There is a new twist in health insurance that some states have initiated to give Medicaid recipients an extra choice in their health care This new provision is called a Health Opportunity Account.
The Health Opportunity Account is an account an individual who has high-deductible health insurance or who has Medicaid can use to offset some medical expenses. This is an account that gives an individual more of a choice in how their health care dollars are spent.
The Health Opportunity Account is set up through a state system in the state you live in, and it can be used to pay for out-of-pocket health care costs. If you choose to set up a Health Opportunity Account, you will be offered Medicaid benefits. That means that if you are not insured now, this might be a plan to look into and see if your state offers this program and whether you qualify.
If you are in a state that has Health Opportunity Accounts, the state will set aside up to a total of $2,500 per eligible adult or $1,000 per eligible child toward deposits in the account. In the event that you enroll in the program and eventually become ineligible for Medicaid, if there is money left in your account, you would be allowed to use the money for up to three (3) years to pay for such things as health insurance premiums and medical expenses.
The program is mostly geared toward relatively healthy adults and children who are Medicaid recipients. There are some restrictions to the program. A person will not qualify if they are:
• Age 65 or older
• Pregnant
• Blind or disabled
• Eligible for Medicaid benefits, but have only been eligible for less than three (3 ) months
• Certain individuals in hospitals, medical facilities or other medical institutions or nursing homes
• Individuals entitled to any part of Medicare
• Individuals who are terminally ill and receiving benefits for hospice care
• Certain individuals who are medically frail or who have special medical needs
• Children receiving Title IV-E foster care or adoption assistance
There are a limited number of states participating in this program. If you are interested in more information or in participating, contact your state Medicaid office, visit www.medicaid.com and enter your state where prompted or call
1-800-MEDICAID.
If you live in Indiana and you have children, there may be some good news coming your way. The Centers for Medicare and Medicaid Services (CMS) has expanded the Children’s Health Insurance Program. Under the expansion, if you are a family that earns less than 2 ½ times the poverty level, you can be eligible to enroll your children in the SCHIP.
The way the income amounts work out translate to families of two earning up to $35,000 annually or a family of four earning up to $53,000 annually. If your family fits into these financial guidelines and your children need to obtain health insurance, you can apply for the SCHIP program for them.
There are reasonable premiums for the program. The premiums range from approximately $22 to $70 monthly, depending on income and the number of children. Basically the premiums work on a sliding scale.
The expansion of the SCHIP program is a positive step toward making sure that as many children as possible have health insurance benefits. The eventual goal is to cover all children living in the state. The state of Indiana and the SCHIP program are actively trying to connect with families who fit the income limits and whose children are not insured.
Most states have some sort of Children’s Health Insurance Plan (CHIP). These are state-backed programs, usually approved by the federal government through the Centers for Medicare and Medicaid Services (CMS) and facilitated in your local area in conjunction with the county health departments.
For information regarding CHIP benefits in your state, or to see if you qualify, contact your local Social Services or Health Department. Even if you are not sure you qualify or you think your earnings are too high, don’t hesitate to check into CHIP coverage. Your circumstance might fit into some of the regulations that would allow you to participate. It is worth checking into. Remember, the states are trying to insure as many children as possible so no child will be left without necessary medical care
It is becoming too common to hear about fraudulent and dishonest individuals trying to either frighten or trick Medicare recipients – especially seniors – into either changing their coverage to inferior plans or giving out personal and sensitive information so they can use it for various types of fraud.
Yesterday, in Pocatello, Idaho there was an NBC news story stating that such a group was targeting individuals in the area by calling them up and telling them that their Medicare was at stake. They would offer a discount Medicare card that was intended to replace the valid Medicare card they already have.
The person that called one woman was a male, who told her about the discount card and stated that he needed some information first. It is interesting that he already had her bank routing number and her address, which is unsettling in itself, but he then asked for her Social Security number and her bank account number.
Fortunately, the woman had a clue. She knew that something wasn’t right, and she had already heard that there was a scam, so she did not give the individual the information he was asking for. Then the man told her that she would lose her benefits for three months, since she would not give the requested information. Instead of continuing the conversation, she called the police.
