Medicare

Medicare is a federal health insurance program generally for people age 65 or older who are receiving Social Security retirement benefits or who are younger than 65 and received Social Security disability benefits for at least 24 months.

Medicare covers inpatient hospital care and some of the doctors’ fees and other medical items for people with Alzheimer’s or dementia who are age 65 or older. Medicare Part D also covers many prescription drugs.

Medicare will pay for up to 100 days of skilled nursing home care under limited circumstances. However, custodial long-term nursing home care is not covered.

Medicare will pay for hospice care delivered in the home, a nursing facility or an inpatient hospice facility for people with dementia who are determined by a doctor to be near the end of life.

For more information on benefits and eligibility go to Medicare’s website: medicare.gov

Reminder: Medicare covers an Annual Wellness Visit and Health Risk Assessment

Medicare pays for an Annual Wellness Visit once every 12 months. Prior to or during an annual wellness visit appointment, a Medicare beneficiary (or caregiver) will be asked by his or her doctor or health professional to complete a Health Risk Assessment (HRA).  The HRA includes some questions about the beneficiary’s health which may provide important information to discuss with the health professional during the annual wellness visit.

Making Sense of Medicare: 

What you need to know about your health-care choices
Medicare can be confusing…but it doesn’t have to be! The National Council on Aging and UnitedHealthcare are partnering to help beneficiaries understand Medicare and how to find coverage that’s right for them. 

The A-B-C-Ds of Medicare 

Part A: Hospital/Inpatient Insurance
Part A helps pay for your care while you are in the hospital. It also pays some of the costs if you stay in a skilled nursing facility after a hospitalization and if you have a medical need for limited, skilled health care at home. You can’t be turned down because of your medical history or pre-existing illness.

Part B: Outpatient Health Insurance
Part B helps pay for doctors’ services, outpatient hospital care, and home health care that Part A does not pay for. It also provides coverage for laboratory tests, ambulance services, and many screenings and preventive services that can help you to stay healthy, including a Welcome to Medicare Exam and Annual Wellness Visits. A monthly premium is charged for Part B services.

Part C: Medicare Advantage (MA)
Medicare Advantage plans (sometimes called Part C) are private insurance plans that deliver Medicare Part A and Part B coverage. Some of these plans also provide Medicare drug coverage. Medicare Advantage plans also may cover additional services that Original Medicare does not pay for—for example, coverage for vision and hearing care. Most Medicare Advantage plans have a network of doctors and hospitals.

Part D: Prescription Drug Coverage
Medicare Part D helps you pay for your prescription drugs. If you have or are eligible for Medicare Part A or Part B or have both, you are eligible to join a Part D plan. You must join a private insurance plan to get Medicare’s drug coverage. There is no screening for pre-existing conditions. Plans must accept everyone who is eligible and enrolls, but you can only join at certain times of the year. Most people can join or change Part D plans during the Annual Election Period from October 15th through December 7th, with coverage starting on January 1, 2012.

 

 The Prescription Drug Coverage Gap or “Donut Hole” 

If your total drug costs (what you and the plan pay for your prescriptions on your plan’s drug list) are greater than $2,840 in 2011, you will probably hit the coverage gap, sometimes called the donut hole. Starting this year (2011), while you are in the coverage gap, you will get discounts on certain drugs your plan covers—50% discounts on brand name prescriptions and 7% discounts on generics. The coverage gap will completely close in 2020.

Five Key Facts about Health Reform and Medicare
The Affordable Care Act—also called the health care reform law—made several changes that affect your Medicare coverage, but some things are staying the same. It’s important to understand the facts so you can make informed decisions about your health care coverage. 

1. Health reform did not cut basic Medicare benefits. Rather, it expanded some benefits. The guaranteed benefits you get from Medicare will not change. Now your Medicare coverage includes a free annual wellness visit and prevention plan with no cost-sharing. Most preventive benefits are free.

2. The Affordable Care Act includes measures designed to improve the quality of care, especially for people with chronic conditions. New pilot projects and demonstrations are helping to better coordinate care among doctors, specialists, and other providers in some parts of the country. There’s also help for you to be better able to manage your own care.

3. The law helps people to find and pay for long-term care at home. Health reform established a voluntary, public long-term care insurance program for full- and part-time workers (called CLASS). The law also supports efforts to reduce unneeded hospital readmissions, and help so you can manage your own care.

4. Medicare Advantage plans are not going away. Medicare Advantage plans will continue to be available for most beneficiaries, and most are expected to continue to offer more benefits and services than Original Medicare alone. Members enrolled in Medicare Advantage plans have access to the same preventive care benefits as beneficiaries enrolled in Original Medicare, including screenings and yearly wellness visits.

5. The Annual Election Period dates are changing. This year, beneficiaries can choose a new Part D or Medicare Advantage plan from October 15th to December 7th. This is earlier than previous years, so it’s important to get prepared now so you’re ready to make smart decisions this fall.

What You Can Do
Learn more about the Making Sense of Medicare initiative at
www.ncoa.org/Medicare.

Visit MedicareMadeClear.com to find easy-to-understand information about the Medicare program, including a resource section featuring videos, frequently asked questions and a glossary of Medicare terms.

Shop around to find a plan that meets your needs. Take advantage of resources to help you sort through the options. Check out the Decision Roadmap on MedicareMadeClear.com/Making-Choices to see a step-by-step list of things to consider when evaluating Medicare plans. Follow the 7 Simple Steps at www.MyMedicareMatters.org to select a prescription plan that’s right for you.

Learn if you are eligible to receive help with your health and prescription costs through the Medicare Savings Programs, Extra Help for Prescription Drugs and/or other programs. Use the free online screening tool at www.benefitscheckup.org or call the Eldercare Locator at 1-800-677-1116.

 

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