Medicare Covers Assisted Living?

Part A covers home health care that is limited to reasonable and necessary part-time or intermittent skilled care, or a continuing need for physical therapy, occupational therapy, or speech-related pathology. Home health services may also include medical social services, home health aide services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers), and medical supplies for use at home. Part B will also cover some outpatient care services. See the Medicare web page for information on assisted living options at this link: http://www.medicare.gov/Nursing/Alternatives/Other.asp

Note that Medicare does not cover custodial care (like help with bathing or using the bathroom), except when you also get skilled nursing care in a skilled nursing facility, at home, or in a hospice. See page 82 of Medicare & You 2008 at this link: http://www.medicare.gov/Publications/Pubs/pdf/10050.pdfor

However, there is something called Programs of All-Inclusive Care for the Elderly (PACE) that combines medical, social, and long-term care services for frail, elderly people. You can get more information from the Centers for Medicare & Medicaid Services at this link: http://www.cms.hhs.gov/pace/

Further, there is a directory called Eldercare Locator that helps you find local resources for assistance. Their web page is: http://www.eldercare.gov/Eldercare/Public/Home.asp

Finally, if income is low enough, one may qualify for Medicaid. You can learn more about Medicaid at the Center for Medicare and Medicaid Services’ website at this link: http://www.cms.hhs.gov/MedicaidGenInfo/

Source:

http://www.medicarebenefits.com

Questions about Medicare? Email to info@medicarebenefits.com

Medicare and New Glasses/Contacts

Medicare Part B will cover one pair of eyeglasses with standard frames, or one set of contact lenses after cataract surgery if that surgery implants what is called an “intraocular lens”. You pay the coinsurance and Part B pays the rest (assuming you have met your annual Part B deductible).

This information is on page 20 of the free booklet, Medicare & You 2008. You can download your copy off the Medicare web site at this link:

http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf.

Source:

http://www.medicarebenefits.com

Questions about Medicare? Email to info@medicarebenefits.com

Medicare Trustees Annual Report Available

The Social Security and Medicare Trustees’ Annual Report Summary for 2007 is a 20 page summary report that provides an analysis of the current and projected future state of the trust funds established by Congress to pay for Social Security and Medicare.

Below are some excerpts on Medicare that point to the financial challenges ahead that will probably require some combination of tax increase, premium increase, and benefit reduction.

Medicare’s Financial Difficulties

“Medicare’s financial difficulties [will] come sooner, and are much more severe than those confronting Social Security. While both programs face demographic challenges, the impact is greater for Medicare because health care costs increase at older ages. Moreover, underlying health care costs…are projected to rise faster than … wages [and] taxes [on which] … benefits are based.”

Part A: Under-Funded in 12 Years

“The projected date of the Hospital Insurance Trust Fund exhaustion is 2019…when tax income will … pay only 79 percent of … costs.”

Part B & Part D: Solvent, But Premiums Will Rise

“Part B … which pays doctors’ bills and other outpatient expenses, and Part D which pays for … prescription drug coverage are both projected to remain adequately financed into the indefinite future… However, expected steep cost increases will result in … substantial increases … in … premium charges.”

Get Your Free Copy. Click Here.

Questions about Medicare? Email to info@medicarebenefits.com

Source:

http://www.medicarebenefits.com/what_s_new_in_medicare_report.html

New Edition of the Guide to Home Health Care Agencies

The Medicare website has a section called Home Health Compare . It has been enhanced to improve the display of local home health agency performance. CMS provides this tool to assist people with Medicare, and their families, to choose the best home health agency. Users are able to review an agency’s past performance based on the care they require.

This tool provides you with information on how well the home health agencies in your area care for their patients. Keep in mind:

• The list of Home Health Agencies generated by your search criteria is based on the places where they have provided services in the past.
• The services that the agencies have available in these areas could change in the future. Contact the Home Health Agency to find out if they still provide the same services in your area.
• Newly Medicare-certified home health agencies may not appear in Home Health Compare for one year.
• Only Medicare-certified home health agencies are required to submit information about home health agencies.
• Agencies that exclusively serve children, or private pay, or privately insured patients are not listed here.