Unfortunately, other individuals who are Medicare recipients have not fared so well. As a result, the Pocatello police have warned seniors about this scam. They have told seniors in the area to be extremely careful about relaying any personal information, especially over the phone. It is also important to note that there are certain ways to verify that the individual is truly from Medicare. If you have caller I.D., the number will show up or the name Medicare or CMS will come up on the I.D. In addition, it is rare that you would be asked for your bank account number unless you call them and ask for direct deposit. Also, they will not usually ask for your Social Security number because they have it. They will often read it to you and have you verify it.
If you are not comfortable with the person who is calling or the questions they are asking, get their name, their employee identification number and their phone number, plus their extension and the city they are in. They should readily give you that information so that you can call back, or they will give you the main number to call and tell you that you can talk to anyone there. If they won’t give you the information you request or if they hang up when you ask, they are probably not legitimate. If this happens to you, report it to your local police as well as the agency they say they are from, such as Medicare or Social Security.
It is important to be aware of people and situations that could jeopardize your benefits or finances. Trust your instincts, and be cautious. Don’t give information out unless you are sure who you are speaking to. Stay on guard and keep yourself safe.
Private Fee-For-Service Plans are Medicare Supplemental Plans that are offered by private insurance companies as part of Medicare Advantage. There are some policies that are excellent and offer good coverage but not all of them offer what individuals need. Though many plans sound great, it is essential that Medicare recipients thoroughly research any plans that they are thinking about purchasing.
The way that Private Fee-For-Service (PFFS) plans work is that Medicare pays insurance companies for coverage for Medicare recipients. The Medicare recipient can then go to any Medicare-approved provider who will accept the plan’s payment. The important difference between PFFS and original Medicare is that there is no limit to the co-payments, nor is there a limit to the premiums that can be charged. This is an area that it is very important to look closely at, because this means that the Medicare recipient in this situation will have to share a portion of the costs involved and this can add up. Medicare allows providers to charge up to 15% above the plan’s payment amount for services.
The Medicare Rights Center has reported that even though the plans seem like they have some advantages, there are often more disadvantages with Medicare Advantage than the older, original basic Medicare. Care can be more expensive due to higher co-payments, and many doctors and health care centers that accept basic Medicare as payment will not accept Medicare Advantage.
Another issue is that Medicare Advantage has been looked at very closely because of aggressive – and sometimes fraudulent – marketing and sales practices. Many Medicare recipients are being pressured and tricked into changing coverage, and, as a result, have been put in a situation where they are not better off at all. In fact, in many cases, they are receiving a plan that does not cover them as well as the coverage they are replacing.
If you are thinking of enrolling in a PFFS plan, it is important to do some research to be sure it is legitimate and advantageous. One of the best ways to protect yourself is to look at the cost of co-pays, premiums and extra coverage and make sure you can afford them. Also, be sure you are comfortable with the individual and company you are buying from, and don’t hesitate to check them out.
To be certain that you are purchasing what you truly need, contact Medicare at www.medicare.gov, www.cms.gov , or call them at 1-800-MEDICARE to talk to trained individuals who will answer your questions and help you to look carefully and understand the coverage you have now and the coverage that is proposed.
It may seem like New York doesn’t have many scams (just kidding), but one scam that is very real and is being addressed by New York’s Attorney General Andrew Cuomo is home health care fraud that is paid for with Medicaid dollars.
Cuomo has started “Operation Home Alone” which is a new program that is rooting out con artists that pose as home health care workers, but really are not. These scams have cost the taxpayers of New York millions of dollars.
The way it works is that a real home health care worker has to have 75 hours of training and be certified to work at home with individuals who need certain health services. The certification is very important because it means that an individual has been trained to treat wounds, feed, bathe and dress individuals and several other health procedures.
