan)

As you review your current Medicare coverage, you should consider:

  • Your access to providers you want to see
  • Your access to preferred pharmacies
  • Your access to benefits and services you need
  • The total costs for insurance premiums, deductibles, and cost-sharing amounts.

If you have Original Medicare, visit www.medicare.gov or read the 2019 Medicare and You handbook to learn about Medicare’s benefits for the upcoming year. You should review any increases to Original Medicare premiums, deductibles, and coinsurance charges.

If you have a Medicare Advantage Plan or a stand-alone Part D plan, read your plan’s Annual Notice of Change (ANOC) and/or Evidence of Coverage (EOC). Review these notices for any changes in a) the plan’s costs, b) the plan’s benefits and coverage rules, or c) the plan’s formulary (list of drugs your plan covers). Make sure that your drugs will still be covered next year and that your providers and pharmacies are still in network. If you are unhappy with any of our plan’s changes, you can enroll in a new plan. If you want assistance reviewing your options, contact your State Health Insurance Assistance Program (SHIP) for unbiased counseling. To contact your SHIP, visit www.shiptacenter.org or call 877-839-2675.

Even if you are happy with your current Medicare coverage, consider other Medicare health and drug plan options in your area. For example, even if you do not plan to change your Medicare Advantage or Part D plan, you should check to see if there is another plan in your area that will offer you better health and/or drug coverage at a more affordable price. Research shows that people with Medicare prescription drug coverage could lower their costs by shopping among plans each year; there could be another Part D plan in your area that covers the drugs you take with fewer restrictions and/or lower prices.

The last change you make to your Medicare coverage during Fall Open Enrollment will take effect on January 1, 2019. To avoid enrollment problems, it is best to call 1-800-MEDICARE (1-800-633-4227) when making any changes to your health and/or drug coverage.

-Marci

Dear Marci,

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Dear Marci,

My mother is being discharged to her home after a stay in a skilled nursing facility. A social worker from the nursing facility is helping her get Medicare-covered home health care. She has Original Medicare. What kinds of services does Medicare cover? Are there services that are not covered?

-Brian (Franklin, TN)

Dear Brian,

Medicare’s home health benefit covers some home health services for people who meet eligibility requirements, including needing skilled care and being homebound. To learn more about these eligibility requirements, click here.

If your mother qualifies for the home health benefit, Medicare covers the following:

  • Skilled nursing services: Services performed by or under the supervision of a licensed or certified nurse to treat your injury or illness.
    • Services your mother may receive include injections (and teaching her to self-inject), tube feedings, catheter changes, observation and assessment of your condition, management and evaluation of your care plan, and wound care.
    • These services are provided up to seven days per week for generally no more than eight hours per day and 28 hours per week. In some circumstances, Medicare can cover up to 35 hours per week.
  • Skilled therapy services: Physical, speech, and occupational therapy services that are reasonable and necessary for treating an illness or injury, and performed by or under the supervision of a licensed therapist
    • Physical therapy includes gait training, as well as supervision of and training for exercises to regain movement and strength in a body area
    • Speech-language pathologyservices include exercises to regain and strengthen speech and language skills.
    • Occupational therapy helps you regain the ability to do usual daily activities by yourself, such as eating and putting on clothes.
  • Home health aide: Medicare pays in full for an aide if you require skilled care. A home health aide provides personal care services, including help with bathing, toileting, and dressing. Medicare will not pay for an aide if you do not need skilled care in the first place.
  • Medical social services: Medicare pays in full for services ordered by your doctor to help you with social and emotional concerns you have related to your illness. This may include counseling or help finding resources in your community.
  • Medical supplies: Medicare pays in full for certain medical supplies, such as wound dressings and catheters, when provided by a Medicare-certified home health agency.
  • Durable medical equipment (DME):Medicare pays 80% of its approved amount for certain pieces of medical equipment, such as a wheelchair or walker.

Medicare’s home health benefit does not cover all home care services. Services excluded from Medicare coverage include:

  • 24-hour per day care at home
  • Prescription drugs
    • If your mother need prescription drug coverage, she should enroll in a Part D plan or a Medicare Advantage Plan that provides drug coverage.
  • Meals delivered to your home
  • Housekeeping services, including light housekeeping, laundry, and meal preparation
    • Home health aides may perform some housekeeping services when visiting to provide other health-related services. However, aides cannot visit with the sole purpose of performing housekeeping duties.

For people who are terminally ill, Medicare covers some of the above services if the person elects the hospice benefit.

For more information about the services that Medicare covers and for information about home health agencies in your mother’s area, you or your mother can call 1-800-MEDICARE.

-Marci