Dear Marci, I will turn 65 soon and need to enroll in Medicare. I’ve heard that there are different parts of Medicare. What are those parts? -Aurelio (Cleveland, OH) Dear Aurelio, There are four parts of Medicare: Part A, Part B, Part C, and Part D. Part A provides coverage for inpatient hospitalization, skilled nursing facility stays, home health care, and hospice care. Part B provides outpatient coverage, including for physician services, diagnostic tests, durable medical equipment, and outpatient hospital services. Part C is an alternate way to receive your Medicare benefits; provides Part A inpatient/hospital and Part B outpatient/medical coverage and supplemental benefits not covered by Original Medicare (see below for more information). Part D provides prescription drug coverage. Most beneficiaries choose to receive their Parts A and B benefits through Original Medicare, the traditional fee-for-service program offered directly through the federal government. It is sometimes called Traditional Medicare or Fee-for-Service (FFS) Medicare. Under Original Medicare, the government pays directly for the health care services you receive. You can see any doctor and hospital that takes Medicare (and most do) anywhere in the country. In Original Medicare: You go directly to the doctor or hospital when you need care. You do not need to get prior permission/authorization from Medicare or your primary care doctor. You are responsible for a monthly premium for Part B. Some also pay a premium for Part A. You typically owe a coinsurance for each service you receive. There are limits on the amounts that doctors and hospitals can charge for your care. If you want prescription drug coverage with Original Medicare, in most cases you will need to actively choose and join a stand-alone Medicare private drug plan (PDP). Note: There are a number of government programs that help reduce your health care and prescription drug costs if you meet the eligibility requirements. Unless you choose otherwise, you will have Original Medicare when you enroll in Medicare. Instead of Original Medicare, in most areas you have the option of getting your Medicare benefits from a Medicare Advantage Plan, also called Part C or Medicare private health plan. This means that you must still pay your monthly Part B premium (and your Part A premium, if you have one). Medicare Advantage Plans must offer, at minimum, the same benefits as Original Medicare (those covered under Parts A and B) but can do so with different costs and coverage restrictions. You also typically get Part D as part of your Medicare Advantage benefits package (MAPD). Many plans also cover supplemental benefits that are not covered by Original Medicare, like dental care, vision care, and gym memberships. Many different kinds of Medicare Advantage Plans are available. You may pay a monthly premium for this coverage, in addition to your Part B premium. -Marci |
Dear Marci,
Dear Marci, My mother has significant medical needs and has a hard time covering the costs of her care. I want to help her apply for Medicaid, but I think her monthly income might be higher than the income limit in her state. Is it possible that she could still qualify? -Alfred (Omaha, NE Dear Alfred, If your mother’s income is above the Medicaid income guidelines in her state, her state may offer a spend-down for aged, blind, and disabled individuals who do not meet Medicaid income eligibility requirements. A spend-down would allow her to deduct certain medical expenses from her income so that she can qualify for ABD Medicaid benefits. If she has medical expenses that significantly reduce her usable income, she can use them to qualify for Medicaid coverage. Below is a general guide to the Medicaid spend-down process. Contact your mother’s local Medicaid office to learn if a spend-down program is available in her state, and the rules for applying. Your mother’s spend-down amount will be the difference between her income and the Medicaid eligibility limit, as determined by her state over a given length of time (one to six months). Some states require Medicaid beneficiaries to submit receipts or bills to Medicaid to show their monthly expenses. Other states may let beneficiaries pay a monthly premium directly to Medicaid for the amount that their income is over their state’s Medicaid spend-down level. Spend-down income limits may be lower than the Medicaid income limits for people who do not have a spend-down. Each period that your mother has enough medical expenses to meet her spend down, she will have Medicaid coverage. If she does not meet her spend-down amount for a certain period of time, she will not have Medicaid coverage for that time. She can still get Medicaid coverage later if she meets her spend-down amount during another period of the year. Medicare will pay first for covered services, and Medicaid will pay second for qualifying costs, such as Medicare cost-sharing. Your mother’s state may require her to qualify and apply for spend-down for multiple periods in order to qualify for Medicaid inpatient hospital coverage. States with spend-down programs may allow people to use the spend-down program to qualify for Medicaid coverage of their nursing facility stays or home- and community-based waiver services. Note: If your mother’s state does not have a spend-down program, it should have more generous Medicaid income guidelines for people who need nursing home care than for those who do not. Your mother will automatically qualify for Extra Help the first month that she meets her Medicaid spend-down amount until the end of the calendar year (even if she does not meet her spend-down amount every period). Trusts—such as Miller Trusts and Supplemental Needs Trusts or Special Needs Trusts—are available in some states to help people become Medicaid-eligible. Trusts allow people with disabilities and income or assets higher than Medicaid eligibility guidelines to place a portion of their income or assets into the trust, where it will not be counted. Rules about how these trusts work vary greatly by state. For more information, contact your mother’s local Medicaid office or an elder law attorney. Some states offer the Medicaid Buy-In program, which allows people who are under age 65 and have a disability to work (as little as one hour per month) and still receive Medicaid benefits. The program is designed to help people with disabilities who would otherwise not be eligible for Medicaid health coverage because their income or assets are too high. If your mother qualifies, she may be able to receive Medicaid by paying a premium to buy in to the program. Financial eligibility guidelines vary by state. Check with your local Medicaid office for eligibility information. If your mother decides to work and is receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI), check with her local Medicaid office to see how much earned income she is allowed to have without losing those benefits. -Marci |
Dear Marci,
Dear Marci,
I have Medicare, and I sometimes find it difficult to afford the costs of my health care. One of my friends suggested that I apply for Medicaid. What is Medicaid, and how does it work with Medicare?