These uncertified home health care imposters are not only dishonest, and not only basically stealing millions of Medicaid dollars, but they are also dangerous. Since they are not trained, it is extremely risky for them to be helping individuals at risk with medical and other health issues. For instance, the average person does not know first aid or CPR. They do not know the correct way to lift someone to help them from a wheelchair to a bed, or vice-versa. They do not know how to take or read blood pressure or blood sugar or what to do in case of a seizure. And that’s the easy stuff!
Most individuals that need home health care receive it because they have health issues that they need help with. A home health care worker is taught how to keep track of and monitor all day-to-day symptoms, vital signs and issues that come up. They know how to track and record information that shows how a person’s health is progressing – for better or for worse. An untrained and un-certified individual usually knows few, if any, of these procedures.
So far, Andrew Cuomo has caught quite a few of these companies who are nothing more than rings of uncertified workers fleecing the system out of a lot of money and putting patients at risk. Cuomo has filed criminal and civil charges to the extent of the law and he is not backing down.
If you are a New Yorker, you can be happy and proud that your Attorney General is trying to protect your citizens – especially those most vulnerable – and protect the taxpayers’ money. If you feel that you have been the victim of this type of fraud by an uncertified healthcare worker, contact Medicaid at www.medicaid.gov or call Cuomo’s office, which is listed under State of New York, Attorney General.
If you are receiving Medicare benefits but even with prescription coverage do not have enough money for drugs or premium, there is help available through the Social Security Administration.
Many people are not aware of this assistance. The assistance is $3,600 that can go toward your prescriptions or your premiums. This assistance is available once every year. This year, if you log onto the Social Security website at www.ssa.gov, you will be able to find the assistance by clicking on the box that says “I helped my mother today.”
There are a few limitations to this assistance. You must be receiving Medicare benefits. If you are single, you must make $15,600 or less annually. If you are married, you must make $21,000 or less as a couple annually. However; the Social Security Administration suggests that even if you are close to those numbers, you should check into receiving this benefit. You can apply on line on the Social Security Website, which is available 24 hours every day.
In addition to the information above, there is another plus to the program. The individual who is applying for this extra help does not need to be the one filling out the application. For instance, if the individual has a caregiver or spouse that could do the paperwork for them, especially if the individual has a disability that prevents them from doing the paperwork themselves, Social Security permits the caregiver, family member, friend or spouse to file on the individual’s behalf.
Since prescription drugs and extra premiums are of extreme concern to many people receiving Medicare, this program will provide relief for a great number of people. The program has been available, but has not been heavily marketed by the Social Security Administration.
If you are a Medicare recipient and need extra financial assistance for your premiums, prescriptions or other Medicare-related issues, be sure to go to www.ssa.gov, the official Social Security Website and explore this little-known option for help.
When we look at the Medicare system of healthcare for individuals age 65 and above, it is important to look at the amount of coverage seniors receive, the amount of co-pays and other out-of-pocket expenses they are responsible for and just how it all works in today’s economy.
With the economy as it is currently, it has become very difficult for individuals and families to pay for the very basics, much less any extras. Because costs have escalated enormously – especially during the past couple of years – people, especially seniors, have to make some truly difficult choices as to what they can and cannot pay for, and how it is possible to find the funds to do so.
Unfortunately, Medicare has become one of those things that seniors have to make difficult choices about. With over 44 million individuals on Medicare, there is a lot involved in these choices. For instance, AARP has stated that most beneficiaries of Medicare are under the false impression that the program is all-inclusive and pays for everything. They do not realize that most Medicare recipients are paying at least 25% out of pocket for medical care.
If that isn’t bad enough, there is talk of raising the premiums for the plan. So, in addition to paying co-pays for everything from doctor visits to prescriptions to hospital and nursing home stays, the monthly amount to keep individuals covered through Medicare could go up, too.
Every year for the past five years, Congress has raised the premiums for Medicare in order to cover payments to physicians. Rather than fixing the system, Congress has continued to raise the premiums that seniors have to pay. Unfortunately, this has put any seniors at risk and in a situation where they need to choose between medicine and medical care they need and food, shelter and clothing.
