All Medicare Advantage (MA) plans must provide at least the same level of coverage for home health care as does Original Medicare, so Medicare Advantage pays for home health care. However, an MA plan may have different rules, costs, and restrictions on services. For example, depending on a person’s MA plan, it may require him to:
- Obtain care from a home health agency that has contracted with the plan.
- Receive prior authorization or a referral before receiving home health care.
- Pay a copayment for home health care.
Center for Medicare & Medicaid Services (CMS) recently announced that Medicare Advantage plan will be able to cover certain types of home health care related services that were not previously able to be offered, beginning in 2019. This will be possible because CMS has expanded the definitional scope of “supplemental benefits” that Medicare Advantage plans can offer. Starting in 2019, insurers can offer additional services to help improve enrollees’ health and quality of life.
Medicare Advantage Can Pay for Home Health Care Supplemental Benefits
Medicare Advantage plans may offer additions benefits not offered by Original Medicare. Previously, CMS did not allow any item or service to qualify as a supplemental benefit. Supplemental benefits were items of “daily maintenance.” In other words, MA plans could not offer items and services that were not directly for medical treatments. The agency has now reinterpreted the requirement for supplemental benefits to include a “primarily health-related” definition as follows:
an item or service that is used to diagnose, prevent, or treat an illness or injury, compensate for physical impairments, act to ameliorate the functional/psychological impact of injuries or health conditions, or reduce avoidable emergency and healthcare utilization
Accordingly, this reinterpretation of supplemental benefits will allow Medicare health plans to offer coverage or benefits for the following:
- Adult daycare services are services provided outside the home, such as assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs)
- In-home support services are services a personal care attendant provides. She assists disabled or medically needy individuals with activities of daily living, such as eating, bathing, and transferring, and instrumental activities of daily living. These activities may include managing money, preparing meals, and cleaning a house. Services must be performed by individuals licensed to provide personal care services, or in a manner that is otherwise consistent with state requirements.
- Home-based palliative care services Medicare does not cover if life expectancy is more than six months. Palliative care (“comfort care”) is to diminish symptoms of a terminally ill patient.
- Transportation for nonemergency medical services is transportation to obtain Part A, Part B, Part D, and supplemental benefit items and services. The transportation must be used to accommodate the enrollee’s health care needs: it cannot be used for nonmedical services, such as groceries or errands.
- Home safety devices and modifications are safety devices to prevent injuries in the home and/or bathroom. The modifications must be non-structural and non-Medicare covered. This benefit can include home and/or bathroom safety inspection to identify any need for safety devices or modifications.
A physician or licensed medical professional must recommend these home care services.
Medicare’s expansion of MA plan benefits, like adult days care, helps patients remain in their homes as they age rather than being institutionalized, which could also result in lower costs for Medicare and Medicaid.
The Advantage of Medicare Advantage for Home Health Care
Medicare Advantage plans may impose different rules, limitations, and costs than Original Medicare, but they must provide at least the same level of home health care benefits.
Starting in 2019, Medicare Advantage plans may offer supplemental benefits that help enrollees with daily maintenance, including transportation for medicare services, in-home support services, and home-based palliative care. Consult the individual MA plan for the details of coverage.
In the Omaha metro area, the MA plans offer some of these benefits. Currently, the plans that do offer a lot of these benefits are the “Dual” or “Special Needs” plans. Those plans are for a person on full Medicaid as well as Medicare or have some special needs because of chronic illness, such as COPD, Diabetes, etc.
In other areas with high population densities, many of the MA plans are much richer with benefits. As it stands in eastern Nebraska and western Iowa, principally Omaha, Lincoln, Bellevue, and Council Bluffs, the supplemental benefits seem to be growing in number and scope each year. A couple of insurance companies recently added transportation to their health plans. More insurance companies are developing Medicare Advantage plans and including this type of home health services.
The Medicare Part C advantage comes in five ways. The Medicare Part C advantages are in relation, or even opposition, to Original Medicare. These are the advantages of Medicare Part C, though they will vary from plan and location.
