Last November, in what the U.S. Department of Justice called “one of the largest health care fraud settlements in U.S. history,” Johnson & Johnson and its subsidiaries were fined more than $2.2 billion to resolve criminal and civil charges because of their aggressive marketing of drugs, including antipsychotics, to nursing homes, when they knew the drugs had not been approved by the U.S. Food and Drug Administration (FDA) as safe and effective for a general elderly population. The corporation also allegedly paid kickbacks to physicians, as well as to Omnicare, the nation’s largest long-term-care pharmacy provider. Omnicare pharmacists were recommending Johnson…
One of the greatest fears of older Americans is that they may end up in a nursing home. This not only means a great loss of personal autonomy, but also a tremendous financial price. The average nursing homes cost, in our area, is approximately, $10,000 per month, that’s $120,000 a year, and the average stay in a nursing home is 4 years, that’s $480,000. For many people this will wipe them out financially. Most people end up paying for nursing home care out of their savings until they run out. Then they can qualify for Medicaid to pick up the…
Medicare beneficiaries who are admitted to a hospital and then discharged to a nursing home have been getting charged for care they thought Medicare would cover. A new self-help packet from the Center for Medicare Advocacy explains how beneficiaries can fight for the coverage they need. The problem arises if a hospital places you in “observation status” instead of formally admitting you. Observation status triggers Medicare Part B, a part of the Medicare law that does not pay for post-hospital care. Medicare covers nursing home stays entirely for the first 20 days, but only if the patient was first admitted…
The Centers for Medicare and Medicaid Services (CMS) has released the new Medicare premiums, deductibles, and co-payments for 2014: Basic Part B premium: $104.90/month (no change from 2013) Part B deductible: $147 (no change from 2013) Part A deductible: $1,216 (was $1,184 in 2013) Co-payment for hospital stay days 61-90: $304/day (was $296 in $2013); Co-payment for hospital stay days 91-150: $608/day (was $592 in 2013) All costs for each day beyond 150 days Skilled nursing facility co-payment, days 21-100: $152/day (was $148 in 2013) Also, note that individuals with annual incomes over $85,000 and married couples…
Medicare only covers home health care if, among other requirements, the beneficiary is homebound. As of Nov. 19, 2013, the Centers for Medicare & Medicaid Services (CMS) will require new criteria for purposes of meeting the homebound requirement. These new requirements will leave many Medicare beneficiaries without access to the medically reasonable and necessary home care coverage. The new policy states: For purposes of the statute, an individual shall be considered "confined to the home" (homebound) if the following two criteria are met: The patient must either 1) because of illness or injury, need the aid of supportive devices such…
AARP has released a report titled “Rapid Growth in Medicare Hospital Observation Services: What's Going On?” The report finds dramatic increase in the use of Medicare observation status for Medicare beneficiaries between 2001 and 2009. The findings raise concerns about the clinical benefit of long-term observation and the high out-of-pocket costs to patients. AARP endorses the legislation, Improving Access to Medicare Coverage Act of 2013 (H.R. 1179/S. 569), introduced in the House and the Senate by Reps. Joe Courtney (D-CT) and Tom Latham (R-IA), and Sens. Sherrod Brown (D-OH) and Susan Collins (R-ME), that would count the time spent in observation…
Medicare only covers home health care if, among other requirements, the beneficiary is homebound. As of Nov. 19, 2013, the Centers for Medicare & Medicaid Services (CMS) will require new criteria for purposes of meeting the homebound requirement. These new requirements will leave many Medicare beneficiaries without access to the medically reasonable and necessary home care coverage. The new policy states: For purposes of the statute, an individual shall be considered "confined to the home" (homebound) if the following two criteria are met: The patient must either 1) because of illness or injury, need the aid of supportive devices such…
Social Security benefits for nearly 58 million people will increase by 1.5 percent next year. The COLA affects benefits for more than one-fifth of the country. In addition to Social Security payments, it affects benefits for millions of disabled veterans, federal retirees and people who get Supplemental Security Income, the disability program for the poor. The amount of wages subject to Social Security taxes is also going up. Social Security is funded by a 12.4 percent tax on the first $113,700 in wages earned by a worker, with half paid by employers and the other half withheld from workers' pay….
With the Health Insurance Marketplace underway, there is information available for those on Medicare about what the Marketplace means to them. The Centers for Medicare and Medicaid (CMS) and the National Council on Aging (NCOA) have developed helpful factsheets for your clients who are 65+ and for people ages 55-64. View the CMS fact sheet and NCOA fact sheet. View the NCOA fact sheet for people under 65.
Easter Seals Adult Day Services recently hosted “Medicare 2014: The Patient Protection and Affordable Care Act” Seminar at The Harry & Jeanette Weinberg Inter-Generational Center. More than 50 social workers and registered nurses attended to gain a better understanding of the Medicare benefits changes of 2014. Presenters Jack Davidson, Director of Community Outreach and Event Planning, Advanced Nursing and Home Support, and David Wingate, Eldercare Attorney at the Elder Law Office of David Wingate LLC, offered information about Medicare exchanges, penalties, waiting periods, pre-existing conditions and more. Davidson helped attendees better understand Medicare Benefits and its changes, ethics, rights and…
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