Home health agencies, hospitals and consumer groups are complaining that a new rule intended to curb unnecessary Medicare spending will make it harder for senior citizens to get home care services. Under the requirement, which is to take effect Friday, Medicare beneficiaries will have to see doctors 90 days before or 30 days after starting home health services in order for the home health agencies to be reimbursed. Those face-to-face visits may be a burden for some home-bound frail seniors, as well as those who live in rural areas, the industry says. Under current law, doctors must prescribe home health…
Medicare patients typically receive home care services because it is difficult or impossible for them to leave their homes. But the Centers for Medicare and Medicare Services (CMS) has now implemented a new Medicare requirement that doctors must meet face-to-face with their patients who are receiving home health care in order for the patient's home health visits to be reimbursed. Under the requirement, Medicare beneficiaries will have to see doctors 90 days before or 30 days after starting home health services. The move is aimed at reducing unnecessary Medicare home health care, which doubled to $19 billion from 2002 to…
The Medicare Part D donut hole affects many millions of seniors. Seniors with annual drug expenses exceeding $2,830 had to pay all of their drug costs up to $4,550, at which point catastrophic coverage went into effect. Unfortunately, some seniors in the donut hole did not take or cut up their medications. Consequently, this made their condition worse. Basically, if seniors don’t be sparing or withhold their prescribed drugs, their long-term health improves dramatically. However, the new healthcare law completely phases out the donut hole. Last year, the government sent $250 rebate checks to Medicare recipients in the gap. This…
Anyone with Medicare Part B has access to the following preventive services: Initial physical exam. If your Medicare Part B coverage begins on or after January 1, 2005, Medicare will cover a one-time “Welcome to Medicare” preventive physical exam within the first six months that you have Part B. Additionally, those at risk for abdominal aortic aneurysms may be referred for a one-time ultrasound at their initial exam. Cardiovascular screening. Medicare covers one test every five years to check your cholesterol and other blood fat levels. Cancer tests. Medicare covers breast cancer screening (mammograms) once a year for women over…
Your doctor suggests you have a minor operation procedure. You took your doctor’s advice and you went ahead with the procedure. However, Medicare won't pay for it. What is your recourse? Appeal. Medicare covers procedures that are deemed medically necessary. "Appealing is easy and most people win so it is worth your while to challenge a Medicare denial," says the Medicare Rights Center, a national nonprofit organization. The denial of coverage may be due, for example, to a simple coding error in your doctor's office. People have a strong chance of winning their Medicare appeal. According to Center, 80 percent…
It’s no secret that state (and federal) budgets are severely stressed. While lawmakers look for revenue and cost-cutting measures, Medicaid services are coming under scrutiny. Managed care plans are becoming increasingly popular as one way to cut Medicaid costs. Currently six states require the elderly and disabled who need long-term care to enroll in a managed care plan. At least 10 other states are reportedly considering the same, according to a recent article from The Kaiser Health News. Traditionally, states pay Medicaid providers directly for individual services. Under managed care, states pay health insurers a fixed monthly fee for each…
The Centers for Medicare and Medicaid Services recently announced they are preliminarily raising the reimbursement rate for Medicare Advantage plans by 1.6 percent in 2012. This could make the popular plans more profitable for the companies offering them, and perhaps help hold the line on premium increases. Medicare Advantage plans are privately run versions of Medicare. Subsidized by the government, the plans offer basic Medicare coverage, but with extras like vision or dental coverage – and usually at premiums lower than standard Medicare rates. According to Forbes, the 1.6% increase is about what investors and provider companies had expected. The…
Qualifying veterans can receive care at VA facilities. Additionally, those 65 years old and older – and those with certain disabilities – may qualify for Medicare. The VA and Medicare offer different, yet valuable, benefits to veterans." Through the VA, eligible veterans have access to a full range of preventive outpatient and inpatient services, within the VA health care system, which includes hospitals, clinics, nursing homes, pharmacies and doctors nationwide. VA co-payments and deductibles, including the costs of prescription drugs, are generally less than Medicare. Eligibility for benefits is based on a priority system. According to the United States Department…
If you are a self-employed senior paying Medicare Part B premiums, the IRS just handed you a surprise tax break. Reversing a long-standing rule, the Service now says that self-employed people can deduct their Medicare Part B health insurance premiums – premiums which previously did not qualify for the self-employed health insurance deduction. Interestingly, there was no “official announcement, revenue ruling, notice or news release from the IRS announcing a change in position,” according to a recent article in The San Francisco Chronicle. Note that any self-employed person, regardless of age, can deduct the premiums they pay for health insurance,…
To be eligible for hospice a physician must certify the patient to be terminally ill with a life expectancy of six months or less and treatment for a cure is no longer provided. The focus for the patient has changed to supportive care and quality of remaining life. Hospice is paid for by private insurance, Medicare or Medicaid Hospice Benefit or personal funds. Here are the conditions that apply for Medicare Hospice Benefits: You are eligible for Medicare Part A (Hospital Insurance) Your doctor and the hospice medical director certify that you’re terminally ill and have 6 months or less…
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