Does Medicare Advantage Pay for Home Health CareMedicare Advantage and Home Health Care

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.

Coverage of Non-Skilled Care and Other In-Home Support Services

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 BenefitsDoes Medicare Advantage Pay for Home Health Care

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

Some Medicare Advantage Supplemental Benefits

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 Medicare Pay for Transportation 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.

Medicare Advantage Home Health AideThe 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.

Jimmo vs. Sebelius On Skilled Nursing

Skilled Nursing Care is amazingly complex. Because the Medicare coverage of Skilled Nursing Facility stays is so confusing, patients sued.  The case went all the way to the Federal Courts. Jimmo vs. Sebelius, a class-action lawsuit, challenged the Center For Medicare & Medicaid Services (CMS) interpretation of the “improvement stand” that many used to interpret Medicare coverage of Skilled Nursing Facility booklet.

Medicare Coverage of Skilled Nursing Facility Stays: Improvement Standard

Medicare Coverage of Skilled Nursing Facilities This one hit home for me because of how it affected my mother and our family. My mother was in the last stages of ovarian cancer. It became clear that no treatment was going to work. She was on palliative care. During one of her episodes, she was in extreme pain. The hospital admitted my mother because intravenously administered pain killers were the only way to get her pain under control. After that, she was supposed to come home. But her condition was such that we were not going to be able to care for her adequately. We talked about a nursing home—skilled nursing—but one of the criteria at the time was the patient must be able to improve. Because she was terminal, improvement was definitely not in the cards. We were initially told that Medicare would not pay for her stay in a skilled nursing facility. However, that was not accurate. The people we were talking with were operating off old, outdated information.

Slow Deterioration of a Condition

On January 24, 2013, the class action lawsuit Jimmo vs Sebelius settled in favor of the patient, and the Center for Medicare & Medicaid Services (CMS) clarified its policy.  Medicare coverage of Skilled Nursing Facility stays no longer required “improvement.”  Instead, care could be prescribed to maintain the status of an individual’s condition, or slow the deterioration of a condition, as well as to improve the person’s condition.

Jimmo Website Explains New Medicare Coverage

As ordered by the federal judge in Jimmo v. Sebelius, the Centers for Medicare and Medicaid Services (CMS) published a new webpage containing important Jimmo vs. Sebelius information about the Jimmo Settlement on its CMS.gov website. The Jimmo webpage is the final step in a court-ordered Corrective Action Plan.  The action reinforces the fact that Medicare does cover skilled nursing and skilled therapy services needed to maintain a patient’s function or to prevent or slow decline. Improvement or progress is not necessary as long as skilled care is required. The Jimmo standards apply to home health care, nursing home care, outpatient therapies, and, to a certain extent, for care in Inpatient Rehabilitation Facilities.

In my mother’s case, the skilled nursing facility admitted my mother, even though she was terminal, to help slow the deterioration of her health. As it turned out, she passed away within two weeks of her admittance, and the personnel at her skilled nursing facility were outstanding! They made her last days as bearable as the situation would allow.

Medicare Coverage of Skilled Nursing Facilities Changed

Skilled Nursing CareMedicare coverage of Skilled Nursing Facility stays practices have changed.  Researchers assessed the impact of the Jimmo settlement by looking at changes to the number of physical therapy and/or occupational therapy visits per year, per patient, focusing specifically on the number of individuals who had 12 or more therapy visits during a 12-month timespan.

Healthcare is very expensive. There are many conflicting groups and interests. The rules, policies, and mechanisms are complex. Some of the people you deal with can be frustrating. The complexity of the system is driven home to me daily as I talk with clients and deal with issues that arise. You need to be aware of the rules and regulations around Medicare coverage and nursing home care. Or have someone who knows them and can help.

Medicare Coverage For Skilled Nursing Facilities

Skilled Nursing Facilities—or better known in the jargon of Medicare as SNF—is the cause of much consternation among people on Medicare.  The reason for the Skilled Nursing Facility Medicare Covereddistress and stress is because Medicare beneficiaries are sometimes denied coverage.  This both confuses and angers Medicare beneficiaries because there doesn’t seem to be any rhyme or reason to the denials.  People ask: does Medicare cover Skilled Nursing Facility?