The Medicare Part C Advantage is Maximum Out-Of-Pocket
The Medicare Part C advantage comes first in a maximum out-of-pocket. Original Medicare Part A has a $1,340 deductible per event in a 60-day period. There is no limit or maximum out-of-pocket on the Part A deductible. You could pay it once, twice, or even ten times in a year. Original Medicare Part B co-insurance is 20%. The twenty percent does not have a limit, cap, or maximum out-of-pocket. The sky is the limit. Twenty percent of a million dollars is real money! All Medicare Part C plans have a maximum out-of-pocket. They are currently set at a maximum of $6,700, but many plans are much lower than that.
Part D Included
The Medicare Part C advantage secondly is the inclusion of Medicare Part D. Instead of purchasing a separate stand-alone Medicare Part D plan for $30, $50, or $100, Medicare Part D coverage is usually included in the Part C plan. You do not have to purchase a separate Medicare Part D plan, and many of the Medicare Part C plans are zero premium or a very low premium. So your Part D is included for zero. Not purchasing a Part D plan could be a $400–$700 savings per year in premium costs.
The Medicare Part C advantage thirdly is minimal co-pays. An emergency room visit with Original Medicare Part B is a 20% co-insurance. When I broke my arm a few years ago, my emergency room visit was over $3,000. If I had been on just Original Medicare at the time, my bill would have been over $600. The co-pay for an emergency room visit on Medicare Part C plan is currently an $80 co-pay.
The Medicare Part C advantage fourthly is the monthly premium. Most Medicare Part C plans in the Omaha area are zero premium. There are a couple of plans that charge a very small premium, but it is minor when considered Medicare supplements or the usual deductibles and co-insurance with most employer group health plans. You continue to pay your Medicare Part B premium out of your Social Security, but there is no additional monthly premium.
Dental and Vision
The Medicare Part C advantage fifthly is some dental and vision insurance. People constantly ask me if Medicare covers dental. Original Medicare does not include any dental plans or prescription eye coverage. It does not cover teeth whitening, dentures, fillings, etc. A person would have to purchase a stand-alone dental insurance for seniors. Some of the Medicare Part C plans include Medicare dental coverage, such as teeth cleaning, eyeglass credit, reimbursement for fillings and extractions, etc.
Medicare Part C has clear advantages over just Original Medicare and a Part D prescription drug plan. The Medicare Part C / Medicare Advantage plan limits your out-of-pocket costs, saves money on Part D, keeps your co-insurance down, does not cost any more than Original Medicare in most cases, and potentially gives some additional benefits, like dental and vision. Medicare Advantage is much more advantageous than just Part A and Part B.
Medicare Advantage or Medicare Part C is another way to receive Medicare. “Original Medicare” is a combination of Medicare Part A and Part B. It is called “Original Medicare” because that was its first plan in the late 60’s. Medicare Part A was hospital insurance and Medicare Part B was added later. It included doctor visits and outpatient procedures. Some people call it traditional Medicare. It became “Original Medicare” when a new form of Medicare was created–Medicare Advantage, also called Medicare Part C. What is the advantage of Medicare Advantage over Original Medicare?
The Advantage of Medicare Advantage vs Original Medicare
Let’s explain “Original Medicare” first. Medicare Part A covers hospital stays. The Part A has a deductible. It is currently $1,340 for every hospital stay for the same event in a 60 day period. If a completely unrelated event lands you in the hospital, e.g., car accident, heart attack, stroke, etc., even within the first events 60-day period, you will still pay the $1,340 deductible for those unrelated events. That kind of deductible schedule could add up to a significant cash outlay in a year. Likewise, Medicare Part B exposes you to a great deal of risk. While Medicare Part B pays 80% of doctor and outpatient costs, your 20% co-insurance has no cap on it. There is no maximum out-of-pocket. Sky is the limit. If you have a million dollars worth of bills under Part B, 20% is $200,000.
The Advantage of Medicare Advantage is a maximum out-of-pocket. The highest maximum out-of-pocket for Medicare Advantage plans in 2018 is $6,700. Some plans maximum out-of-pocket are much less, depending on the area, the company, and the type of plan. However, the easiest and clearest difference between Original Medicare and Medicare Advantage is a definite limit on what you pay out of your pocket. Medicare Advantage has a maximum out-of-pocket. Original Medicare does not.
