medicare

Get the best medicare coverage at the best price for YOU

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In order to achieve the selection of an optimal plan for you, it is often helpful to seek the services of a licensed broker who specializes in Medicare.

The fact that there are an abundance of insurance plans available is only beneficial if you’re able to determine your unique needs and compare those needs against benefits contained within multiple and varied insurance plans.  In order to achieve the selection of an optimal plan for you, it is often helpful to seek the services of a licensed broker who specializes in Medicare.

While a representative from a specific insurance company may be licensed to sell you a particular plan, keep in mind that if they only represent one company they only understand and believe in that one product. Local health insurance general agencies have licensed brokers who are trained experts and certified to represent a multitude of plans in your area.  Seeking the advice of a trained broker who specializes in Medicare plans allows you to relate your needs and circumstances to someone who knows what types of plans are available in your area and can professionally recommend appropriate coverage to suit your specific situation.

Remember, that one of the most important things to discover before making your selection is which insurance plans your doctor accepts.
A plan may not serve your specific needs if your doctor does not accept it, and doctors are not required to accept every plan.

In addition, by securing a plan through a broker you are in turn getting an advocate, meaning that if insurance issues or circumstances should arise that require assistance, your broker is able to help with the resolution of your issue. Enrolling directly with a plan leaves you, and you alone, to communicate with the plan’s customer service department and all of the answering system queues that often go along with that.

No matter how you make your Medicare coverage selection, it is often useful to review your plan options annually as plan benefits can change from year to year and what worked for you one year may not in the next.  If you’re already on Medicare, you may want to mark your calendar now to remember to review your plan options sometime in early October. Typically, the Annual Medicare Open Enrollment Period, where you can make a plan change without penalty, is October 15th – December 7th.

Article Provided by: Lance Ghiorso,
Connexion Insurance Solutions
866-448-0160
www.MedicareConnexion.com 

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Home Health Services and Medicare

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Before you start getting your home health care, the home health agency should tell you how much Medicare will pay.

How often is it covered?
Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services like intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. Usually, a home health care agency coordinates the services your doctor orders for you.

Medicare doesn’t pay for:

  • 24-hour-a-day care at home
  • Meals delivered to your home
  • Homemaker or Companion Services
  • Personal Care or In-Home licensed care

Who’s eligible?
All people with Medicare who meet all of these conditions are covered:

  • You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.
  • You must need, and a doctor must certify that you need, one or more of these:
    • Intermittent skilled nursing care (other than just drawing blood)
    • Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally-predictable period of time, 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.
  • The home health agency caring for you must be Medicare-certified.
  • You must be homebound, and a doctor must certify that you’re homebound (you have trouble leaving your home, or leaving your home is not recommended).

You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care.

You can still get home health care if you attend adult day care.

Note: Home health services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.

Your costs in Original Medicare

  • $0 for home health care services.
  • 20% of the Medicare-approved amount for durable medical equipment.

Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them. This should be explained by both talking with you and in writing.

Article acquired from:
www.medicare.gov
Provided by Retirement Connection

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Home Health Services and Medicare

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Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services

Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) covers eligible home health services like intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. Usually, a home health care agency coordinates the services your doctor orders for you.

Medicare doesn’t pay for:

  •  24-hour-a-day care at home
  • Meals delivered to your home
  • Homemaker or Companion Services
  • Personal Care or In-Home licensed care

Who’s eligible?

All people with Medicare who meet all of these conditions are covered:

  • You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.
  • You must need, and a doctor must certify that you need, one or more of these:
    • Intermittent skilled nursing care
      (other than just drawing blood)
    • Physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively. To be eligible, either: 1) your condition must be expected to improve in a reasonable and generally-predictable period of time, 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.
  • The home health agency caring for you must be Medicare-certified.
  • You must be homebound, and a doctor must certify that you’re homebound (you have trouble leaving your home, or leaving your home is not recommended).

You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled nursing care.

You can still get home health care if you attend adult day care.

Note: Home health services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.

Your costs in Original Medicare

  •  $0 for home health care services.
  •  20% of the Medicare-approved amount for durable medical equipment.

Before you start getting your home health care, the home health agency should tell you how much Medicare will pay. The agency should also tell you if any items or services they give you aren’t covered by Medicare, and how much you’ll have to pay for them. This should be explained by both talking with you and in writing.

Article acquired from:
www.medicare.gov
Provided by Retirement Connection

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When does Medicare pay for home health care?

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To find out more about home health care programs where you live, you will want to contact your local aging information and assistance provider or area agency on aging (AAA).

When Does Medicare Pay for Home Health Care?

The program will pay for home health care if all of the following conditions are met:

1. The patient must be homebound and under a doctor’s care

2. The patient must need skilled nursing care, or occupational, physical, or speech therapy, on at least an intermittent basis (that is, regularly but not continuously)

3. The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient

4. The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary”

5. The home health care agency providing the services must be certified by the Medicare program.

6. To get help with your Medicare questions, call

7. 1-800-MEDICARE (1-800-633-4227, TTY/TDD: 1-877-486-2048 for the speech and hearing impaired) or look on the Internet at: http://www.medicare.gov/.

Learn more About Home Health Care

There are several national organizations that can provide additional consumer information about home health care services. These include the following:

The National Association for Home Care www.nahc.org

The Visiting Nurse Associations of America www.vnaa.org

The Eldercare Locator www.eldercare.gov

To find out more about home health care programs where you live, you will want to contact your local aging information and assistance provider or area agency on aging (AAA). The Eldercare Locator, a public service of the Administration on Aging at 1-800-677-1116 to help connect you to these agencies.

Source: U.S. Department of Health and Human Services Administration on Aging, www.AoA.gov

Provided by: The Staff at www.RetirementConnection.com
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