It is right and fair for seniors to pay their share; however, it is not fair that the costs continue to rise constantly. Congress needs to look for another way to cover these expenses and find a way to give seniors a break. They are looking at different ways to get this done.
If you are a Medicare recipient or will be one soon, it is important to do your research, find out what is best for you, and determine what you can afford. Visit www.medicare.gov or www.keepmedicarefa.org for information on Medicare coverage and premiums, plus the efforts to keep premiums fair and affordable
Birth Control has become an intense topic during the past few decades. No matter what side of the debate you are on, there is some type of controversy. In response, there are a variety of birth control medications and procedures available to women today.
In the past, women who wanted or needed an effective method of birth control had few choices. They could take some form of birth control or they could have what amounted to major surgery. They could also use an intrauterine device called an IUD.
None of these methods were perfect. Whenever you are changing the systems in the body there can be a reaction. All of these birth control procedures had reactions ranging from pain and bleeding to nausea and headaches – plus everything in between.
There is a relatively new procedure available to women. The Essure procedure has been approved by the FDA since 2002, but until now it has not been covered under Medicaid.
The Essure procedure is non-invasive, can be done in a doctor’s office and takes only about 10 minutes. Instead of a hospital stay and a longer recovery time lasting 3 to 6 days, the recovery time is one day, and the procedure is done as an outpatient procedure.
In essence, the Essure procedure is a permanent procedure that replaces tubal ligation for women. The doctor inserts soft micro-inserts into the fallopian tubes through the cervix. This blocks the tubes and enables women to discontinue other forms of birth control. Eventually, the tube grows around the inserts, making this a permanent procedure that is 99.8% effective. This is the first and only sterilization procedure to have zero pregnancies in the clinical trial.
California is the latest state to embrace the procedure, with 45 other states having done so. The Essure procedure gives women a safer, permanent choice regarding birth control.
For further information you can check with Medicaid for your state or you can contact the Essure Information Center at 1-877-ESSURE-1 or at www.essure.com on the web.
It hasn’t been long since we have seen the overzealous use of restraints in nursing homes. In fact, restraints are still in use now – mostly legitimately – however; too many times they are used too much and for the wrong situations.
A Medicare initiative through Lumetra has helped reduce the use of restraints in nursing homes by an average of 26% during the past few years. This is a good sign, and it has taken a collaboration between the Centers for Medicare Services, working with nursing homes and their employees to make this work.
Even though nursing homes throughout California had limited their use of restraints since 2004, there were still a high number of incidents. However, the nursing homes that started working with Lumetra, a non-profit organization dedicated to improving the quality of healthcare, and beginning to focus on person centered planning, including the nursing homes previously considered the most “poor performing” reduced their use of restraints by 55%, working through Lumetra’s Quality Improvement Collaborative.
This is a great step forward to reach this much of a reduction in restraints. In addition to becoming a great step forward, it is a credit and a relief to the staff involved on such an important issue.
Lumetra worked with 138 California nursing homes for over 18 months, specifically trying to decrease – and eventually eliminate – restraint, as well as further establishing and sticking to person centered plans. Person centered plans are more successful in obtaining positive results and less resistance, mainly because the person has helped develop the plan for themselves and, as a result, this is more of an encouragement for them to set up their own goals and boundaries and work within them. The idea of person centered planning has moved forward rapidly, and has been a breakthrough.
When a person sets up their own goals, dreams and boundaries and is given the support and tools to work toward them, it becomes a “win-win” situation. For further information check: www.Medicare.gov.
Medicare used to be one basic program with very few – or no – variables. You got what you got, it paid what it paid, the doctors were pretty familiar with it and so were Medicare recipients. Sometimes the payment was slow getting to the doctors, but everyone knew that was how it was and simply lived with it.
Fast forward to today. There is still a basic Medicare program; however there are a total of 57 prescription drug programs (Part D) that a recipient could ask for. Any combination of them could work for a recipient; however, there is usually one combination that will work best. Supposedly, the way to find that combination is to go onto the Medicare website at www.medicare.gov and type in all of your prescriptions where asked. At that point, you should receive a plan recommendation that is best for you.
