Hospice Care & Medicare

I recently got a call from someone asking how Hospice care works when you’re on Medicare.  Here is what I discovered…

According to the Medicare.gov website, if you qualify for hospice care, you’ll have a specially trained team and support staff available to help you and your family cope with your illness. Your doctor and the hospice team will work with you and your family to set up a plan of care that meets your needs.

Your plan of care includes hospice services that Medicare covers. For more specific information on a hospice plan of care, call the Maine Hospice Council & Center for End of Life Care 1-800-438-5963 or visit http://mainehospicecouncil.org/hospice-programs-in-maine/ for a list of programs in Maine.

The hospice program you choose must be Medicare-approved to get Medicare payment. To find out if a certain hospice program is Medicare-approved, ask your doctor, the hospice program, your state hospice organization, or your state health department.

Can I get hospice care in my own home?Elderly couple embracing

Yes!  Medicare also states that most hospice patients get hospice care in the comfort of their home and with their families.  Depending on your condition, you may also get hospice care in a Medicare-approved hospice facility, hospital, nursing home, or other long-term care facility.  The hospice benefit with Medicare allows you and your family to stay together in the comfort of your home unless you need care in an inpatient facility. If the hospice team determines that you need inpatient care, the hospice team will make the arrangements for your stay.

  • Hospice care is intended for people with 6 months or less to live if the disease runs its normal course.  
  • You can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.  
  • A benefit period starts the day you begin to get hospice care and it ends when your 90-day or 60-day period ends.  
  • You have the right to change providers only once during each benefit period
  • At the start of each period, the hospice medical director or other hospice doctor must re-certify that you’re terminally ill, so you can continue to get hospice care.
  • If you live longer than 6 months, you can still get hospice care, as long as the hospice medical director or other hospice doctor re-certifies that you’re terminally ill.

Also all Medicare-covered services you get while in hospice care are covered under Original Medicare, even if you’re in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan. That includes any Medicare-covered services for conditions unrelated to your terminal illness or provided by your attending doctor.

What happens if I need other medical services?

Once you choose hospice care, Medicare will no longer cover treatment intended to cure your terminal illness so talk with your doctor if you’re thinking about getting treatment to cure your illness. Prescription drugs to cure your illness (rather than for symptom control or pain relief) also will no longer be covered by Medicare.  But remember, you always have the right to stop hospice care at any time for any reason. If you stop your hospice care, you’ll get the type of Medicare coverage you had before you chose a hospice program (like treatment to cure the terminal illness) If you’re eligible, you can go back to hospice care at any time as well.

All care that you get for your terminal illness must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different provider, unless you change your hospice provider. However, you can still see your regular doctor if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care.

Medicare doesn’t cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.

Care in an emergency room, inpatient facility care, or ambulance transportation is also not covered, unless it’s either arranged by your hospice team or is unrelated to your terminal illness.  This means you MUST contact your hospice team before you get any of these services or you might have to pay the entire cost.

What are the costs for Hospice Care under Original Medicare?Elderly woman kissing young girl

  • $0 for hospice care and there is no deductible.
  • Co-payment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management.
  • 5% of the Medicare-approved amount for inpatient respite care (short-term care given by another caregiver, so the usual caregiver can rest).
  • Your usual Part B deductible and coinsurance for your doctor’s services (if your attending doctor isn’t employed by the hospice).
  • Medicare doesn’t cover room and board when you get hospice care in your home or another facility where you live (like a nursing home).
  • If you pay out-of-pocket for an item or service your doctor ordered, but the hospice refuses to give you, you can file a claim with Medicare. If your claim is denied, you may file an appeal.

Please Contact Me if you have any questions. 