Their website has information on:

• Finding a Home Health agency.
• Quality measures to help you compare home health agencies.
• Your choices in selecting a Home Health agency.
• Your rights when you are a Home Health patient

Questions about Medicare? Email to info@medicarebenefits.com

Source:

http://www.medicarebenefits.com/what_s_new_in_medicare_newedition.html

5 Ways to Lower Your Drug Costs

Medicare's website lists 5 ways in which you can lower your prescription drug costs:

Consider Switching to Generics or Other Lower-Cost Drugs.

You may wish to talk to your doctor about the drugs you are currently taking to find out if there are generic or less-expensive brand-name drugs that would work just as well as the ones you're taking now. Cost savings information through the use of mail-order pharmacies, generic or less-expensive brand-name drugs is also available in the Medicare Prescription Drug Plan Finder.

Explore National and Community-Based Charitable Programs

National and community-based charitable programs (such as the National Patient Advocate Foundation or the National Organization for Rare Disorders) may have programs that can help with your drug costs. Information on programs in your area is available on the Benefits Checkup website.

Look into Pharmaceutical Assistance Programs

Many of the major drug manufacturers are offering assistance programs for people enrolled in Medicare Part D. You can find out whether a Patient Assistance Program is offered by the manufacturers of the drugs you take by visiting Medicare’s Pharmaceutical Assistance Program site.

Look at State Pharmaceutical Assistance Programs

There are also 21 states and one territory offering help with paying drug plan premiums and/or other drug costs. You can find out if your State has a program by visiting Medicare’s State Pharmaceutical Assistance Program site.

Apply for Extra Help

If you have Medicare and have limited income and resources, you may qualify for extra help paying for your prescription drugs. If you qualify, you could pay between $1-$5 for each drug. Contact Social Security by calling 1-800-772-1213. TTY users should call 1-800-325-0778.

For additional information, visit the Medicare website by clicking here.

You can also get a free copy of Medicare booklet Bridging the Coverage Gap by clicking here.

Questions about Medicare? Email to info@medicarebenefits.com

Source:

http://www.medicarebenefits.com/what_s_new_in_medicare_5ways.html

Medicare Coverage For Home Infusion Therapy?

A new bi-partisan bill pending in Congress would provide Medicare drug coverage for Medicare patients who require ‘infusion therapy’ (specialized medications that are delivered intravenously). The new legislation would enable this to be done in the home.

Currently, Medicare does not cover home infusion therapy because Part D will pay for the drugs themselves, but not the nurses, equipment and supplies necessary to administer the treatment in the home. Says Rep. Kay Granger (R-TX), another sponsor, "Our bill would cover home infusion supplies, equipment, and professional services under Part B, thereby making the Part D coverage of infusion drugs meaningful and effective."

"Medicare is virtually the only payer in the country where home infusion therapy is not adequately covered," said Rep. Eliot Engel (D-NY), one of the bill’s sponsors. I intend to fight to secure passage of this bill so that Medicare beneficiaries receive the same level of care given to individuals with private insurance."

Questions about Medicare? Email to info@medicarebenefits.com

Source:

http://www.medicarebenefits.com/what_s_new_in_medicare_infusion.html

Medicare Changes Coverage For Anemia Drugs

Many people who are on chemotherapy suffer from anemia, and counteract this with drugs that increase the production of oxygen-carrying red blood cells. Popular brands include Aransep and Procrit.

There have been some safety concerns about these drugs. In particular, they are approved only for the anemia resulting from chemotherapy, but have also been used by cancer patients who are not getting chemotherapy.

Back in May, Medicare proposed that use of these types of drugs be limited, but a public outcry from doctors and patients caused them to modify the rules under which they would be covered.

However, the revised rule still retains some significant restrictions. For example, the program will not cover the use of these drugs to treat the anemia caused by cancer itself, but just the anemia caused by chemotherapy. Thus patients not getting chemotherapy will not have these drugs covered by Medicare.

For more information, go to the CMS website by clicking here.