The problem is that there is no way to be sure. It is essential that you sign up for Medicare Part D when you are ready to turn 65. Do your research in advance, because you have only three months after your 65th birthday to sign up for Part D. In addition, you have the right to refuse Part B which covers , but experts say that it is not wise to do so. L Though it costs $96 per month and comes out of your Social Security check each month, it could cost much more if you had to pay the cost of the medical bills it covers out of your own pocket.
In some states and counties, such as in southern Oregon, there are meetings being held to discuss Medicare and unscramble what means what. There are organizations with volunteers in Oregon to help you understand – in plain, understandable English – exactly what is covered and exactly what you need.
Dick Heintz of Senior Health Insurance Benefits Assistance (SHIBA) will be facilitating workshops in Oregon. This is important information for you to know. If you are in areas other than southern Oregon and need information, go to www.medicare.gov.
The Arizona Hospital and Health Care Association launched a new web site Tuesday called the Hospital Choice Web Site. This is an innovative move to help consumers determine costs at hospitals throughout Arizona. The site compares average charges, lengths of stay, and the number of procedures performed at each hospital.
This is extremely important for the growing number of uninsured or underinsured individuals. It follows the pattern that Medicare started two years ago when they began posting information about their payments for medical procedures and the range of costs in each county, plus the number of procedures performed at each hospital.
Medicare also provides information online regarding how well hospitals take care of their patients, mortality rates, and how well they care for individuals who have had issues such as heart attacks and strokes.
The idea behind having this information readily available is so that it is easy for individuals – especially potential patients – to comparison shop just as they would at the grocery store or when buying a car. They can now decide - along with insurance or Medicare/Medicaid benefits, which hospital would be best to suit their financial and medical needs. As a result, they become more in charge of their own personal healthcare, rather than leaving it in the hands of a program and its administrator.
The hope is that the quality of care will continue to rise while costs diminish due to public scrutiny. With an easy to understand, transparent reporting system that is available to the public, it will be easier to hold hospitals accountable, and it will be in their best interests to create more or better quality control mechanisms so that they will hold themselves accountable.
Transparent reporting is a positive step in improving health care and increasing the dialogue between patients/consumers and providers to come up with real solutions for the short and long term.
Over ten years ago, a woman in New Jersey heeded home care with basic daily needs after a serious illness. Medicaid would pay for a home health worker to come into her home and help care for her; however the overtaxed New Jersey home health care system had no available workers.
The woman’s daughter did not know what else to do besides putting her in a nursing home. Before that happened, however, an alternative idea was that the Medicaid funds could be used for the woman to hire family to take care of her.
Through this first small step for Medicaid, but huge step for this individual’s family, the Cash and Counseling program began. Grants were given to New Jersey, Arkansas and Florida to pilot the program, and since that time in the late 1990’s, this program has spread to many states in the country.
It has been an excellent program for any reasons. One situation is that the individual is being taken care of at home by their family and not a stranger. They are in familiar place, where statistics show that they will have better resources, more interaction with family and friends, and less isolation and loneliness, all of which lead to faster and stronger recovery. In addition, staying at home and not in a nursing home is certainly much more cost effective and will definitely help the person’s health stay or become more stable.
The federal government has made it easier to participate in this program because it has eliminated the requirement for people to get a Medicaid waiver to participate. According to AARP, this will save a tremendous amount of money. AARP says that home health care costs about a half of what care in a nursing facility costs, and most individuals and their families prefer to stay at home to be cared for unless they are extremely ill or frail.
If you or someone in your family or circle of friends are in this situation, be sure to contact Medicaid at www.medicaid.gov to get further information. It is quite possible that health care can be continued at home with the comfort of being surrounded by family and friends.
A stunning and positive development has taken place with regard to Medicare coverage. The Centers for Medicare & Medicaid Services (CMS) has approved coverage for the artificial heart, manufactured and distributed by Abiomed.
This is a huge step forward. With heart-related illness and issues comprising a very large percentage of hospitalizations and deaths, there has been the discovery of more and more individuals that need ear transplants.
