Earlier this month, the Centers for Medicare and Medicaid Services announced a “final rule” to increase care of Medicare recipients with End-Stage Renal Disease. The rule, according to CMS, “will modernize the Medicare conditions for coverage for the nation’s dialysis centers and promote a higher quality of care for patients receiving dialysis”. It is intended to impact over 4700 renal dialysis amenities throughout the country.
The new rule will diminish the some of the redundant, time consuming previous requirements of dialysis facilities and instead focus on improving patient care. The safety and rights of patients, as well as their participation in their health care plans, are all outcomes of the rule.
Each facility will be responsible for creating a QAPI program, or “quality assessment and performance improvement” program in order to assure improvement in patient care. They will all also be required to have defibrillators on hand, upgrade fire safety standards, increase patient infection control procedures, promote safer water for dialysis, and implement minimum qualifications for patient care technicians. In order to protect patient rights, it will be mandatory to inform recipients of their right to have advance directives, to apply a clear and standardized grievance process, to create a personalized patient plan of care, and to give a 30 day written notice before discharging a patient involuntarily. Facilities will need to complete a comprehensive patient assessment for each patient, based both on the patient’s needs and the advances in current medical practices.
Adherence to the new rule will be necessary for dialysis facilities to continue to be certified by Medicare. It will improve the quality of life and the standard of care for over 336,000 Medicare recipients who have End-State Renal Disease.
Medicare is federally run health insurance. It is specifically designed for individuals who are at least 65 years old, as well as people who have End-Stage Renal Disease or who are under 65 with certain disabilities.
Medicare generally has 4 elements: Part A , which represents your hospital insurance, Part B, your medical insurance, Part D, prescription drug coverage plans, and Part C, Medicare Advantage Plans. Part C, of course, can include Parts A, B, and D.
If you’ve been paying into Medicare while working, you are likely eligible to be automatically enrolled in Parts A and B at age 65. In most cases, if you are automatically enrolled in Part A, you don’t need to pay a premium. Part B, however, usually does require a standard, monthly fee.
If you require prescription medication, or think you may in the future, the best time to sign up for Part D is when you are first eligible; three months before to three months after you turn 65. If you wait, you may be required pay a late enrollment penalty. Because there are a number of options in prescription drug plans, consider the available coverage and potential costs of each.
Finally, you’ll need to decide whether you want the Original Medicare Plan or a Medicare Advantage Plan, such as an HMO or PPO. Many Medicare Advantage Plans may charge extra fees but cover a number of additional benefits, such as vision and dental.
By understanding the four parts involved in Medicare, you can ensure you have the coverage you require. Your Medicare plan, through careful, informed decision making, can help you meet your healthcare needs, both now and in the future.
Whether you have the original Medicare plan, a Medicare Advantage plan (like an HMO) or another Medicare health plan, you will, most likely, want to include hospital insurance. Referred to as “Part A”, hospital insurance helps to cover your in-hospital care, as well as any stays in skilled nursing facilities or religious non-medical health care institutions. It also helps to cover home health care and hospice care.
One of the great features about Medicare Part A is that if you paid enough Medicare taxes while working, you aren’t required to pay a monthly premium for part A. If you didn’t pay enough Medicare taxes while working, but are 65 or older – or if you’re disabled and have returned to work – you can still purchase Part A; if you have limited resources, your state may even help you with your premium!
Signing up for hospital insurance isn’t difficult, either. In most cases, in the month you turn 65, you will automatically receive this coverage. Automatic enrollment in Medicare Part A happens at age 65 if you are getting benefits from Social Security or the RRB. You will also be automatically enrolled if you are disabled, 24 months after receiving disability benefits from Social Security or RRB. An exception to these two payment schedules is if you have Lou Gehri’s disease, in which case you will receive Part A the same month you collect your disability benefits.
If you aren’t able to receive Medicare Part A without paying a premium, you will not be automatically enrolled. However, you can purchase it from three months prior to your 65th birthday to three months afterwards, and between January 1 and March 31 of each year. There may be other times you can enroll if you have group health coverage through work.
Having hospital insurance is essential to receiving affordable, quality care. If you have been regularly paying Medicare taxes, you can rest easy knowing you will have the plan in place to allow you to obtain the care you need. If you haven’t, now is the time to look into signing up. Part A may be a vital part of your Medicare coverage.
The Centers for Medicare and Medicaid recently announced a nationwide increase of almost $36 million in order to assist seniors in understanding Medicare. The $35.8 million is only the beginning of a promised $50 million in funding this year and will be given to State Health Insurance Assistance Programs (SHIPs) throughout the country.
The funding is intended to help SHIPs continue to provide Medicare recipients with vital information regarding their insurance plans and to help them make their way through the system. Whether individuals need help understanding their benefits, making informed choices about prescription drug plans, or dealing with specific Medicare difficulties, SHIPs can provide guidance. Seniors who are currently enrolled in Medicare or who are interested in enrolling, as well as their family members or caregivers, are able to utilize the programs.