Questions about Medicare? Email to info@medicarebenefits.com

Source:

http://www.medicarebenefits.com/what_s_new_in_medicare_anemia.html

Part D Premiums For 2008 To Be Lower Than Expected

Due in large part to strong competitive bidding by health and prescription drug plans and beneficiaries’ choices, the Centers for Medicare & Medicaid Services (CMS) anticipates that the actual average premium paid by beneficiaries for standard Part D coverage in 2008 will be roughly $25, compared to $22 in 2007. This is nearly 40% lower than originally projected.

“Competition and smart choices have been two important factors in holding down the cost of the Medicare drug benefit. The Part D program is serving beneficiaries at a far lower cost than originally expected,” said CMS Acting Deputy Administrator Herb B. Kuhn. Bids from insurance companies that want to participate in the program are “well below projections” because prescription drug costs are not rising as fast as expected, and because of increased use of generic drugs, better negotiations with the drug companies, and strong competition.

Further, the vast majority of people who are enrolled in a Part D plan will have access to coverage that will cost them the same or less than their coverage in 2007 if they enroll in a lower-cost Part D plan in their region. Those on a Medicare Advantage plan will also benefit from lower prescription drug premiums. Note however that it is important to compare your coverage options for 2008 based on the overall cost, the type of coverage, and convenience in order to select the plan that best meets your needs.

Questions about Medicare? Email to info@medicarebenefits.com

Source: http://www.medicarebenefits.com/what_s_new_in_medicare_part_D-Premiums.html

Part B Premiums Will Rise 3.1%

The standard Medicare Part B premium will rise to $96.40 a month in 2008, an increase of $2.90 a month (or 3.1%). This is the smallest since 1999-2000. Medicare Part B covers doctors’ services, outpatient hospital care, X-rays, laboratory services and other diagnostic tests.

More affluent beneficiaries (annual incomes exceeding $82,000 for individuals and $164,000 for couples), will pay higher premiums on a sliding scale, up to a maximum of $238.40 a month for the most affluent ($205,000 individual or $410,000 joint).

The increase in the standard Part B premium was less than many experts had expected, in part because officials decided to correct an accounting error. As a result of the error, money for certain hospice benefits was inadvertently drawn from the Part B trust fund rather than a separate trust fund that pays hospital costs. The money will be paid back in the coming year.

In addition, the premium for 2008 is artificially low because it assumes that Medicare payments to doctors will be cut about 10 percent next year, as required by law. Congress has usually stepped in to avert such cuts, and the cost is passed on to beneficiaries in subsequent years. The chief Medicare actuary said, “The low increase in premiums is good news for 2008,” but he added that it was probably a one-time phenomenon.

The annual deductible for doctors’ visits and other Part B services will be $135, up from $131. For a beneficiary admitted to a hospital, the deductible will be $1,024 next year, up from $992.

Kerry N. Weems, acting administrator of the Centers for Medicare and Medicaid Services, said one factor contributing to the increasing premiums was an increase in payments to private Medicare Advantage plans. Beneficiaries in these plans appear, on average, to be sicker than in the past, Mr. Weems said.

Questions about Medicare? Email to info@medicarebenefits.com

Source: http://www.medicarebenefits.com/what_s_new_in_medicare_oct2.html

Caregiver Costs Rise

The cost of caring for an aging parent or spouse averages about $5,500 a year, according to a recent survey by the National Alliance for Caregiving. A previous survey 3 years ago put the average at $2,400 a year.

The highest out-of-pocket costs were incurred by long-distance caregivers (almost $9,000 a year), followed by those who live with their ailing relative. Caregivers who live nearby spend the least.

The survey also found that the most common expenses for caregivers are household goods, food, transportation, medical expenses, clothing, and home repair and maintenance.

The most common strategy for covering these costs is for caregivers to cut back on their own spending on things like leisure activities, vacations, home improvements, retirement savings, and personal health care.

It is estimated that 34 million Americans provide care for older family members or friends. If you are one of them, Medicare has a free booklet called Guide For Family and Friends of People With Medicare that you may find useful. For your free copy, click here.

Questions about Medicare? Email to info@medicarebenefits.com

Source: http://www.medicarebenefits.com/what_s_new_in_medicare.html