Posts tagged 'disability'
Medicare can help offset medical expenses, which is a good thing. However; there are gaps in coverage with Medicare, and they need to be filled. One way to fill these gaps is to take the money out of your pocket, your bank account your life savings or your retirement.
Especially if you have the original Medicare plan, you need to look into supplements, also called Medigap. These will help you pay for expenses that are not covered and pay for some – or most, or all – of those costs.
There are 12 Medigap policies and each is a little different and covers different things. The premiums can differ a lot, as well, so it is essential that you thoroughly check each company selling these supplemental policies to make certain which covers offered through
Study each Medigap plan before deciding which one to select. This is extremely important, particularly because there are so many people on Medicaid and/or Medicaid who don’t understand how the program works and often don’t realize that their billing. Information you receive could make a vast difference as to whether your medical bills will be covered and how much you could save by only having to pay a basic and affordable for the most part.
Why not find out what benefits you qualify for and which ones are right for you? Study all the Medigap plans to figure out the differences and which one would suit you the best. You can check the internet for a vast amount of information, you can talk to someone by calling 1-800-MEDICARE, and you can call your local insurance agent.
Whatever you decide, it is essential to find out what coverage is available and how it works, as well as, which plan will work best for you.
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.
There is a lot of information around about what a Medigap or Supplemental Medicare Insurance policy is and what it covers. What it does not cover is just as important to you if you are contemplating whether or not you should purchase a supplement.
The 12 Medigap plans cover basic benefits, but each differs depending upon what state you are in. The twelve plans are labeled A through L, with plan A being the basic policy. Plan B through L offer the same basic coverage found in plan A, and also offer other additional benefits. Plans K and L offer similar coverage as plan A, but the cost sharing is different.
None of the standard or basic Medigap plans cover certain benefits, such as long term care for help with bathing, dressing or using the bathroom. They also do not cover vision, dental care or hearing aids, private duty nursing or prescription drugs. As mentioned, there are other variations based on the state you are living in and receiving benefits from.
To explore the differences and to look for coverage you can contact your state insurance department, or find The Guide to Health Insurance for People with Medicare: Choosing a Medigap Policy.
Another offering is Medicare Select, which is a type of Medigap policy that often costs less than standard Medigap plans. That’s the plus part. The negative is that you can only go to certain participating physicians and hospitals if you need any sort of medical treatment or assistance. To find out if Medicare Select is available in your state, simply call your state insurance department.
Since Medicare Part A is the most basic plan let’s start there. Plan A covers your hospital stay up to 60 days. Starting with day 61, you are responsible for costs through day 150. Since Medicare doesn’t pay at that point, All Medigap plans cover days 61 to 150, though you will have to pay the shortfall, as the Medigap plans don’t cover the entire cost during that time. You will also be responsible for any deductible before Medigap kicks in.
With Part B, you will pay your annual deductible which is $135 in 2008. Medicare then pays 80% of the doctor and other medical services, 50% of some health services and 100% of some preventative services.
Since Medicare does not pay for all services, as described in the paragraphs above, this is where a Medigap policy takes over. Plans B through J cover expenses such as the deductible above, skilled nursing home costs, some deductibles for other services, including at home recovery, preventive care, prescription drugs and foreign travel emergency or urgent care.
As you can see, the expenses that the right Medigap policy covers can offset a lot of out of pocket expenditures. It is an excellent idea to research this type of coverage so that you can see how cost-effective the coverage could be and whether it is right for you. To research the plans more thoroughly you can call Medicare at 1-800-MEDICARE or you can check on the internet at www.aarp.org and www.cms.gov. These sites have links to other information, as well.
Whatever you decide to do, research thoroughly, ask questions, calculate the cost of purchasing a Medigap plan vs. the cost in out of pocket expenses if you don’t purchase one. Get information from your employer, your insurance agent and any other sources on the web. Another great way to get information is to ask friends what type of insurance they have and how happy they are with the coverage.
They say that people spend more time looking for furniture or buying groceries than they do researching their insurance, yet it is your insurance – especially Medigap – that can literally make them or break them. Don’t get caught without protection. Determine what your needs are and then do your homework. You’ll be glad that you did.