One of the specific goals of this year’s increase is to assist people in recognizing their eligibility for Medicare’s low-income-subsidy and then helping them apply for it. The subsidy may help recipients pay their monthly premiums and provide them with extra help in affording a Medicare Prescription Drug plan.
The SHIPs will likely be focusing on community-based outreach to individuals who might otherwise be unable to access this type of support. Counselors with the program are usually available in person and via the telephone, as well as through other pubic programs. The increase in funding will help seniors throughout America better understand their health care options and make the most out of their Medicare.
So, you’re familiar with Original Medicare. Perhaps you’ve even researched the Advantage Programs. But did you know that you may have a third option? Medicare offers, in many places, other Medicare health plans worth considering.
Like Original Medicare and Medicare Advantage Plans, the other Medicare health plans will provide you with your hospital and medical insurance, or Part A and Part B. Some also include the option of prescription drug coverage (Part D) or allow you to purchase a Medicare Prescription Drug Plan. The three types of other Medicare health plans include demonstrations or pilot programs, Medicare Cost Plans, and Programs of All-Inclusive Care for the Elderly (PACE).
Demonstration, or pilot, programs are used to test Medicare improvements. These projects are offered to a specific group of people, in specific locations, in order to test improvements in coverage, payment, and care quality. Right now, Medicare is offering a pilot program for people with Medicare who have at least one chronic illness.
Medicare Cost Plans, also available only in specific locations, work much like Medicare Advantage Plans, except that if you need services that are not within the plan’s network, the Original Medicare Plan will pay your Medicare-covered expenses.
PACE, or Programs of All-Inclusive Care for the Elderly, provides long-term care services for elderly people who receive community health care. Available only in some states, PACE serves as an alternative to a nursing home. If you are eligible for nursing home care and are at least 55, PACE can supply you with social, medical, and prescription drug coverage.
Choosing a Medicare plan is an excellent way to prepare for your future. By examining your available options, you will be able to chose the plan that fits your lifestyle. To find out if there are any demonstrations, Cost Plans, or PACE in your area, call your State Medical Assistance Office.
Medicare, the federally run health insurance exclusively for people age 65 or older, as well as people with permanent kidney failure or who are under 65 with certain disabilities, can help provide you with affordable health care both in and out of hospital. It can, if you choose, include medical insurance, hospital insurance, prescription drug coverage and, in some cases, other services such as dental and vision. The coverage you receive all depends on the choices you make when selecting your plan.
There are primarily three categories of health plans for you to consider when choosing your Medicare: Original Medicare plans, Medicare Advantage plans, and other Medicare plans. Within each category, you can select various options to further help you to customize your coverage.
In the Original Medicare Plan, you are able to receive hospital insurance and medical insurance, as well as join a prescription drug plan. You can also buy a Medical Supplement Insurance, or Megagap, policy, in order to cover some of the areas your hospital and medical insurance may miss. You will automatically be enrolled in the Original Medicare Plan, receiving hospital and medical insurance, if you receive benefits from Social Security or the RRB. You can then choose to purchase the additional coverage. While you will likely need to pay a premium for your medical insurance, a premium for the hospital insurance is not usually necessary.
In Medicare Advantage Plans, such as HMOs, you can select a privately run (Medicare approved) health plan. Like the Original Medicare Plan, these health plans cover hospital and medical insurance and provide the option of prescription drug coverage. They also offer additional coverage for services like vision and dental. They can, however, charge copayments, coinsurance, and deductibles for all parts of your coverage. Moreover, they may limit the doctors and hospitals available to you in your plan.
Other Medicare health plans are available in specific areas of the country and work in a way comparable to Medicare Advantage Plans. They include Medicare Cost Plans, demonstrations and pilot programs, and PACE. Each type of plan has a specific set of rules and, in some cases, certain stipulations for joining, so if you think you might be interested in one of these other Medicare health plans, you should contact the ones you are considering to find out more, or visit www.medicare.gov.
Over 20% of Medicare patients are enrolled in Medicare Advantage Plans, confirming that these privately run companies do, indeed, offer a viable alternative to the original Medicare Plan.
All Medicare Advantage Plans, approved by Medicare and often referred to as “Part C”, must include hospital and medical insurance, and are required to cover the same medically necessary services as Original Medicare. There are, however, some fundamental differences which set them apart.
Medicare Advantage plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for Services (PFFSs), Medical Savings Accounts (MSAs), and Special Needs Plans (SNPs). One of the key differences between an Original Medicare Plan and one of these Advantage Plans is that an Advantage Plan usually limits your choice of doctors and hospitals, requiring you to choose one from their provider network, while Original Medicare allows you to go to any doctor or hospital that accepts Medicare. If you do go to a doctor who is not on a provider network, you may be responsible for covering the cost of care. Some plans, for a higher fee, allow you to select a doctor who is not an approved provider or use an outside doctor who will agree to their terms of payment before treating you.