Each Medicare Advantage Plan has its own schedule of co-pays, deductibles, and co-insurance. One co-pay that is standardized in all plans is the emergency room visit. In 2018, the emergency room visit co-pay is $80. I would rather pay $80 with a Medicare Advantage plan rather than 20% of any amount on Original Medicare. I broke my arm a number of years ago biking. My emergency room visit was $3,000. The advantage of Medicare Advantage I think is an $80 co-pay rather than 20% bill–$3,000 x 20% = $600.
Part D Prescription Drug Included
With Original Medicare, you still need to get a Medicare Part D prescription drug plan, even if you don’t take any medications. Otherwise, you will be penalized when you eventually do enroll in a Medicare Part D plan. The Part D plan is generally included in a Medicare Advantage plan at zero or little cost. If you purchase a Part D plan, you may pay between $21–$100 per month. The advantage of Medicare Advantage is paying zero or very little for your drug plan.
Vision and Dental
Most Medicare Advantage plans have additional benefits, such as vision, dental, and over the counter items. How would you like to get your teeth cleaned twice a year at zero cost? That is all most people are interested in when it comes to dental usually. They don’t want to spend $50 a month on a dental plan when cleanings are all they really want or need.
Compared to Original Medicare, the advantage of Medicare Advantage makes complete sense. It limits your maximum out-of-pocket, combines Part D at little or no cost most times, includes extra benefits, like dental and vision. There are usually many plans in your area. Here is Omaha there are eleven Medicare Advantage plans among five insurance companies. You should be able to find something that fits your needs among that variety. Call us to find out 402-614-3389.
100’s of Supplements to Pick From
Insurance companies offer hundreds of different Medicare supplements, Medicare Advantage plans, and Medicare Part D prescription drug plans. Picking Medicare plan means choosing between Medicare supplements and a Part D prescription drug plan OR Medicare Advantage/Part C. Next picking Medicare plan means choosing the plan type. Medigap plans range from plan A through the alphabet to plan N, which doesn’t include a Part D drug plan. The drug plans can be a little simpler because you can use the Medicare tool to narrow down the selection. The Medicare calculator bases the plan selection upon the prescriptions you enter into the system. The calculator picks the Medicare Part D plan that will cost the least in total costs for you. On the other side, Medicare Advantage plans consist of a wide variety of co-pays, co-insurance, deductibles, and maximum out-of-pocket costs and amounts that may or may not include a Part D plan.
Foreign Language of Medicare
Medicare itself is like a foreign language of Part A, Part B, and Part D with rules around enrollment that includes penalties when you do not comply. The Medicare.gov website is meant to be helpful, but the shear amount of information, jargon, legalese makes it a barrier to entry rather than a door. Even the Medicare handbook is hundreds of pages. Its size makes the evaluation of information almost impossible.
The Pain of Picking Medicare Plan
As a consequence, picking a Medicare plan is a frustrating and painful process for people. That is why I take people through a 3-step process. 1.) There is a brief, foundational explanation of Medicare and how it works. 2.) Look at ALL of the plans, but in an organized and ordered fashion. The first step helps you evaluate the plans. I share the story behind each company from my fifteen years of insurance experience because each company has a history in the market. 3.) I find out about you. Everyone is unique. Some people are risk takers. Others are not. Some have health concerns that are foremost of mind. Others do not have any.
The logic of the process enables people to narrow down choices and make the best one for them. I ask questions as we go along. Test and probe. Explain aspects of the plans as we go through each. Constantly test for understanding. So the process of picking a Medicare plan becomes clearer as we move through it. I generally meet with people twice. The first time is usually months before they can do anything. There is no pressure to make a decision or ‘buy right now.’ Clients have time to think, collect more information, verify what they’ve learned, talk with confidants. The next time we get together is to review with updated information. That is the time for picking a Medicare plan. By then you are comfortable and confident with your decision because your decision is well informed. It is logical. The decision is made over time without pressure. You know what you are doing when you pick your Medicare plan.
If you would like to go through this process, there is not cost or obligation. Call 402-614-3389 to find out more.
We’ve all experienced that less than happy holiday vacation spent ill. What’s worse is getting sick abroad and worrying about Medicare insurance coverage. If you’re planning a winter getaway, check out and share our healthy Medicare travel tips to ensure your vacation goes off without a hitch.
