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Medicare PACE a New Program for U.S. Seniors Needing Medical Care

Good news for seniors who wish to stay in their home and community instead of going to a senior care facility. A new program offered by Medicare — Medicare PACE — will allow seniors to receive health care from the comfort of their homes and communities. This program is not available in all states.

Medicare PACE stands for Program of All-Inclusive Care for the Elderly. Currently roughly 40,000 seniors participate in Medicare PACE and receive in-home care. The program is optional but is turning out to be a really good support for elderly Americans in need of social services and more inclusive, personal, in-depth medical care.

The Medicare PACE program is designed to allow seniors to continue to live at home and in their communities instead of senior facilities. Seniors may qualify be eligible for the PACE program if they are in need of nursing home-level care, are able to live safely in the community, are 55 or older and are living in a PACE service area.

Those participating in the program have a medical team dedicated to them and their health care needs. Each team features a primary care doctor, occupational therapist, recreational therapist, nurse, social worker, physical therapist, activity coordinator, home care liaison, dietician and various other medical professionals.

With a team working with you, you get personalized, one-to-one care. You may need use a PACE-preferred doctor, but that is to your advantage as the physicians are trained in a multi-disciplinary approach to senior care. There is no deductible/co-payment for medications, services or care approved by your health care team. It is covered under the program for eligible beneficiaries.

What does PACE cover? Currently, it covers a wide variety of services that may change over time or be added to as it grows. The services covered include:

  • Physical therapy
  • Occupational/recreational therapy
  • Laboratory
  • X-ray services
  • Home/Hospital care
  • Emergency services
  • Meals
  • Medical specialty services
  • Nursing home care
  • Adult day primary care
  • Mental health services
  • Dentistry
  • Prescription drugs (partially covered under program)

It is important to note that you may choose to get your medications through the PACE program and can still enroll in Medicare Part D. However, if you do enroll in a prescription drug plan, you are disenrolled from PACE.

What do you pay for PACE? If you have or qualify for Medicaid, you do not pay the premium for long-term care. However, if you do not qualify for Medicaid but have Medicare, you do pay the monthly premium and a premium for prescription drug coverage.

Posted on Friday, November 30th, 2018. Filed under Medicare.

More and Better Medicare Advantage Plans on the Horizon

Recently Washington, D.C. hinted that changes to Medicare are coming. Medicare is the federal health program for people 65 and older.

Medicare Advantage plans are becoming made available through private health insurers and include Medicare Part A, for hospital/catastrophic care, and Part B, doctor visits/routine medical care. They can address dental and vision insurance and prescription drug coverage. Currently, one in three Medicare beneficiaries out of a total of 19 million seniors has a Medicare Advantage plan. Between 2016 and 2017 enrollment in Medicare increased by approximately 1.4 million people.

The Chronic Care Act, one of the most welcome new acts affecting medical care for seniors, will boosts Medicare Advantage plans by adding more benefit flexibility for non-medical coverage — meaning items such as wheelchair ramps or grab bars for the bathroom. The act also makes more telehealth services available for seniors with Medicare Advantage.

Following the footsteps of the Chronic Care Act, the Centers for Medicare and Medicaid Services (CMS) announced the expansion of the definition of “health-related” supplemental benefits in Medicare Advantage to include compensation for physical impairments, reduce avoidable ER visits and reduce the impact of health conditions or injuries. That means the supplemental benefits in Medicare Advantage would include “additional service that increase health and improve quality of life.”

This is exciting news as it means Medicare Advantage would be able to offer services such as aides to help with daily living activities; home modifications; and home delivered, medically appropriate meals that are currently limited to a small number of conditions. Aging at home is something that a great number of seniors would prefer as opposed to living in a nursing home facility. Aging at home also means lower costs for Medicare and Medicaid. Medicare Advantage plans have 77 percent enrollment in the 65 to 84 age group compared to 71 percent for original Medicare.

Currently, Congress and the Trump administration support Medicare Advantage. With such support it appears that healthcare for seniors is not going anywhere.