Medicare Advantage Plans also often provide extra benefits not traditionally covered by Original Medicare, like preventive, vision, hearing, dental and, in many cases, prescription drug coverage. The added coverage offered by a Medicare Advantage Plan can be a vital help for people requiring these services.
When choosing a plan, consider the cost, benefits, and convenience of each. Visit www.medicare.gov or call 1-800-663-4227 for help. By weighing your choices carefully, you can choose the plan that’s best for you.
Sometimes, the more important the choice we need to make, the greater our indecision, especially when it comes to our health care. Between Original Medicare, various Advantage Plans, or other Medicare health plans, it can sometimes seem difficult to know where to begin when choosing your plan. By focusing on a few key areas, however, you can compare your options to your medical needs and make a confident, self-assured decision.
The first thing you may want to think about is what, specifically, your coverage needs are. If you use prescription medication on a fairly regular basis, or think you may in the future, make sure you sign up for a Medicare drug plan – or that your plan includes drug coverage. If you have additional needs, like dental or vision, you may want to choose a plan that offers extra benefits.
Next, you will want to look at your choices in health providers. Because most Advantage Plans require you to use certain doctors and hospitals only, it is important to find out if your doctor is on an Advantage provider network or not. You will also want to consider how important choices in hospitals and doctors are and how convenient you need your care. It’s a good idea to look at network care provider’s hours and locations and whether or not you are confident of the quality of care offered at these sites.
Finally, consider the costs. Premiums, coinsurance, copayments, and deductibles all make a difference in your expenses. Find out how much you will be required to pay in each plan, where there may be extra fees involved, and how you can best afford care that meets your medical needs.
By considering coverage, providers, and costs, you can reflect on your needs and successfully compare plans. Most importantly, you will be able to select a plan that offers you sense of security and peace of mind.
You may already know that Medicare is a health insurance program that is federally funded for the senior citizen above the age of 65. There may be certain individuals who might meet the specific requirements that are needed to qualify for the coverage even if they are less than 65 years, they may be suffering from permanent kidney failure, Lou Gehrig’s disease or maybe receiving Social Security benefit once for at least within 24 months. Medicare is divided into two parts, part A and part B; we will familiarize you with the Medicare part B.
Medicare Part B is a coverage that takes care of several outpatient services. It is a voluntary service for the individual receiving Medicare. This may include the expenses such as, outpatient hospital visits, doctor visits, medical equipment, mental health services and other diagnostic tests. The amount that you have to pay for the Medicare part B totally depends up on your income. The costs for these services are basically deducted from an individuals Social Security check every month prior to its arrival in your mailbox.
Medicare Part B pays for certain medical equipments such as oxygen tanks, wheelchairs, walkers, neck, leg, scooters, electric wheelchairs, arm and back braces, eye glasses and more. You might get confused at times, since the Medicare Part B does not cover the expenses that may not be related to medically equipment such air humidifier and safety bars. With the Medicare Part B, you will see that some of the medical equipment will be brought while there are some items that will have to be rented.
You can also receive certain coverage for preventive procedures by the Medicare Part B. the very first thing that you will receive is a physical within six months after its allotment. You will receive triglycerides and cholesterol testing once in two years. Individual who are deemed to be at high diabetic risk are also covered by Medicare Part B. The annual mammograms such as PAP, pelvic examinations are also covered every two years. Certain screening of colon cancer is also covered by it.
Medicare Part B is an affordable service that can be purchased by any individual who require them, who receive Medicare or Social Security benefits. It will cover most of your medical expenses for outpatient doctor visits, preventative screenings and medical equipment items.
If you do not get the Medicare Part B services, your medical weakmess may take a toll on your financial condition since they can be quite expensive. It is also important to enroll in Medicare Part B right away when you enroll for Medicare A because if you add it later, it can cost considerably more.
It’s surprising how many people who have Medicare decide not to sign up for the prescription drug coverage available to them when first eligible, making it necessary to, when they later change their minds, pay penalties for late enrollment.
Under normal circumstances, you can only join a Medicare drug plan during specific time frames. The logical time to sign up, even when it seems you may not need it, is when you first become eligible for Medicare; three months prior to turning 65 and three months immediately after. Personal health situations and thought processes change so quickly that planning ahead simply makes the most sense!
You can also apply for coverage between November 15th and December 31st each year, your coverage then beginning on January 1st. If you are receiving Medicare because of a disability, you can sign up for drug coverage three months before to three months after your 25th month of cash disability payments. Some situations, however, allow you to join a prescription drug program at other times, like if you qualify for extra help, move out of your service area, or live in an institution.