However, the waiting lists are long, and even if a person is on the list, waits their turn and moves to the top of the list, they may not be able to find a heart that is a match for them. Now that hospitals can be reimbursed by Medicare for the cost of the heart itself and the cost of implanting it into individuals, many people may have the opportunity for this operation to save their life.
Because this is an artificial rather than a human heart, the possibility of rejection is much less than the human heart. There are fewer question marks, and there are less complications projected. In addition to less complications, the recovery rate with the artificial heart is said to be shorter than with a human heart.
During the pilot part of this new development, there are four hospitals that are slated to be able to use the artificial heart and the operation to put it into individuals. These four hospitals are Johns Hopkins University Hospital in Baltimore, Robert Wood Johnson University Hospital in New Brunswick, N.J., Texas Hear Institute in St. Luke’s Episcopal Hospital in Houston, and St. Vincent in Indiana. If the program is successful, it will expand over time.
The fact that Medicare will be prepared to cover this artificial heart procedures a great stride forward. This should save many lives as it increases over time. Even if it saves only one life, it will have been an important step forward in Medicare coverage.
Understanding how Skilled Nursing Rehab works and where Medicare fits in is extremely important. There are a lot of facts that can affect your situation and create some serious issues for you if you or someone in your family needs this type of care.
The way Medicare handles Skilled Nursing Rehab is that the original Medicare plan pays 100% of the first 20 days. Most of the time, if there is any improvement that the facility can say is enough improvement; Medicare will try to have you discharged within those first twenty days.
After the first 20 days, the Medicare beneficiary pays $128 and Medicare pays the remainder of the day’s bill for up to 100 days. Looking at these figures, this is where supplemental insurance becomes very important. This could be a Medigap/Medicare Supplement plan or it could be an employer retiree plan. This type of plan will pay most or all of the $128 per day out-of-pocket expenses that are your responsibility.
Because Medicare is a health insurance plan that provides medical benefits, in order to receive those benefits, they have to determine that there is a medical need. If you are in a medical facility or skilled nursing rehab center, Medicare has determined the need, they will pay their share, however, when your condition improves, they will not continue to pay.
Sometimes and individual or family does not agree with the decision that the person is ready to be released even though that person has improved. If that happens, it is important to very firmly and specifically relate your concerns to staff, the social worker, the doctor and the social worker. If the person has had a stroke and is still unable to get in and out of the house safely, still have severe balance issues or other barriers, specifically let the facility and all the individuals we mentioned know.
Regardless, it is very important to study the issue of Skilled Nursing Rehab and Long Term Care very carefully. Take the tie to do some research on the net, through your doctor and even at your local hospital and find out what good policies are available and how they work. Be prepared so that if you or your family is ever in the situation where you need this type of coverage, you will be ready.
Medicare benefits are usually thought of as being only for those people age 65 and over. However, there are exceptions to this. There are individuals with disabilities and others who are eligible for Medicare.
There is a program called the Medicare Buy-In Program which includes QMB (Qualified Medicare Beneficiary) and also SLMB (Specified Low-Income Medicare Beneficiary). The program is designed to help keep low-income Medicare recipients from having to pay the increasing Medicare costs that are continuing to rise, so that these particular Medicaid beneficiaries do not lose their benefits. This includes helping beneficiaries with co-pays and deductibles.
In an effort to make this happen and help keep coverage in tact for individuals who need it most QMB and SLIMB combine Medicare and Medicaid. Medicaid pays part or all the premiums and deductibles for the individual or family’s Medicare coverage for individuals who qualify financially.
QMB (Qualified Medicare Beneficiary) Program serves individuals or families of little means who need assistance the most. Their assets must be under $4,000 per individual and $6,000 per couple, and their combined income must not exceed 100% of the federal poverty level. In addition, the state Medicaid plan pays the Medicare part B premium and other costs that they would normally share. SLIMB only pays only the Part B premiums for people whose income is between 100 and 130% of the poverty limit, with assets of $4,000 per person or $6,000 per couple.