Whether you’re going foreign or domestic, Medicare travel tip #1. Always research your destination. Even learning about a stomach bug going around could help save your trip. Also be sure to take a look into potential health facilities by contacting the U.S. embassy in the country you’re going to visit or by getting help from your hotel. Know and have the contact information for the hospitals and urgent care centers that could be available to you during your trip.
Common Traveling Illnesses
Important Medicare travel tips is to know what to avoid on your trip. Here are some common illnesses you can bring back from your vacation:
- Malaria – Often found in tropical climates, Malaria is contracted though an infected mosquito bite. Although the disease has flu-like symptoms, it may become deadly. The CDC (Centers for Disease Control and Prevention) has the need-to-know information on Malaria for travelers.
- Traveler’s Tummy – One of the most common maladies foreigners experience when traveling abroad. Traveler’s tummy is common throughout Asia, Africa, Latin America and the Middle East. You can learn more about the gastro-intestinal sickness and how to avoid it from the CDC.
- Zika Virus – Zika is something we’ve all heard about on the news in the past year. Symptoms can range from flu-like to joint pain and rashes. It’s been linked to Asia, Brazil, Central America, Mexico, The Caribbean and The Pacific Islands. This CDC Infographic has tips on preventing Zika while traveling abroad.
You can read up on what to specifically watch out for depending on where you’re going on the travel section of the CDC website.
Check Your Coverage
Compare Plans and Explore Your Options
Your health coverage will vary depending on your Medicare plan. Original Medicare will usually only provide coverage within the U.S. Some Medigap plans have travel coverage. Some Medicare Advantage Plans may as well, but you’ll have to check your specific plan.
If you need some help navigating your Medicare coverage options, our agents can help and are available all year-round.
Doctor Knows Best
Before traveling, meet with your doctor to have a check-up, talk about any health concerns you may have, if you’ll need any vaccinations, etc. Your physician should be able to inform you on any must-know health concerns in regards to wherever you’re going.
Pack Smart Most Important of Medicare Travel Tips
Pack weather-friendly, and don’t forget your necessary prescriptions and medications in your carry-on luggage. That is the most important of Medicare travel tips. If you’re traveling by car, keep your meds in an easy-to-access designated location. If you have any special medical supplies that you need to use, get a note from your doctor that explains why you need them. It’s better to be safe than sorry! If you need help thinking through these Medicare travel tips or you want to invest in travel insurance, give us a call at OmahaInsuranceSolutions.com 402-614-3389
With these tips, you should be enjoying your vacation in no time. Happy travels!
Medicare Advantage Growing
Medicare Advantage or Medicare Part C is an alternative to traditional or original Medicare. While the majority of Medicare beneficiaries are still on original Medicare, Medicare Advantage has grown to 31% of all Medicare beneficiaries, which is triple the number from only twelve years ago. In Nebraska the number of Medicare beneficiaries in a Medicare Advantage plan is 12% and growing each year. The percentage would be much higher if Nebraska had a higher population density. The success of the Medicare Advantage plans depends upon concentrated pools of beneficiaries which is a challenge because the majority of Nebraska is rural. Though Medicare Advantage is growing, consistent concerns continue to arise. People may wish to consider something to backup Medicare Advantage.
Backup Medicare Advantage
Medicare Advantage is “a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits.” The co-pays, deductibles, co-insurance is set up differently from original Medicare. Like original Medicare, there are co-pays, deductibles, and co-insurance. While many Medicare beneficiaries chose to backup their Medicare Part A and Part B with a supplement, most people on Medicare Advantage plans chose not to purchase any additional insurance. They don’t backup Medicare Advantage. The reasons may be because co-pays are minimal. Medicare Advantage also has a maximum out-of-pocket where original Medicare does not. Still, people on Medicare Advantage do have concerns about serious illness and possible large co-pays, such as from a hospital stay. They may wish to backup Medicare Advantage, but they don’t know how.
Cover Co-Pays and Deductible
A possible solution to backup Medicare Advantage would be to add an indemnity plan. Indemnity plans are not health insurance. They are insurance plans that reimburse clients for certain specified events. For example, insurance company ABC will pay $500 each day you are in the hospital for a total of ten days. The money paid is to the policy holder to use as he or she wishes, not to the hospital or another insurance company. Indemnity plans may pay for skilled nursing stays past the 21st day when the co-pay is added. A stroke could require prolonged stays in a nursing home. A skilled nursing facility co-pay from day 21-57 could be as high as $160 per day. Most indemnity plans have options for cancer treatment too. The indemnity plan could reimburse several hundred dollars per treatment to compensate for high co-pays or just present a one-time lump sum, such as $5,000 or $10,000 for an occurrence of cancer.