Many individuals with disabilities want to go to work and are able to work at a job. This is a very positive thing in many ways. It helps the individual to build their self-esteem and pride, helps them become a more integrated part of the community, it helps the individual become more self-sufficient and it helps the economy.
There is a drawback for many people with disabilities who want to work. The drawback is simply that individuals are worried that they will lose their benefits – especially their medical benefits – if they go to work. It can feel devastating to be willing and ready to work but have to choose between work and medical care.
The truth is, however, that an individual with a disability can begin – and continue – working and still maintain their benefits. States can extend Medicaid to people who are working but who are earning too much money to qualify for Medicaid under the current rules.
A person can qualify if their income is less that 250 times the national poverty level or if they meet the definition of “disabled” under the Social Security Act and would be eligible for Social Security Disability Insurance (SSDI) if they were not working and bringing in an income. An individual can qualify for the buy-in without receiving SSI, and the state would then have to determine whether or not the individual has a disability. The fact that an individual is working will not have a bearing as to whether they are disabled or not.
Another important piece of this equation is the Ticket to Work and Self-Sufficiency Program. In fact, this program is the foundation through which many of these benefits are protected when a person goes to work. The Ticket to Work program allows for and encourages states to cover individuals between age 16 and 65 years old who decide to go back to work and the states can provide Medicaid to individuals who are working who have improved enough to lose their coverage, but still qualify as being disabled.
So, if you are considering trying to work, find out about the Ticket to Work and find out about whether your state will continue your Medicaid benefits. Take the first step toward working by finding out how you can continue receiving your benefits. You can do this by contacting your State Medicaid Office or go online for information at www.cms.hhs.gov and look up Ticket to Work.
The information you discover may make the difference between you being able to work or not.
Medicare recipients can look forward to improved delivery of Medicare and Managed Care benefits including medical products and prescription related products through Nations Health. These include diabetes supplies and insulin pumps, and other medical products throughout the U.S. In addition, Nations Health provides education, information and other assistance to Medicare recipients – including details about Medicare Part D.
There are other statements through Nations Health that talk about better, more efficient services and products, however, it is important to keep an eye on things to see if they deliver and how well they deliver what they say they well.
There is hope when a company like Nations Health offers assurance of improvement; however it is not always a guarantee. Various world and national events, including decrease in revenue to Nations Health could cause results not to turn out exactly as predicted.
With the advent of organizations such as Nations Health – as long as their performance is efficient, effective and organized in such a way to truly help Medicare recipients, the results can be positive for all – a win/win situation. Though it may very well turn out to be a plus if the delivery of products and other benefits is improved, it is essential to watch and see what happens.
In addition, when researching any information regarding Medicare, Medicaid or other benefits, it is essential to check the facts, compare various services available and check with the Medicare and Medicaid offices and/or websites. Get a well-rounded, realistic view of what services you can receive and who can deliver them in the best way for your needs.
Many people throughout the country are eligible to receive Medicaid benefits. Unfortunately, there are a large number of individuals who are eligible for Medicaid who either don’t realize they are eligible or are not taking advantage of benefits that could be helpful to them, or both. How does a person find out whether or not they are eligible? One county in Ohio has created a unique program to try to locate about 30,000 residents that it thinks are eligible for Medicaid.
Hamilton County has joined forces with the FreestoreFoodbank to try to locate these individuals and enroll them in the program. The Over-The-Rhine-based food pantry has received a $1 million contract to help locate and sign up at least part of the individuals that are eligible, as well.
Hamilton County Commissioner, Todd Portune issued a press release in which he stated, “These residents are eligible for assistance that can provide them the care and preventive treatment they need to lead healthy, fulfilling lives; they just don’t know it. It is long past time that we reached out to them.”
This unique move is one of the positive things that are happening regarding the Medicaid program and supporting individuals who qualify. In addition, the pantry will be engaging local businesses with employees who are uninsured and either work part-time or have a low income. The program will also reach out to schools, health centers that serve low-income residents and social service agencies working with the poor and the elderly.
