Medicare Eligibility

Long-Term Care is NOT Covered by Medicare in All Situations

Long-term care is important in your life when it comes to being elderly or sick and this makes having the right insurance coverage vitally important.  The problem with this is that Medicare doesn’t necessarily cover this type of care when you might really need it.  Here is the definition by Medicare of what type of long-term care is covered and what type is not. Read more…

Stopping Medicare Supplier Fraud: Doctor Requirements are a Red Flag

Any insurance company in any field of insurance should know better than to require you to see anyone to fix whatever your need for insurance is. Car insurance companies cannot require that you go to one particular body shop and health insurance companies cannot require you to go to any one particular doctor. This is another form of Medicare supplier fraud that is becoming an issue, when suppliers are requiring participants to see specific doctors before receiving any further materials. Read more…

Medicare Long Term Care Options for 2012

A few options are available for long term care and how to pay for it in Medicare for 2012. You would have total control over how to pay for your long term care if you used your savings, but that is a risky chance to take. You could go through a local or community group to have long term care covered or you could purchase coverage outside of Medicare. Read more…

Medicare and Therapeutic Shoes or Inserts for Diabetes

Diabetes can wreck havoc on a person’s body and one of the places where this is most apparent is when you look at the feet of a diabetic.  If this person has diabetic foot disease you will notice that great help and support is needed for the feet of the patient.  Medicare can help in the way of diabetic foot wear and inserts to protect the feet. Read more…

Medicare and Cancer Screening

Everyone has encountered someone in their lives that is struggling with or has passed away due to cancer. The widespread nature of the condition has made it to where people are aware of the need for research to cure cancer. Preventative screening is always a good idea regardless of whether or not the doctors have found a cure yet. Read more…

Is a Hospital Comparison Necessary with Medicare?

Having Medicare shouldn’t be different than any other insurance coverage when it comes to the hospital, your nervous energy won’t change. The vague nature of what is and is not covered can be confusing and frustrating when you are trying to get treatment. The type of care provided by the hospital is what you should concern yourself with when making a decision. Read more…

Do you need a prescription to get a supply on Medicare?

Medicare is not unlike any other health insurance plan when it comes to getting things approved for your use every day. Protecting the public from fraud and unnecessary payments there is a process that has to be followed. One such thing that can be referenced is the need for certain items that could make your life better or more enjoyable. Read more…

Prostate Cancer Screenings for Medicare Patients

Prostate Cancer for men is the breast cancer that women deal with on the scale of how it affects the population as a whole.  Men generally don’t like to have the procedure done because it is invasive and this doesn’t help to convince men, who generally don’t like medical procedures, to keep up with the screenings.  If you are trying to prevent any issues from popping up with your health it is definitely recommended, however, that you have this screening. Read more…

HIV Screening and Medicare

Few things have captured the attention of the world over the last 30 years like the onset of HIV and AIDS across the world.  Because of all of the attention there are a lot of rumors and disinformation that spread about what causes AIDS and how the spread of the condition occurs.  While there is much out there that you can ignore about AIDS and HIV, there are many reasons to pay attention if it could happen to you. Read more…

Skilled Nursing Care and Your Medicare Benefits

There are times in a person’s life when survival or just good quality of life depends on the expertise of medical professionals.  When you are in this case and have Medicare coverage it is possible that your care will be completely covered.  You must still qualify for home health benefits by meeting the four standards of home health coverage, but once you do the following skilled nursing benefits will apply.
Medicare’s website states the following about skilled nursing services allowed covered by policies: “…Skilled nursing care on a part-time or intermittent basis. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse)…”  This is a relatively liberal interpretation of the coverage, which is a good thing for you, the policy holder.
What you must do now is find someone that qualifies to provide this service and will do work through Medicare policies.  If your doctor is the one that is recommending that the services be done he or she will likely be able to recommend someone to you that can care for you.  If not, contact your local Medicare or Social Security office and ask for a referral to a skilled nursing professional that performs this work in the area.

Medicare Part A: Hospice Benefits

As an individual’s condition deteriorates it is often the view of the family involved that the person should be taken care of in the home with the help of Hospice.  These well-trained individuals can care for your loved ones in their final days with great dignity and respect, however, it can be costly.  This is why Medicare Part A offers a Hospice benefit to those that may be terminally ill.  Below is how to qualify for Hospice benefits under Medicare Part A:

If you are eligible for Medicare Part A, which is the “hospital insurance” portion of Medicare, you have started on the right track.  The next thing that must happen is that your doctor and hospice medical director must certify that you are terminally ill and likely have less than six months to live.  This gives the clear direction that your well-being will be in the hands of hospice from this point on.

You must then sign a statement stating that you choose hospice care instead of routine Medicare covered benefits for your terminal illness.  Your Medicare Part A plan will pay for hospice providers that are approved by Medicare, but Medicare will still pay for health problems not related to your terminal illness.  Medicare Part A can take care of your loved one with the help of hospice related care.

BIO and American Academy of Physician Assistants Applaud SCHIP Renewal

Both the Biotechnology Industry Organization and American Academy of Physician Assistants are happy with the passage of SCHIP. Both Congress and President Obama have been applauded. BIO has applauded the passage of SCHIP because it supports universal healthcare. It is very essential for everyone to be insured. BIO and its associates look at expanding the fringes of available health care – bringing to life innovative therapies which patients can benefit from.