Indemnity plans could be a nice way to fill in the gaps to a Medicare Advantage plan, and they could be a great addition to Medicare supplements or health plans in general. Medicare and health insurance only pays for medical cost that are incurred from approved medically necessary treatments. Heart attacks, strokes, and cancer come with many other non-medical expenses. You may need assistance at home after a stroke that neither Medicare or your health plan cover. Transportation to doctors’ offices are an expense because you cannot safely drive. Wages are lost when your illness prevents you from going to work. Health care costs go beyond the doctor and hospital bills. Indemnity plans may help off set the losses due to illness.
Health insurance is like a puzzle. There are many pieces and different sizes. They can be put together in a multiplicity of ways. They best way to put the puzzle together is to get all the pieces out on the table and see what fits together the best. If you have gone the way of Medicare Advantage, it may be beneficial to backup your Medicare Advantage plan. We can help you see how the puzzle works at Omaha Insurance Solutions 402-614-3389.
What is Medicare? A basic question. Or rather, why should anyone care about Medicare? The reason people should care is that most bankruptcies are medical bankruptcies. In other words, if you wish to protect your retirement nest egg from bill collectors, Medicare is important to know about. There are few things that are more disturbing than a pile of medical bills sitting on the kitchen table. The golden years could be tarnished with worrying about actual or potential medical expenses. Medicare–if implemented proper–will protect you from a potential catastrophe. It is critical for people entering into retirement to understand what is Medicare.
What is Medicare?
Medicare is a Federal health insurance program for people who are 65 and older (or on Social Security disability). It began in 1965 when President Johnson signed it into law. It was designed to provide medical covered to the elderly at a reasonable price. In 1965, few people had health coverage once they stopped working. As a result, many seniors fell into poverty because of burdensome medical expenses. Medicare was a solution to a national problem.
Medicare is divided into two parts: Medicare Part A and Medicare Part B. Medicare Part A has everything to do with the hospital. It doesn’t cost anything because you paid for it during your working years. It was one of the deductions in your payroll taxes. Medicare Part A covers a 100% of the medical expenses incurred in the hospital, but there is deductible that many people are not aware of. The Medicare Part A deductible is currently $1,288. This is NOT an annual deductible. It is a deductible per benefit period, and a benefit period is 60 days. So each event has a deductible, and the time for the event is 60 days. In other words, you could have multiple events and pay multiple deductibles because the event is not limited to just a 60 day period. Each new event, even if it overlaps with another event, has its own 60 day timeline. While rare, it could happen, and probably more importantly, you could pay the Part A $1,288 deductible more than once in any given year.
Medicare Part B, however, does cost something. For most people going on Medicare and Social Security in 2016, the Medicare Part B premium is $121.80 per month. It is generally taken out of your Social Security check. Medicare Part B covers doctors’ visits and outpatient procedures, such as X-rays, blood work, emergency room visits, etc. Medicare Part B covers 80% of the cost. Your portion is 20%. The 20% coinsurance, however, is unusual. There is no cap. There is no maximum out-of-pocket. Most group plans you were ever on probably had a maximum out-of-pocket. It may have been $1,000, $2,000, even $10,000, but at some point, you stopped paying and the insurance company covered everything. Medicare Part B does not have that, so 20% of a big number will be a big number. You keep paying your 20% coinsurance as long as the bills come in.
These are the basic building blocks to what is Medicare. You must understand Medicare, Medicare Part A, and Medicare Part B to understand the rest that follows. In the next blogs and videos, we will cover how to get Medicare, how to cover the Part A deductible, and how to fill the unlimited 20% gap in Part B coverage.
More Than Medicare Supplement Plans
I help people sign up for Medicare Part A and Medicare Part B. We go to Medicare.gov and run their medications. I check to make sure their doctors and hospitals are in network for the Medicare Advantage plans. I explain their Medicare eligibility and show All the Medicare supplement plans, Medicare Advantage Plans, and Medicare Part D Plans, but there is much more to being an independent insurance agent who offers Medicare insurance. It is about a long term relationship with my clients. It is more than Medicare supplement plans.