The program is made possible through the county’s Department of Job and Family Services, who is providing funding. Outreach will focus on children under the age of 19, pregnant women, adults age 65 and older, individuals with disabilities and homeless individuals.
This is a big step forward in one area of the country. It will be wonderful if this type of program catches on in other counties and states, and spreads throughout the country. With all the issues surrounding people who are uninsured, having programs such as this one could cut those numbers by a good amount and leave many thousands of people protected instead of vulnerable.
Since its introduction, Medicare Part D has improved some issues surrounding prescription drugs for seniors. Reports and surveys from 2004 through 2007, approximately 25,000 Medicare beneficiaries were surveyed and the results were positive, for the most part.
Harvard Medical School analyzed that data from these surveys and found that after the drug benefits were introduced, the number of individuals on Medicare Part D who skipped medication went down by nearly 4%, and the number of individuals who cut back on basic needs, such as food or housing decreased by about 4%, as well.
This is good news. There has been a negative side, however. Studies showed that individuals with some of the most serious illnesses and conditions were not affected positively by Medicare Part D, and they have continued skipping doses of medicine and cutting back on basic needs, as well.
Another study published by JAMA stated that even with Medicare Part D, many beneficiaries have changed their behavior and cut back on the number of refills they get or have changed to generics in order to cut costs. Research has also shown that 60% of all Medicare Part D participants are not aware of the fact that there is a gap in coverage as use of the plan increases. Cost sharing is involved in Plan D, but is misunderstood by this 60%, some of whom do not realize that there is a gap in coverage at all, or that they will be responsible for a higher amount of costs of prescriptions once they hit a certain amount that has been paid by Medicare Part D to cover those prescriptions.
It is important, then, that everyone on Medicare Part D, or planning to enroll in Part D, research carefully and obtain as much information as possible so that they know what their coverage will be and how it will work. There are numerous ways to get information. You can call the 1-800-MEDICARE or log on to www.medicare.gov.
If you have Medicare benefits and are confused about Medicare Part D, you are not alone. There are a great many individuals who do not understand Medicare Part D, which is prescription drug coverage.
Many individuals are getting into a situation where they are eligible for Part B of Medicare but they have limited income. As a result, they are worried about getting this important part of Medicare coverage.
Part B covers doctor visits and various outpatient services. If you find yourself in the situation where you cannot afford to pay for Part B, your state may be able to help you with premium payments, deductibles and co-pays.
There are several ways to get correct information regarding this issue. First, call your state or local office for medical assistance, social services or welfare. If they can’t give you all the specifics, they can at least get you started and give you some information. You can also call the Medicare hotline and ask about Medicare savings programs at 800-633-4227. For more information about the Medicare program, call 800-772-1213.
There are questions regarding help for prescription drug coverage for those who have a limited income. There is good, specific information regarding prescription coverage (Part D).
If you receive Medicare benefits you are eligible for prescription drug coverage, no matter what your income is. In addition, you can receive this coverage regardless of how healthy you are or the number or cost of the prescriptions you already take. If your income is limited, you may be able to get help paying your premiums.
If you are not sure whether or not you qualify for premium assistance, you can find out and sign up at 800-772-1213 or goon the internet to www.socialsecurity.gov/prescriptionhelp and you can find out. You can also go to www.Medicare.gov or call 1-800-MEDICARE to get information about Medicare prescription drug plans.
If you need assistance it is essential that you contact Medicare or Social Security to find out how they can help you. Don’t hesitate to call or visit them on the web. There is information and assistance available. Make sure that if you qualify for it, you receive it. Help is just a click or a call away.
As you may or may not know, Medicaid is different than Medicare. With Medicare, when you turn 65 years of age, if you are receiving Social Security Benefits, you are almost always automatically enrolled in Medicare.
Medicaid is different. Information about whether or not you are eligible is determined by your state’s Department of Children and Families. This department helps determine whether children and/or their families have an income under a certain amount so that they can qualify for coverage.
Also, if you are on SSI or SSDI, you can get information through the Social Security Administration. Another important resource is your local Health Department or Department of Workforce Services. These two departments usually have information and phone numbers, as well as websites that will direct you to your state’s program. You will be able to discuss your individual situation with a representative who will help you with the qualification and enrollment process.