Beware of Scare Tactics about Obamacare

Regardless of your political sensibilities, intentionally scaring people with inaccurate and incomplete information is unethical.  The tactic of frightening senior citizens in order to advance a political agenda has become far too common.  When a new client asked me not about the security and peace of mind that Medicare would bring him but instead about how he would pay for his medical care once “Medicare premiums double or triple in the next two years” I decided things had gone too far.
Over the past few weeks I have been getting a lot of questions about rumors that Obamacare is going to cause Medicare premiums to double or triple by 2014.   It seems to have started with an email circulating that states as part of Obamacare (known more formally as the Patient Protection and Affordable Care Act, or PPACA) the Medicare premium will increase to $247 in 2014. The short answer to the question of the whether these figures for Medicare insurance premiums are accurate is no.
In the last few years, the standard monthly premiums for Medicare Part B have been set as follows:
2009 $96.40*
2010 $110.50*
2011 $115.40*
2012 $99.90*
(The actual premiums paid by some Medicare participants may be slightly higher or lower than these standard amounts.  For example, many beneficiaries paid less than the listed amounts in 2010 and 2011 because of the “hold-harmless” provision of Medicare which states that if the dollar increase in your Medicare Part B premium is bigger than the dollar increase in your Social Security check, you don’t have to pay the difference.)
As for future Medicare Part B premium rates, the information cited in the rumors that this email has generated is wrong on two counts: No provision of the health care legislation passed during the Obama administration sets Medicare premium rates, nor is a whopping jump of over 100% to a $247.00 monthly premium in 2014 a realistic figure.  New Medicare premium rates come out each fall and take effect in January.   Medicare beneficiaries as a group are required to pay one-fourth the cost of running Medicare, and annual premiums are set at a figure calculated to achieve that level of revenue.  In other words, Medicare beneficiaries receive a 75% subsidy for Part B, with every $1 in Part B premiums for enrollees matched by $3 in general revenues.
Although the annual premium rates aren’t officially set until they are announced each fall, Medicare administrators track trends and anticipated changes and use them to formulate projections of Medicare premiums for the next several years.  According to the most recent report (https://www.cms.gov/ReportsTrustFunds/downloads/tr2011.pdf) of the system’s trustees, issued in May 2011, those projected premiums (as listed on page 218) are:
2013: $110.50
2014: $115.80 
2015: $120.80
2016: $126.00
2017: $132.70
2018: $140.30
2019: $148.40 
2020: $158.60
I hope this helps put your mind at ease! Please share this with your friends who have also heard this terrible untruth!  

Medicare Supplemental Insurance & Medicare Advantage Plans

Someone on Facebook recently asked me,

“What’s the differences between Medicare Supplemental Insurance and Medicare Advantage Plans?”

Questions like these are the reason I love this business. People need to know that there are many options in Maine when you turn age 65.

There are many differences. One difference between Medicare Supplemental insurance (Medigap) and Medicare Advantage plans is that Medicare Advantage contracts operate on a calendar year basis (annually renewable) and Medicare Supplement policies are guaranteed renewable. Guaranteed renewable means that the insurance company cannot change what your Medigap policy covers once it is issued, or terminate your policy, unless you do not pay your premium within the grace period and/or you made a material misrepresentation on your application.

Faced with too many medicare options?

Another difference is the cost. Medicare Advantage Plans generally have lower monthly premiums than Medicare Supplements but you are required to share in your medical costs by paying co-pays as you use the plans.  Medicare Advantage Plans operate very similar to the Medical insurance you may have had before you retired if you had an HMO or a PPO plan.  Medicare Supplemental insurance (Medigap) plans generally have a higher monthly premium but you are usually not required to pay much else, if anything, out of pocket.

This is why many people turning 65 choose to meet with someone who can help them decide which plan is best for them. Choosing between these two types of Medicare insurance plans is an individual decision. What is the best plan for you may not be the best plan for your spouse.  For more information you can also visit the Medicare website at www.medicare.org or call your local Area Agency on Aging to speak with a volunteer.

Need more help comparing the different health insurance plans?  I can help you.

You can use the BOOK APPOINTMENT(link is external) button below to set up a time to speak with me on the phone or in person. I can also send you information ahead of time to get you started.
Have a question that needs to be answered right away? Just give me a call at your convenience.  You can talk to a licensed insurance agent at (207) 370-0143 or call toll free 866-976-9038.
Book an appointment with Maine Medicare Options using SetMore

Are you turning 65 and still working?  Read this.

If you would like me to come to your home and meet with you one-on-one please Contact Me.  My phone number is (207) 370-0143.

There is no obligation to you and no cost to meet with me.

Am I Eligible for Medicare if I am Receiving Social Security Disability Benefits?

If you are unable to work due to a disabling condition, your income is not the only thing that ends – in most cases your medical insurance ends as well. This is why so many Social Security Disability applicants wonder whether or not they will are eligible to receive Medicare benefits. The answer is yes you can receive Medicare benefits to help cover medical costs, but not right away.

If you have been entitled to Social Security Disability benefits for a period of 24 months then you will become eligible to begin receiving Medicare benefits on the 25th month.