-Jeanne (Manchester, NH)
Dear Jeanne,
Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. Each state tuns various Medicaid-funded programs for different groups of people, including older adults, people with disabilities, children, pregnant people, and parents and/or caretakers of children. All states have Medicaid programs for people with limited income and assets who need nursing home care, long-term care services, and home health care services. Some states also have programs for individual adults who do not fit any of these categories.
If you are eligible for both Medicare and Medicaid (dually eligible), you can enroll in both. If you qualify for a Medicaid program, it may help pay for costs and services that Medicare does not cover. Here are a few examples of how Medicaid can work with Medicare:
- Medicaid can provide secondary insurance: For services covered by Medicare and Medicaid (such as doctors’ visits, hospital care, home health care, and skilled nursing facility care), Medicare is the primary payer. Medicaid is the payer of last resort, meaning it always pays last. When you visit a provider or facility that takes both forms of insurance, Medicare will pay first and Medicaid may cover your Medicare cost-sharing, including coinsurance charges and copays.
- Medicaid can provide premium assistance: In many cases, if you have Medicare and Medicaid, you will automatically be enrolled in a Medicare Savings Program (MSP). In other cases, you can apply for an MSP even if you are not automatically enrolled. MSPs pay your Medicare Part B premium and may offer additional assistance.
- Medicaid can provide additional cost-sharing assistance: Depending on your income, you may also qualify for the Qualified Medicare Beneficiary (QMB) MSP. If you are enrolled in QMB, you do not pay Medicare cost-sharing, which includes deductibles, coinsurances, and copays, when you see a provider who accepts Medicare.
- If you are eligible for Medicaid, you are eligible for prescription drug assistance: Dually eligible individuals are automatically enrolled in the Extra Help program to help with their prescription drug costs.
- Medicaid can offer care coordination: Some states require certain Medicaid beneficiaries to enroll in Medicaid private health plans, also known as Medicaid Managed Care (MMC) plans. These plans may offer optional enrollment into a Medicare Advantage Plan designed to better coordinate Medicare and Medicaid benefits. Note: You cannot be required to enroll in a Medicare Advantage Plan.
Make sure to call 1-800-MEDICARE or contact your local Medicaid office to learn more about Medicare and Medicaid costs and coverage, especially if you are dually eligible.
-Marci
Simple remedies for knee pain!
The following are simple remedies that can help with many forms of knee pain.
Exercise by stretching your quads.
Strengthening certain muscles like the quadriceps can ease pain in the knees.
Exercise helps to slow the progression of osteoarthritis, a common cause of knee pain. Physical activity is important to the normal health of cartilage tissue.
Exercise is also good for strengthening the body’s support for its joints. For the knee, strengthening the leg muscles is particularly helpful.
Water aerobics is especially helpful for joint pain. This is because the benefits come without any strain on the knees.
Strengthening exercises
Physical therapists can help work out the best exercises and programs for an individual to follow.
Exercises to strengthen the muscles in the upper leg can help to protect the knee joint. Known as the quadriceps muscles, these muscles are at the front and sides of the thighs.
Simply raising a straightened leg while sitting or lying down is an exercise that will strengthen these muscles and help them to stabilize the knee.
Other exercises that might reduce knee pain include stepping – putting one foot up on a step followed by the other, stepping down again, and repeating the step-ups.
Posture and support
Simple measures to avoid putting strain on the knee include avoiding chairs that are low to the ground or couches in which the sitter “sinks.” Sitting on a pillow may help with this. Putting a pillow underneath the knees can make the problem worse, however. A good sitting posture is also important.
Shoes that are supportive are helpful. Shoes with broken arches may produce abnormal force and wear on the knee causing pain.
Long periods without moving should be avoided. In osteoarthritis, for example, prolonged sitting can produce a stiff, painful joint.
Weight loss and diet :
A healthy diet helps people to keep weight off and ease pressure on the knees.
People who are overweight or obese are more likely to have knee pain than others.
Carrying extra weight gives the joints more work to do. Losing it helps to reduce long-term knee pain, including pain caused by arthritis.
Eating well helps with keeping weight off. A healthy diet means a balanced one that is:
Low in fat
High in fruit, vegetables, and fiber
Avoids lots of meat and animal fat
There are no special diets that are particularly good for knee pain or arthritis. It may do more harm than good to follow a diet being promoted for knee pain.