Most states also have a Social Security Insurance related fact sheet that will give you information about Medicaid eligibility for disabled, blind and aged individuals, including any Medicare cost-sharing information for Qualified Medicare Beneficiaries, Specific Low Income Beneficiaries and other Qualified Individuals.
It is also easy to find Medicaid information for your state by typing Medicaid in (your state’s name) into Google or other search engine. This will pull up several sites. Beware, however, to be careful that you are not searching sites that charge you or sites that are trying to sell you information or legal services. You should not have to pay for information regarding Medicaid eligibility.
No matter what Medicare Plan you are on, you have the right to appeal any decision about your Medicare coverage. If Medicare does not pay for an item or service that you feel you are entitled to, you can appeal that decision.
This is not necessarily an easy process; however, there are ways it can be done. For instance, there are various appeal forms depending upon what plan you are on. They are available by downloading from the internet or calling the Medicare program you are enrolled in. The information should be on your Medicare card and your monthly statement.
If you file an appeal, Medicare has a limited amount of time to respond to you and at least let you know that they are looking into the matter. Often, you will hear from them in 7 to 10 days.
If you are not satisfied with any decisions regarding your appeal, you will be advised as to the next level you can go to. It is similar to taking a matter to civil court, then superior court then district court then the Supreme Court. With Medicare, hopefully you won’t have to go all the way to court.
There are five levels to an appeal. First, redetermination by a Medicare carrier, intermediary, or Medicare Administrative Contractor. Second is review by a Qualified Independent Contractor. Third is hearing by an Administrative Law Judge in the Office of Medicare Hearings and Appeals. Fourth is review by Medicare Appeals Council, and Fifth is Judicial Review by Federal District Court. Most cases are settled long before they get to step number five.
No matter what your question, grievance or appeal is, try to start by getting information directly from your Medicare provider. This may take some work, research and time, but it can save a lot of time and effort in the long run if you do not have to go through the entire appeals process.
For questions or information, call Medicare at 1-800-MEDICARE.
Medigap plans are designed to cover the “gaps” or expenses that Medicare does not cover. They help pay for these services and are sold by private companies. It is important to research companies and plans if you are thinking of purchasing this type of coverage.
Another important thing to be aware of regarding Medigap coverage is that if you decide to purchase this type of coverage, you should do so within six months of getting Medicare Part B. The reason this is so important is that because during this six month period insurers cannot deny you Medigap coverage. In addition, they can not postpone the time when your coverage starts and they cannot charge you additional rates based on pre-existing health conditions – health problems that you already have. This is critical if you are dealing with serious or ongoing health issues, such as diabetes, high blood pressure, heart problems and more.
If you wait until after the six month period, you could be denied coverage; there is no guarantee that you will be able to be approved.
There is information available regarding Medigap insurance and it is a very good idea for you to research this information. There are a number of places to find this information by going on the internet. The easiest way is to go to Google and type in Medigap Insurance. In addition, go to www.ssa.gov and look under Medicare coverage and there will be links to Medigap information as well.
Medicare is designed for individuals 65 years old or older, and individuals with disabilities or on renal dialysis. Medicare Part A covers hospital and inpatient services, while Part B covers doctor visits and other services received as an outpatient (outside of the hospital).
Many people worry about how to enroll in Medicare. They worry that it will be difficult or confusing, but it doesn’t have to be, and it usually isn’t.
If you are receiving Social Security benefits, you will automatically be enrolled in Medicare Part A & B on the first day of the month that you have your 65th birthday. In other words, if you turn 65 on February 10th you will be enrolled at the beginning of February.
Your Medicare card will come in the mail up to three months before your 65th birthday. If you do not receive it in a timely manner, you should call the Social Security Administration at 1-800-772-1213 or visit them on the internet at www.ssa.gov. Either way, you will get assistance and can have the Medicare card sent to you.