There are various states that have this program available. If you need assistance and think you might qualify, contact your local health department, your doctor or your local hospital. You can also find information at www.medicare.gov or www.medicaid.gov.
The New England Journal of Medicine recently released an article regarding the place that Long Term Care will play in the future. Because it affects such a large part of the population, it is an important topic to tackle.
The article brought out that there are serious flaws in the long term care system and that these flaws expose the people who need the care the most to serious financial risk. How will those who cannot afford the financial risk be able to be taken care of? That is an important question that has not been addressed enough – even by the candidates that are currently running for office.
For now, of the nearly 10 million individuals who need assistance with daily living, most live at home and receive assistance from their family and friends. Because most Americans enter retirement without large sums of money set aside, they must be quite frugal regarding day-to-day living, much less money for extras, including medical care – especially long-term care.
State governments are struggling with the funding of long-term care through Medicaid. As costs for long term care get higher, Medicaid works to keep up the best it can, but with current flaws and no definite solutions in sight, Medicaid could very likely buckle under the strain
In addition, when Baby Boomers are factored into the equation, the picture becomes even more abstract. The solution is not cut and dried, nor is it an easy one. As we look at the legislators who will take office after the elections, it will be important for them to look at the issue of long-term care and raise awareness about it. There has to be a long look at where Medicare and Medicaid fit into long term care and acute care, as well. New approaches must be explored.
Most importantly, though, the discussion needs to begin and the questions need to be asked This should all be done in earnest with open minds truly looking for realistic answers to this situation.
Keep your eyes on the news and check with www.medicare.com and www.medicaid.com and AARP. Make sure you know what your situation is with regard to long-term care and your Medicaid or Medicare benefits.
As of Monday, thousands of Medicare beneficiaries enrolled in fee-for-service plans will be able to access their doctor and hospital claims online as part of a new pilot program in South Carolina. This Personal Health Pilot is a new program from the Center for Medicare Services (CMS) and will help thousands of Medicare beneficiaries.
CMS has created the program to help encourage consumers to learn the use of PHRs and see how much and how well consumers use them. Beneficiaries who use the PHR will also be able to enter some of their own information such as prescriptions they are taking and over the counter medications as well. In addition, they will be able to use links to find websites with information about their individual health conditions.
On excellent benefit of the PHR is that individuals using it will be able to share their health information with their health care providers and their families by giving them authorization to be their authorized representatives. These representatives will be given their own user I D’s and passwords.
The PHR Pilot began in South Carolina at the beginning of April 2008, and will continue indefinitely. Security is of the utmost importance, and, as a result, the PHR Pilot was delayed by the concerted effort to make sure that the program is in strict compliance with federal data security standards and the highest privacy safeguards for patient information.
The PHR Pilot is an important step in involving all individuals in the medical process. Of course, the Medicare recipient is the individual who will make the decision as to who has permission to access their information. In the event that the beneficiaries allow their families or their physicians to access the information, the result could be better communication leading to better health care and more support.
It will be both interesting and important to see the progress and results of the Personal Health Records Pilot. Hopefully it will be a foundation for more pilots and permanent programs throughout the country.
Durable equipment, such as wheelchairs, walkers, hospital beds and other medical equipment has long been the subject of frustration because of their costs. If an individual has Medicare, often Medicare pays for some or all of these items, with little cost to the recipient.
However, the costs of much of this equipment are extremely high, and not affordable to most Medicare recipients. Even though Medicare helps with the expenses, there are still issues that are being addressed.
Medicare has determined that the costs are too high for them, as well. They have proposed a solution that would help consumers and help the Medicare program itself. To save money for recipients and the Medicare system, Medicare wants to institute a competitive bidding process for some durable medical equipment. This would mean that companies that supply these items would have to bid toward the lowest price in order to be given contracts through Medicare. In addition, these lower price savings would be passed on to Medicare Beneficiaries.
On the surface this seems like a good idea, and in many cases, it would work. The problem is that many of the companies that provide this equipment are small businesses that have a small profit margin. Some of these businesses have no room to decrease their prices and as a result, might be shut out of the process of providing durable equipment through Medicare. This could severely cripple the businesses or even put them out of business.