Of course, not all plans cover all medications. It’s essential that, if you do decide to sign up for coverage with Medicare, you research the various plans in order to select the one that best meets your needs.
Changes in Medicare policy this year will effectively save the system money and protect patients while in hospital, according to Ellen Griffith, the Centers for Medicare and Medicaid Services public affairs specialist.
Beginning October 1st, 2008, any of eight preventable conditions occurring in-hospital will no longer be the responsibility of Medicare. In the past, Medicare would pay for the initial diagnosis as well as any further diagnosis, even when resulting from accidents which happened while the patient was in the care of the hospital. Now, because Medicare will no longer be covering the cost of these second diagnoses, and the hospitals cannot charge Medicare patients for this procedure not covered by Medicare, the resulting expenses will consequently fall on the hospital itself. These changes, supported both my Medicare and by a number of hospitals, should save Medicare $20 million dollars during the first year while encouraging hospitals to take further steps in preventing hospital injuries.
The accidents no longer covered include three types of infections; vascular catheter-associated infection, which results from installing a catheter in conditions which are not sterile, catheter-associated urinary tract infections, and surgical site infections, also resulting from less sterile circumstances. The other accidents which will now be the responsibility of the hospital are objects left inside patients after surgery, pressure ulcers or bedsores, blood incompatibilities, air bubbles blocking arteries or veins, and falls.
What this means for you is that if you require in hospital care after October 1 and are injured in a way which could have been prevented, neither you nor Medicare will need to worry about the costs.
Many hospitals, however, have already been using careful monitoring and specific procedures created to prevent hospital related accidents. As a result, a number of hospitals report success in drastically reducing these hospital errors and further protecting the care of their patients.
If you are currently enrolled in a Medicare prescription drug program, or are planning to enroll, you will be pleased to hear that Medicare has been working on improving their standards when it comes to Part D e-prescribing. New regulations, issued on April 2, 2008 and coming into effect April 1, 2009, are designed to promote clearer communication between your pharmacist, your doctor, and your prescription drug plan sponsor, to save money by offering generic drug alternatives, and to limit your chances of having an adverse reaction to the drug or drugs you are prescribed.
The way the new standards work is by creating four categories of information – or four standards – which will be used consistently in e-prescribing. These categories will work together to protect you.
“Formulary and Benefits”: This first standard will be used to deal with the coverage you are receiving in your chosen Medicare prescription plan. It will let doctors take into account which drugs are covered in your drug plan and look into the possibility of other generic prescription drugs that may be less costly to you.
“Medication History”: The second standard will have doctors, pharmacists, and other health care providers sharing information about the medication you have been, or are currently, taking. By sharing this information, your health care professionals will be able to greatly reduce the chance that you’ll have an adverse reaction to the medication, which might otherwise result from that drug’s reaction with another medication.
“Fill Status Notifications”: In the third standard, doctors or other health care providers will be notified electronically when you pick up your prescription. This also serves to protect you, since it allows your doctor to know if you have been taking your medication and further helps him/her care for your medical needs.
“Provider Identifier”: Finally, the last standard will increase the programs efficiency by requiring providers to use the National Provider Identifier – or NPI – for health care providers in any e-prescribing dealings. What this does is make obsolete the need for pharmacies and medical offices to personally verify the authenticity of prescribers.
With these new standards in place next April, you should notice an increased efficiency and level of safety in e-prescribing. Some changes, we see, are definitely good.
If you have Medicare Hospital Insurance and/or Medicare Medical Insurance, signing up for an additional Medicare prescription drug plan is always a good idea, especially if you spend a great deal of money each year on medication. These drug plans, offered to you through private companies working with Medicare, have different costs and diverse types of coverage. Consequently, finding the right plan can seem daunting when you’re faced with the many options available to you.
A good place to start when choosing a prescription drug plan is by figuring out what type of medication you most frequently purchase. In many plans, medications are organized into “tiers” of various costs. The type of drugs for which you need coverage will affect the tier, or category you fall into, impacting the cost to you. Some plans have more tiers than others. You will also want to make sure the drugs you use most are, indeed, on the plan’s coverage list.
Weigh the overall cost of the plans, considering the medications you will most need covered. Some plans will require a deductible and/or a monthly premium, and some won’t. Additionally, you want to make sure the plans you consider allow you to use pharmacies you are comfortable with. Some will limit accepted pharmacies.
Fortunately, if you’re feeling overwhelmed, there are a number of resources available to you. Online, you can find help at www.medicare.gov. You can also call 1-800-633-4227. Finally, you can call your State Health Insurance Assistance Program.
Whatever you do, don’t let uncertainty about drug plans deter you from choosing the right one for you! Once you find a Medicare prescription drug plan that best suits your needs and are able, then, to better afford the medication you need, you will be on your way to a healthier, happier you.