If you are not receiving Social Security, you will need to sign up for Medicare. This is an easy process and you can do this a couple of ways. You can call Social Security Administration at 1-800-772-1213. They will take the information over the phone to get the process underway and then they will send you some paperwork in the mail.
If you prefer, you can go to your local Social Security office and apply in person. The advantage to this is that there is an individual there who will walk you through the entire process. Either way, it is your choice. You cannot, however sign up on line for Medicare only.
To sign up for both Medicare and Social Security Retirement Benefits together you can apply online at www.ssa.gov, or by phone at 1-800-772-1213, or go in person to your local Social Security office. Either way, you should be able to easily get enrolled for Medicare benefits without extra effort or worry.
One of the biggest worries that individuals with disabilities have when they attempt to work is the loss of benefits – especially health care coverage. They are worried that they will have no coverage at all or be forced into an employer’s plan that they cannot afford or that won’t cover their disability.
There are solutions to this dilemma, however. The solutions are found as part of the Social Security Act- especially part 1619b and Medicare. One of the most important provisions is the Medicaid Buy-in program. This program was designed to provide access to comprehensive health care for working people with disabilities. This is essential for many people with disabilities who find it difficult to find affordable and comprehensive coverage privately.
The Medicaid Buy-in program allows people with disability to pay a premium for coverage through their state’s Medicaid program, just as they would if they were buying private health coverage. The concept behind the buy-in was originally put forth in the Balanced Budget Act of 1997 to allow for individuals who lost SSI or SSDI benefits because they were making more money working. These individuals were able to support themselves without receiving SSI or SSDI checks because they were making enough money through their paychecks from work. However, they still needed health coverage, and Medicaid was the best choice for many situations. As long as the individuals continued to meet the Social Security definition of disability, they would be eligible for the buy-in program.
If you find yourself in this type of situation, there are several steps you can take. You can contact your county health department to determine what local programs are available; you can check with your state Medicaid office to see whether you qualify for the Medicaid Buy-in or other benefits; and you can check the Social Security Administration, Medicaid or Medicare websites for further information.
Medicaid has taken a giant and important leap recently. Because of this move forward, it is now possible that thousands of people will be able to get home-based care rather than being institutionalized. This new provision allows people to get care in their homes or in the community instead of an institutional setting.
The Deficit Reduction Act (DRA) allows states to provide people who qualify for Medicaid benefits to receive this care without having to apply for a demonstration waver to prove their eligibility. Having the option as to how an individual will receive long-term support is an historic step in leveling the playing field.
Individuals will now be able to receive person-centered care and have a part in the development and decision making about that care. Some of the services that states will be able to provide under this new provision will be case management, homemaker, home health aide, personal care, adult day health and respite care. In addition, individuals with chronic mental illness can receive day treatment, partial hospitalization, psychosocial rehabilitation and clinic services.
This new provision is an essential step in helping individuals with disabilities have the choice to be part of and participate in the community, stay in their own comfortable surroundings, make choices regarding services and have the support of a program that will offer them these options and more.
Many people have questions about Medicare and Medicaid including the question of what the differences are between the programs. There are some major differences between the two.
Medicare is funded by the federal government as an entitlement program, which mainly focuses on the older population. It is a social insurance program for individuals age 65 and over and it covers many individuals with disabilities. Medicare also covers individuals of all ages with end stage renal disease.
There are several parts to Medicare. Part A covers hospital bills, Part B covers medical insurance and Part D covers prescriptions.
Medicaid is different from Medicare in several ways. It is also an entitlement program, however, Medicaid is not funded only by federal government, there is a state component as well, and in some states, counties pay part of the cost.
Medicaid is based on need and social welfare, with eligibility based on income. If a person has limited income and/or financial resources, Medicaid covers a broader spectrum of services than Medicare does. It usually covers children, pregnant women, parents of eligible children, seniors and individuals with disabilities. Though poverty is used to determine eligibility, a person must fall into one of the coverage groups in addition to being determined eligible due to being in poverty. Medicaid benefits are paid directly to the provider of services. In addition to covering individuals who meet financial requirements, in some states Medicaid covers individuals who cannot otherwise afford insurance.
Some individuals qualify for coverage by both programs.