What Does Medicare Cover?

The type of coverage you are provided through Medicare depends on the type of Medicare you decide to accept. Medicare Part A is hospital insurance. In most circumstances, there is no charge for Medicare Part A coverage. This type of Medicare pays for inpatient hospital care, skilled nursing facilities, long-term hospital care, inpatient rehabilitation, hospice care, home health care, inpatient psychiatric care and obesity bariatric surgery.

Medicare Part B is different from Medicare Part A. Medicare Part B is more like a traditional medical insurance plan. In most cases, you will need to pay a premium in order to receive Medicare Part B. Medicare Part B covers any services or supplies that are needed to diagnose or treat your medical condition as long as they meet the accepted standards of medical practice. Medicare Part B also covers preventative services such as vaccinations and routine physical exams.

You can learn more at www.medicare.org or by calling 1-800-MEDICARE.

You can also Contact Me to schedule an appointment and we can sit down and talk about your individual needs and answer any of your questions. There is no cost or obligation to talk or meet with me.  I would be glad to talk to you and answer questions about Medicare in Maine.  You can use the Contact Me page or call me at (207) 370-0143*. 

Medicare Advantage Is Living Up to Its Name!

Heritage policy analyst Kathryn Nix has analyzed research that shows that private health plans participating in Medicare Advantage are making strides in what Congress has tried—and failed—to achieve in traditional Medicare fee-for-service (FFS) for decades. Competition among private plans has maintained patient satisfaction, lowered costs, and increased the quality of care. Success is obvious and abundant in the MA program. Medicare Advantage (MA) is more advantageous to beneficiaries when compared to traditional FFS Medicare. It was created in 2003 to allow seniors to receive their Medicare benefits through a private health plan of their choice. The private plans are required to offer the same benefits as traditional FFS. MA has become increasingly popular, with almost 20 percent of the Medicare population enrolled as of 2010. The program’s popularity is justified by the astounding improvements to the quality of care. MA has led to the opportunity to compare the performance of participating plans with that of traditional Medicare. In a Center for Policy Innovation Research Summary, Nix analyzes two separate research studies that show MA outperforming FFS on several measures of health care quality:

  • MA performed better than Medicare fee-for-service on most measures reflecting patients’ receipt of appropriate care.
  • MA also performed better than FFS when assessed using discharge data on hospital utilization.
  • MA plans may be doing a better job of preventing unnecessary inpatient care by increasing use of outpatient services and office visits.
  • MA plans may be avoiding unnecessary re-admissions through superior discharge planning and coordination of care following an inpatient episode of care.

read more

Remember: At any time during the year, you can switch to a Medicare Advantage Plan or Medicare Prescription Drug Plan that has a 5-star rating. Plan ratings are based on member surveys, information from doctors and health care providers, and other sources. The plan ratings are scores that show the quality and performance of the plan, on a scale of 1 to 5 stars, with 5 being the highest rated plans.
You can Contact Me to schedule an appointment and we can sit down and talk about your individual needs and answer any of your questions. There is no cost or obligation to talk or meet with me.  I would be glad to talk to you and answer questions about Medicare in Maine.  You can use the C.

Medicare Covers Hospice and Comfort Care

Do you care for someone who is terminally ill? It isn’t always easy to care for a loved one in difficult times, but Medicare can help – you don’t have to do it alone.

Medicare covers care for people who are terminally ill, and they have resources to help you. Hospice is a program of care and support for people who are terminally ill. The focus is on comfort, or “palliative” care, not on curing an illness. Hospice care can include doctor and nursing services, counseling, medical supplies, pain medications, and other services. If your doctor has certified that your loved one is terminally ill, Medicare covers hospice care, which is usually provided in the home. Medicare will still pay for covered benefits for any health problems that aren’t related to your loved one’s terminal illness.

To get more details about Medicare’s coverage go to https://www.medicare.gov/publications/02154-medicare-hospice-benefits.pdf   Remember, you’re not alone – Medicare has resources to help. You can get more information from http://www.medicare.gov/coverage/hospice-and-respite-care.html. 

If you or a family member would like to learn more you can also contact me anytime.  There is no cost or obligation to talk with me.  I would be glad to talk to you and answer questions about Medicare in Maine.  You can E-mail Me page or call me directly at (207) 370-0143. 

1 9 10 11