Alternative and complementary remedies
Acupuncture might help some people against some forms of pain. For osteoarthritis in the knee, however, it is unclear if it has any benefit or not. Massage may relieve pain.
Healthy eating, exercise, reducing overweight and obesity, and taking non-steroidal anti-inflammatory medications remain the proven options for knee pain caused by arthritis.
A warmer climate is not thought to improve knee pain itself, but may make living in pain psychologically easier. It may also provide easier opportunities to achieve a more healthy lifestyle.
Pain at the front of the knee
Pain at the front of the knee is one of the most common aches and pains. It is second only to lower back pain – around a quarter of people will get it at some point in their lives.
It commonly affects teenagers, especially young female athletes. It is the most common overuse syndrome in sportspeople.
Most cases of front knee pain are injuries from overuse, or from poor preparation for exercise. The problems usually go away on their own, and sporting activities can resume after the pain subsides.
The pain varies but tends to:
Be a dull ache that starts gradually, and is linked to activities
Produce clicking or other sounds
Come on when going upstairs, or when getting up after a long time sitting, squatting down, or kneeling
Produce a weakness in the legs
Recommended treatments for front knee pain include:
Stopping the activities that trigger it until it is resolved
Applying ice when the knee is painful
Taking over-the-counter pain relievers such as ibuprofen or naproxen
Using strengthening exercises
Dear Marci,
How can I access supplemental benefits? |
Dear Marci, I have Medicare, and I’m interested in getting services like dental, transportation, and home-delivered meals. Do I need a Medicare Advantage Plan to get these supplemental benefits? Is there a way to get these services if I have Original Medicare? -Xavier (Ogden, UT) Dear Xavier, A supplemental benefit is an item or service covered by a Medicare Advantage Plan that is not covered by Original Medicare. These items or services do not need to be provided by Medicare providers or at Medicare-certified facilities. To receive them, you just need to follow your plan’s rules. Some commonly offered supplemental benefits are dental care, vision care, hearing aids, and gym memberships. Supplemental benefits must be primarily health-related, with some exceptions for people with chronic conditions. Some supplemental benefits are offered to everyone who is enrolled in a plan, but for an additional premium, such as to add dental coverage. Other benefits may be covered for everyone enrolled in the plan, regardless of whether you use the benefit, such as a gym membership. Medicare Advantage Plans can also cover supplemental benefits that are not primarily health-related for beneficiaries who have chronic illnesses. These benefits should address environmental factors that may affect the health, functioning, quality of life, and risk levels of beneficiaries with chronic conditions. Some examples of these benefits are meal delivery, transportation for non-medical needs, and home air cleaners. In order to be eligible for this category of supplemental benefits, you must be considered chronically ill. This means that you: Have at least one medically complex chronic condition that is life-threatening or significantly limits your health or function Have a high risk of hospitalization or other negative health outcomes, and Require intensive care coordination If you meet these criteria, a Medicare Advantage Plan may offer you one of these benefits if it has a reasonable expectation of improving or maintaining your health or function. Medicare Advantage Plans will be able to create sets of supplemental benefits for people with specific chronic illnesses, which means not every member of a Medicare Advantage Plan will have access to the same set of supplemental benefits. For example, a plan might cover services like home air cleaning and carpet shampooing for members with severe asthma. A member of that plan who has severe asthma may be able to get that service covered, while a member who does not have asthma, or whose asthma is mild, may not. In some cases, there may be no Medicare Advantage Plan in your area that covers the supplemental benefits that you need, or you might find that Original Medicare offers better coverage of services that are important to you. You may still be able to access services that Original Medicare does not cover. Medigaps: Generally, Medigaps, which are insurance policies that supplement Original Medicare, pay second to Medicare when Medicare covers a service and pays first. All Medigaps also offer additional days of inpatient hospital care beyond what is covered by Original Medicare, and some cover emergency medical services received outside of the United States, which are not covered by Original Medicare. Medigaps can also offer fitness benefits or other targeted supplemental coverage in some states. Medicaid: Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. In some states, Medicaid covers services that are not covered by Medicare, including dental, vision, long-term care, and transportation. A state may also have a Medicaid waiver program that covers additional services, too. To learn more about your state’s Medicaid program, contact your local State Health Assistance Program (SHIP). Contact information for your SHIP is on the last page of this document. Reduced-cost or free clinics: You may be able to access the services you need through a free or reduced-cost clinic in your area. Use resources available at needymeds.org, healthcare.gov, freeclinics.com, and hhs.gov for more information. Donated dental service programs or dental schools: Donated dental services programs operate in some states. Dentists in these programs offer free dental services if you qualify. You may also be able to get low-cost dental care at a dental school, where dental students work with patients under the supervision of experienced, licensed dentists. Administration for Community Living (ACL) eldercare locator: Visit eldercare.acl.gov to learn about other resources in your community, such as long-term care and legal aid. Marci |
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