The opportunity to work with policy makers is welcomed by BIO so that access to innovative health therapies are made available. In addition the American Academy of Physician Assistants which represents almost seventy five thousand physician assistants in the US has applauded President Obama and Congress as well.
Read more…

Medicare Part D Issues

An additional 511 million dollars per year of taxpayer money is being spent which is not necessary. This is due to certain regulations that require Medicare Part D prescription drug plans to include all drugs of certain classes. This cost could increase substantially due to a new law that is in the works. This law entails an expansion of the number of drug classes.

Even though the intentions are good costs may rise substantially in the future. According to Cahill, this change is not necessary. Patients are already set in a manner that they may obtain required medications. According to the present regulatory guidance, there are six classes of protected drugs – antipsychotics, antidepressants, immunosuppressants, anticonvulsants, antiretrovirals and antineoplastics.
Read more…

Medicaid Pilot Program Expansion Recommended By Florida Agency

Last week a proposal was sent to Governor Charlie Crist by the Florida Agency for Health Care Administration. The proposal recommended and expansion of the Medicare Managed Care Pilot Program to 20 more counties. This pilot program is currently operational in 5 counties. It requires that beneficiaries sign up for managed care plans. The plans are mostly HMO’s that offer some additional benefits but can also be limited by choice.

Part of the request is an increase in Medicaid payment to specialist. This is likely to increase access to beneficiaries. At the same time as the proposal, there is also a  request from Governor Crist that staff be reduced by ten percent. The agency has agreed to comply with this proposal.
Read more…

APA Fights On

On the latest in the medical world, Nada Stotland, MD, MPH and President APA said that the American Psychiatric Association will continue its struggle for legislation to stop the unfairness of the system which discriminates against Medicare patients who are in genuine need of mental health care.

 This comment was made by Dr. Stotland after the chance to debate on the Bill was lost on Thursday as they were six votes shorter than the necessary requirement of sixty votes.

Read more…

Missed Your Optimal Enrollment Period for Medicare Part B? When to Sign Up

If you are eligible for automatic enrollment in Medicare Part A, you will start getting it the first day of the month you turn 65, or, if you are disabled and under 65, after you have been receiving disability benefits from Social Security or Railroad Retirement Board for 24 months. If you are not eligible for automatic enrollment, you should sign up when you’re close to 65.  However, if you miss your initial enrollment period, there are some other times when you may be able to enroll.

Starting January 1st and running until March 31st each year, the General Enrollment Period is the next best thing.  When you sign up during the General Enrollment Period, your coverage will start on July 1st. The drawback for waiting until the General Enrollment Period, of course, is that you may be responsible for paying a late-enrollment penalty.  Unfortunately, you might need to pay the late-enrollment penalty for as long as you have the plan. 

Another time you might be able to enroll is during a Special Enrollment Period.  You may be eligible for a Special Enrollment Period if your or your spouse have a group health plan based on your current work.  You can then sign up for Part B at any point during your workplace coverage or in the eight-month period that starts when the employment (or group health plan coverage) ends.  Finally, if you didn’t enroll in Medicare Part B during your initial enrollment period because you were volunteering in a foreign country and already had health insurance for that reason, you may qualify for a Special Enrollment Period For International Volunteers.  Usually, when you are enrolling during a Special Enrollment Period, you won’t need to worry about a late-enrollment penalty.

While there are, then, ways for you to enroll in Medicare Part B outside of your initial enrollment period, the optimal time is, of course, when you are first eligible.

Eligibility and Enrollment in Medicare for End-Stage Renal Disease

Most people know that Medicare is health insurance designed for people 65 and over, or under 65 with certain disabilities.  What a number of people don’t realize is that Medicare also covers individuals at any age who have End-Stage Renal disease, or ESRD (permanent kidney failure requiring dialysis or a kidney transplant).

In order to receive Medicare coverage for ESRD, if you need regular dialysis or have had a kidney transplant, you must be enrolled in Medicare Parts A and B.  To be eligible to receive Medicare Part A, you or your spouse (or your parent, if you are a dependent child) need to have worked the required time under Social Security, the Railroad Retirement Board, or as a government employee, or you need to be getting or eligible for Social Security, Office of Personnel Management, or Railroad Retirement benefits. You are eligible for Part B if you get Part A.    

To enroll in Medicare due to ESRD, visit your local Social Security office or call them at 1-800-772-1213.  Remember, you must sign up for Medicare Parts A and B in order to receive ESRD coverage.  It’s a good idea to apply for Part B at the same time as Part A to avoid any late penalties. 

Low-Income Subsidy Designed to Help Qualifying Seniors Pay for Prescription Drugs

If you qualify for Medicare and have limited resources, you may also qualify for the low-income subsidy available to people who need extra help. This subsidy is intended to help individuals pay for their Medicare drug plan’s monthly premium, yearly deductible, and coinsurance/copayments.  It can also limit any coverage gaps.

 To qualify for extra help, you need to have limited income and limited resources available to you.   This year, you might qualify if you alone make below $15,315 and have resources under $11,710.  If you are married and living with your spouse (with no other dependents), you must make below $20,353 per year and have resources under $23,410. 

A number of people automatically qualify for this extra help. For instance, if you have full Medicaid benefits, are receiving help from your State Medicaid program, or are receiving SSI without Medicaid, you will most likely automatically qualify for the low-income subsidy.  If you do, you will receive a letter from Medicare to inform you of your status.  After qualifying, you need to choose a Medicare drug plan in order to reap the benefits of your extra help. Research your available plans and select one that covers the medication you require.  If you don’t select a plan, Medicare will select one for you.

Even if you don’t automatically qualify for extra help, you may be able qualify by applying.  To apply, contact Social Security at 1-800-772-1213 or visit them online at