Losing a Medicare Client
I recently lost a couple of clients. They passed away suddenly. I happened to have spoken with one of them a few days before her passing. She had called about some photos she had seem on my personal Facebook page. It is painful when a client dies because I get connect with my clients, especially over time.
More Than Apply for Medicare
The recent loss also reminded me of the nature of my relationship with my Medicare clients. It is a relationship that is meant to last over time. It is more than helping them apply for Medicare. I tell my clients when I enroll them that this is a relationship until “Death do us part.” I will be checking in on them every six months to make sure their plan is working well. I check in especially during Open Enrollment Period when beneficiaries may make changes to their plans. I want to make sure that clients have the best possible plan that fits their needs at the best possible price because we know three things for certain. Medicare will change, the Medicare plans will change, and their needs will change. I want to be on top of those changes for them.
If you want someone who will take care of your Medicare needs over the years, give us a call 402-614-3389.
Delay Medicare Enrollment
Many people work past 65. They continue on with them employer group coverage. They delay Medicare enrollment. At 66+, they wonder what to do about Medicare.
How to Enroll after 65
Here is what to do. Go to Medicare.gov. Click on “Forms, Help, Resources” on the top right. Then click on “Medicare Forms” on the left middle. You will see the enrollment forms in the middle of the page in PDF form. There are two forms: one to enroll in Medicare Part B and a second for your employer to sign off on your coverage. You fill out the enrollment in Part B. Give the second form to your employer. Your employer will verify that you have had health coverage as good as Medicare since you turned 65. They will sign the form. It is important for you to write in the date that you wish your Medicare Part B to start. Give yourself enough time to find a Medicare plan and prescription drug plan. (There are much shorter and restrictive time limits when you have delayed Medicare Part B enrollment.) Drop the forms in the mail or hand deliver them to the local Social Security office.
Medicare Employer Enrollment Forms
Why do you want to involve your employer with your enrollment in Medicare Part B? If you do not have your employer verify that you had health coverage from the time you could have enrolled in Medicare until the time you did take Part B, Medicare will assume you did not have creditable coverage and will asset a penalty. The penalty is a 10% increase in Part B premium for every year you did not have coverage. That can be significant over time and completely unnecessary. Delay Medicare enrollment at your own risk. Get the form. Your employer is required to verify. The human resource department will know exactly what to do. It is a very simple matter.
At Omaha Insurance Solutions, we help clients who delay Medicare enrollment all the time. We can get this done quickly and easily. Give us a call 402-614-3389. We can email you the forms, walk you through filling them out, and explain what to do.
A distressed prospective client told me that Medicare did not cover mental health treatment. I stammered a bit because the subject had never come up before, and I was surprised. I said that it did. She had read that it only covered a one time welcome visit to Medicare. I then showed her in the Medicare & You Handbook on pages 40 and 59 where it detailed the coverage. There is the welcome to Medicare screening, an annual screening, and complete medical coverage. She was surprised and relieved there was Medicare mental health care.
Seniors Need Mental Health Care
Mental health is a serious problem in society, and it is growing among seniors. The World Health Organization documents how important among seniors this issue is. Depression is under reported, little recognized, and often an untreated illness; but Medicare mental health cares for beneficiaries with mental health concerns, like depression. It probably does it better than most employer plans do.
Medicare Mental Health Part A
Medicare Part A deals with the hospital. The same rules around hospital deductibles and co-insurance apply to psychiatric hospitals as to other hospitals. There is, however, one difference. Medicare only allows a lifetime amount of 190 days for a stand alone psychiatric hospitals.
Medicare Mental Health Part B
Medicare Part B covers psychiatrists, counselors, treatment groups. Again the same 20% co-insurance applies as to any other Part B doctor visit. If you have a long standing relationship with a psychologists before Medicare, you may keep that relationship going after you go on Medicare if the medical professional takes assignment for Medicare.
Medicare Supplements will cover Medicare mental health issues and professionals the same as other fees in accordance with your particular Medicare supplement plan. Medicare Advantage will have the same co-pays for psychiatrists and psychologists as for other specialists.
No need to be stressed or depressed about Medicare mental health. You are covered.