Another drawback is that there would probably be fewer choices for Medicare recipients along with fewer knowledgeable providers. Patients might have to switch from their current providers to a new one that they don’t know. Some beneficiaries have been affected already, as the bidding process has started. It is taking longer to get their equipment. A high percentage of providers have already had to cut back or go out of business.
In the long run, things will even out. In the short term, however, if you are a Medicare recipient, try to deal with durable equipment in advance. Put your order in early, and try to be patient as everything is sorted out. We can all be hopeful that the discounts will truly be passed on, saving beneficiaries money on essential equipment they need.
During the past decade or more, there has been a push by citizens, advocates and, yes, even congress, to allow individuals to have home health care rather than staying in a facility. As many of us know, a person that can live at home and interact in the community, while being taken care of medically, will most likely live a longer and fuller life.
One state, Connecticut, has moved into the cadre of states who are working to allow individuals to stay at home, get home health care, and live full lives. Senators there have passed a bill that will move about 5,000 individuals who are elderly or disabled out of care facilities and institutions back to their homes and their communities.
This is vitally important. Statistics have shown that individuals that have community support and independent living, live longer and are healthier than those who are confined to hospitals, institutions and long-term care facilities. This does not mean that everyone is capable of living on their own and interacting in the community without assistance. Some individuals might be better in a variety of care settings. However, it has long been known that there are many individuals in facilities, hospitals and institutions that should really be able to live in the community.
This is a win-win situation. Medicaid will save money – it is much less costly to live in a group home or apartment and have a variety of supports defraying the costs, than it is to stay in a hospital, facility or institution where rates range (depending on the area the person lives in) from nearly $200 per day to over $1,000 per day.
I have personally worked in several states with individuals who were involved in independent living programs. Some lived in group homes and others lived in their own apartment. Still others were able to live at home with their families. Many of them had gainful employment, meaning that in many cases, they either needed less benefits and actually paid taxes, helping the economy; or they had small jobs that prepared them to move forward in the community and eventually be self-sufficient.
No matter what the situation, helping individuals that are able to integrate into the community and work toward independence is a huge step forward for the individual, the community they live in, and society in general.
At this time, it looks as though the trend has caught on and is continuing. In the long run, it can save Medicaid and communities millions of dollars. In the short term and the long run, it will heal individuals, families, and the community and make all of these entities stronger and richer for the progressive change.
Most people who are Medicaid recipients know that their income must stay below a certain level in order for them to maintain their Medicaid eligibility and benefits. Therefore, they must carefully check their finances so that they do not exceed that amount and lose their benefits. This is critical, since Medicaid is a lifeline for many who can’t otherwise get health care and need to continue treatment, medicine or both.
There has been a lot of confusion regarding the tax rebate checks that are being distributed right now. Individuals receiving Medicaid are worried about whether this extra money will count as income and cause them to lose their benefits.
The answer to this is, “No.” The economic stimulus rebate will not count as income; therefore will not cause individuals to lose their Medicaid, according to South Dakota State University.
Some Medicaid programs count resources as assets, so it is best to check the information at www.ssa.gov, which is the federal Social Security Administration website. Some nursing-home waiver and other SSI-related programs count resources as assets, so it is important to check the site to see if any of these situations apply to you. They could include Disabled Adult Children, Widow/Widower, Grandfathered Children or a few others. You can get specific information regarding these situations on the site.
If you or someone in your family is part of any of these programs, Medicaid will not count the tax rebate as income during the month the rebate is received or for two months afterward. That means that this money will not be counted when Medicaid is deciding whether a person is eligible for that month and the two months after the rebate is received. It is important, however, to note that if the money has not been spent or otherwise disbursed by the fourth month, it will be counted as a resource for the programs listed in the previous paragraph.
If you are a Medicaid recipient, hopefully this clears up the confusion so you can breathe a bit easier now. If you have further questions, go to www.medicaid.gov or www.ssa.gov for more information.
Previous Posts