According to a Congressional Budget Office study, 41 percent of Medicare enrollees are expected to choose Medicare Advantage by 2027 — a figure that looks like it may keep growing.

Posted on Tuesday, November 27th, 2018. Filed under Medicare.

There may be a late enrolment penalty for Medicare. How much is it?

If you do not enroll in certain Medicare programs/plans when you are first eligible during the Medicare Initial Enrolment Period (IEP), you could increase your premiums. There are late-enrollment penalties for Medicare Part A, Part B and Part D plans.

The IEP begins three months before you turn 65 and lasts seven months in total.

The vast majority of Medicare beneficiaries automatically receive Part A premium-free provided they have worked for at least ten years and have paid Medicare taxes. If you already get Railroad Retirement benefits or Social Security, you are auto-enrolled in Medicare Part A.

Not qualified? Then you are not enrolled and may end up paying a 10 percent higher monthly premium if you do not enroll during the IEP period. You would also be paying this increased premium for twice the number of years that you could have had Part A but were not enrolled. As an example, the Part A premium can be as high as $422, without the penalty, in 2018.

Part B may also come with a late enrolment penalty if you do not enroll when you are first eligible. That may send your monthly premium up 10 percent for each year you were without Part B after your IEP closed. This penalty may be with you for the remainder of the time you are enrolled in Medicare.

Part D may have a penalty as well if you go 63 or more consecutive days without a creditable drug plan after you IEP closes.

It is definitely confusing trying to keep track of all the ins and outs and if you need more information before you make Medicare choices, contact a knowledgeable health insurance agent. They are your best friends when it comes to helping you choose what you need and what suits your lifestyle.

Posted on Friday, November 23rd, 2018. Filed under Medicare.

Is it possible to have Medicare and Medicaid?

You may find yourself wondering if you qualify for both the Medicare and Medicaid programs. If you are a senior with medical needs and are living on a small income, you may qualify.

Qualifying for both Medicare and Medicaid is called dual eligibility. Those that are eligible for both programs are usually low-income adults over the age of 65, or a low-income individual with a disability. This dual eligibility can be quite confusing and for that reason, the Centers for Medicare & Medicaid Services (CMS) try to ensure that each program works with the other efficiently and effectively.

CMS offers an extensive collection of resources for those searching for information on how to co-ordinate their benefits. You can find that collection here.

If you still have more questions about your eligibility contact an insurance agent. They are trained in helping individuals like you.

Posted on Wednesday, November 21st, 2018. Filed under Medicare.

What is Medicaid?

Medicaid is not to be confused with Medicare, although the two often get mixed up. Medicaid is funded by federal and state governments, helps low-income individuals and families and is really an assistance program. Also, it is for all individuals of all ages.

Each state has different qualifications for Medicaid eligibility, but one thing is constant, income levels do determine eligibility. For seniors to be eligible for Medicaid, they must pass an income, medical necessity and asset test. Should they qualify, they find that Medicaid may actually offer some benefits that Medicare does not, such as routine hearing, dental and vision care, and prescription drug coverage. There are no extra supplement plans needed if you quality for Medicaid.

If at any time you are not certain which program is for you ask a qualified insurance agent, check with the Medicaid and Medicare government websites if you are computer savvy and ask your friends. The more information you have, the better informed your health insurance choices.

Posted on Friday, November 16th, 2018. Filed under Health Insurance.

Many confuse the two government health care plans – Medicare and Medicaid

Right now it is more important than ever to understand the differences between Medicare and Medicaid. Under the new administration, things are changing so rapidly, it is hard to keep track. It may be necessary for you speak to an insurance agent to understand what are the changes may affect you.

Medicare is a federal program for all seniors 65 years of age or over. Medicaid is jointly funded at federal and state levels and is usually intended to serve lower income individuals and families.

To find out what program is right for you, you will need to speak to a highly trained health insurance agent who knows the industry, as well as their products. An insurance agent can help you choose what best suits your needs. While it is confusing, with the help of a qualified insurance agent, the choices are much easier to understand.

Posted on Tuesday, November 13th, 2018. Filed under Medicare.