Posts tagged 'eligibility'
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 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.
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.
