Tag: Medicare
If you have recently been diagnosed with diabetes, Medicare provides tests and supplies for those who currently have the disease. Medicare also covers many other preventive tests and screeningsĀ for seniors
Test and Supplies
Part B covers blood sugar self-testing equipment and supplies including glucose testing monitors and test strips, lancet devices, lancets, and glucose control solutions for testing the accuracy of the equipment. There may be limits to how much, or how often you can get these supplies. You may be required to use specific suppliers. If you use insulin, you may be able to get more strips and lancets than someone who does not. Part B also covers foot exams and treatment (including therapeutic shoes or inserts). Yearly eye exams and glaucoma tests, insulin pumps and the insulin used by the device, nutritional therapy services, and diabetes self-management training to help you learn how to better manage your disease.
Cost
The amount that you need to pay for many of these services and supplies varies. However, some factors can influence your cost. For instance, where you receive treatment, and whether or not your doctor accepts Medicare can impact your cost. Medicare does not cover all recommended diabetes treatments. If your doctor suggests you receive additional supplies or services beyond what it covers, you may pay some or all of those costs.
National Mail Order
As long as you use a Medicare national mail-order contract supplier, you can have diabetes testing supplies delivered right to your home. Medicare pays for test strips and lancets to be sent to you by mail. Or, you can pick them up locally at a pharmacy near you. In either case, you pay the same, whether you receive your testing strips in the mail or purchase them elsewhere. Local stores that accept Medicare cannot charge more than your 20 percent coinsurance, and any unmet deductible.
References:
https://www.medicare.gov/coverage/diabetes-supplies-and-services.html
https://www.medicare.gov/Pubs/pdf/11022-Medicare-Diabetes-Coverage.pdf pg. 6, 7, 8, 10, 11
https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdfĀ pg. 2
MUC64-2017-BCBS
Tag: Medicare
As a senior about to retire and eligible for Medicare and COBRA, understanding your options will help you decide which coverage is best for you.
COBRA
Consolidated Omnibus Budget Reconciliation Act, was passed by Congress in 1985 to protect qualified beneficiaries and their dependents from losing health coverage abruptly should group health insurance stop. Benefits are typically available when a qualifying event occurs, such as a divorce or legal separation, death of a covered employee, retirement, or, in some cases, eligibility for Medicare.Ā
Current Coverage
Seniors often delay signing up for Medicare Part B if they have comparable health insurance, COBRA is not considered comparable coverage. If you wait to enroll in Part B until your coverage ends, you will pay a late enrollment penalty. If you have coverage at the time you become eligible for Medicare, sign up for Part B to avoid the late penalty. Enrollment in Part B triggers open enrollment rights for Medicare Supplement. You will have six months from the date you enroll in Part B to choose a plan without regard to your current health condition.Ā If you have COBRA before enrolling in Medicare, your benefits may end on the date you sign up for Medicare. However, your spouse and dependents may be able to keep coverage for up to 36 months. You may be able to keep benefits for services not provided by Medicare. For example, if dental or vision coverage is provided, you may be able to continue paying for benefits for as long as you are entitled.
Enrolled in Medicare
You may have already signed up for Medicare when benefits are made available to you. You can sign up for coverage even if you are already enrolled in Medicare. Medicare becomes your primary payer, while COBRA acts as your secondary payer. However, you will be responsible for both the Part B premium and your COBRA premium. Maybe your benefits include prescription drug coverage or vision care. With Medicare, these services are not included but are extra. You do have the option to turn down coverage benefits. But, if you have dependents who rely on you for health coverage, be sure to consider your options carefully. Only applies to companies with 20 or more employees. If you are planning on retiring or leaving employment where it is offered, you should receive a letter notifying you of your rights and offering you the option to elect continuation coverage. Typically, benefits extend for 18, and in some cases, 36 months.
References:
https://www.medicare.gov/supplement-other-insurance/how-medicare-works-with-other-insurance/who-pays-first/cobra-7-facts.html
MUC55-2017-BCBS
Tag: Medicare
While the Affordable Care Act (ACA) was signed into law in 2010, there is still confusion, particularly in the senior community about how the healthcare law impacts Medicare coverage.
Not Replacing Medicare
The new law established a Health Insurance Marketplace (online exchange) where consumers can go to purchase healthcare coverage. Many seniors are concerned that they are now obligated to purchase coverage through the Marketplace. Medicare isnāt part of the Marketplace. If you are enrolled in Medicare or have a Medicare Part C plan, your coverage will stay the same and you will never need to obtain your benefits through exchanges. It is against the law for anyone to knowingly sell you a health insurance plan through the Marketplace if you are currently enrolled in Medicare.
Essential Coverage
The individual mandate as described by the ACA can be confusing. While it is true that some people who are uninsured or underinsuredĀ will be required to pay a penalty, seniors on Medicare do not have to worry. Medicare is considered āessential coverageā and recipients will not be required to add healthcare coverage to an existing plan. Since most seniors are eligible for Medicare coverage at 65, as long as you are enrolled, you will not be responsible for paying a fee under the Affordable Care Act.
Preventive Care
The passage of the Affordable Care Act also means more services for seniors in Illinois, on Medicare, particularly preventive care. Medicare is now required to cover a host of services at no additional cost to you, including immunizations, mammograms, colonoscopies, annual wellness visits, and more ā all without a co-pay.
Prescription Drugs
The coverage gap, also called the ādonut holeā that many seniors experience with prescription drug coverage can make it challenging to afford medication. Provisions of the Affordable Care Act require Medicare to pay more, which reduces costs for seniors entering the gap. The ACA plans to eliminate the donut hole completely by 2020, but until then, seniors enjoy a 55 percent discount on covered brand name prescriptions and a 35 percent discount on generic drugs until out-of-pocket limits have been reached. While prescription drug costs have decreased for most recipients, costs have increased slightly for individuals who earn more than $85,000 and couples earning $170,000 or more.
References:
https://www.medicare.gov/Pubs/pdf/11493.pdf
MUC18-2016-BCBS
Tag: Medicare
Illinois seniors suffering from a debilitating chronic health condition may qualify to enroll in a Medicare-approved Special Needs Plan. These different plans provide additional benefits above and beyond Medicare, offering seniors special healthcare and services.
Special Needs
Treatment of certain chronic health conditions such as cancer or dementia may require additional services above and beyond that which Medicare provides. For many seniors, the extra cost associated with treatment is a burden and Special Needs Plans address these concerns. Most benefits provided are paid in full for recipients who are enrolled in both Medicare and Medicaid. However, for seniors who do not qualify for Medicaid, participating in the plan costs about the same as enrollment in a typical Part C plan.
Eligibility
You must be enrolled in Medicare Part A and B, reside in the planās service area, and meet specific health requirements. Seniors with a disabling chronic condition or who live in a nursing home, require in-home care or currently receive both Medicare and Medicaid benefits may qualify. Plans may not be available in all states as insurance companies providing benefits decide which counties will offer plans.
Qualifying Conditions
You must have one or more of the following conditions:
Alcohol or drug dependence
Hematologic disorder
Autoimmune disorder
HIV/Aids
Cancer
Chronic lung disorder
Cardiovascular disorder
Disabling mental health conditions
Chronic heart failure
Neurologic disorder
Dementia
Stroke
Diabetes
End-stage liver disease
A Special Needs Plan may be the right choice, with an increased network of providers who specialize in treating your condition and providing additional benefits.
References:
https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/special-needs-plans.html
https://www.medicare.gov/Pubs/pdf/11302.pdf
MUC14-2016-BCBS
Tag: Medicare
Seniors over the age of 55 and in need of care may be eligible for the Medicare Pace Program ( Programs of All-inclusive Care for the Elderly) Designed to provide personalized, coordinated care for the disabled in a community setting. The goal is to help Illinois seniors preserve their independence and delay nursing home care as long as possible.
Eligibility
Enrollment in the program is involuntary, but to be eligible to receive benefits, seniors must meet a few conditions. Applicants must be at least 55 years old and certified by the state as requiring a nursing home level of care. Must reside in the service area of the PACE organization and be capable of living safely in the community. Seniors who are eligible for Medicare, Medicaid, or both can enroll. While PACE uses Medicare and Medicaid funds to pay for care and services, the cost of the program depends on each applicantās financial situation. Medicaid recipients may pay nothing at all or a small fee for services. Medicare-only recipients who join pay a monthly premium for long-term care and prescription drugs. In either case, there are no deductibles or coinsurance.Ā
Coverage
Benefits in Illinois include all Medicare and Medicaid-covered services in addition to some services not covered by Medicare. This includes doctor and nursing services through a primary care physician, care while in the hospital (including laboratory and x-ray services), emergency services, physical and occupational therapy, nursing home and home care, prescription drugs, dental, meals, and nutritional counseling, social services, and transportation. Seniors who enroll will receive all of their Medicare benefits through the program. Each applicant is assessed daily on an individual basis by a team of skilled healthcare professionals.
Primary care physician
Activity Coordinator
Nurse
Dietitian
Social Worker
Center supervisor
Physical therapist
Home care liaison
Occupational therapist
Driver
For older adults suffering from a disability or chronic condition, having medical and supportive services available in a community setting offers peace of mind, promoting independence and delaying nursing home care. The mission of PACE is to help well-deserving seniors and their families accomplish this goal by offering comprehensive medical and social services provided by a team of health professionals.
References:
https://www.medicare.gov/your-medicare-costs/help-paying-costs/pace/pace.html
MUC13-2016-SSI/CDIS