Medicare Billing Guidelines For Skilled Nursing Facility

From my observation over the years, doctors’ offices sometimes don’t follow the Medicare billing guidelines for Skilled Nursing Facility.  I understand everyone is busy and people are certainly well-intentioned, but Medicare is insurance.  Insurance has rules, protocols, and forms.  A lack of adequate explanation to Medicare is many times the cause of Medicare denials, I’ve seen over the years.  Other times the situation does not meet the Medicare criteria for Skilled Nursing Facility stays.

What are the Medicare Skilled Nursing Facility Requirements?

Skilled Nursing Facility Medicare CoveredWhen skilled nursing is prescribed, five Medicare Skilled Nursing Facility requirements must be met.  The first is a qualifying hospital stay.

The Medicare beneficiary must stay as an inpatient for three consecutive days in the hospital.  Each of these is an essential ingredient.  The beneficiary must be admitted to the hospital.  If the patient is only admitted for “observation,” she will not qualify.  She must be an “inpatient.”  Next, the stay must be consecutive.  It can’t be a day or two within a short period of time.  It must be at least 3 consecutive days.  And finally, it must be at least 3 days, not counting the day of dismissal.

Many times, people assume the day of dismissal counts, but that is definitely not the case.  Three days of inpatient care at least with a fourth day for the dismissal.  Sometimes people will complain that the patient doesn’t need a third day, but if you want the person to qualify, she must stay at least three consecutive days.

Medicare Skilled Nursing Facility Benefit Period

The second ingredient for Medicare to cover a skilled nursing facility stay is the admittance must occur with 30 days of dismissal from the qualifying hospital stay.

Skilled Nursing Facility Medicare Covered My mother-in-law had open heart surgery a while back.  Her cardiologist prescribed that she stay in a skilled nursing facility for cardiac rehab.  She was not a very cooperative patient.  She refused.  My wife was insistent and explained that if she didn’t go then, she would lose the opportunity for skilled nursing rehab.  My mother-in-law’s response was she would do it later if she needed it.

Many people mistakenly think they can go to a nursing home for rehab if they simply want to.  It must be within the 30-day window after dismissal from an inpatient stay.  Otherwise, Medicare will not pay.  Now you may think it is not fair, or right, or make sense.  I am simply stating the rules and facts.

Medicare Guidelines for Skilled Nursing Facility

Skilled Nursing Facility Medicare Covered The third requirement for admittance to a skilled nursing facility (SNF) is the treatment can only be provided by a skilled nursing facility.

What this usually means is “full time” or five day a week care.  In other words, the same level of treatment cannot be provided by going to a treatment center by appointment a few times a week.  Only an inpatient skilled nursing facility can provide the level of intense treatment needed for adequate recovery.  This can be a tricky call and where judgments can and are questioned.

Medicare Denial Skilled Nursing Facility

I had a client who had a knee replacement.  Usually a knee replacement, even with does medicare pay for chemotherapy in a skilled nursing facilitycomplications, does not require admittance to a skilled nursing facility (SNF) because physical therapy is something that can be completed by going to the physical therapist’s office and/or doing exercises on your own.  This situation was different.

She was living in a small apartment with lots of furniture.  There was a pet.  The husband was feeble.  While she was not very old, her knee was not recovering at the usual pace.  The doctor recommended skilled nursing care, but Medicare denied the prescription.

The family came to me with questions.  I suggested they explain the situation to the doctor in greater detail and with more urgency.  She was a serious “fall risk” because of her living situation.

Once the idea was emphasized sufficiently in the doctor’s notes to Medicare, Medicare understood that the work that had been done would be undone if she fell at home because of a pet, furniture, and/or feeble husband, etc.  The request was approved.

Skilled nursing is very expensive.  Medicare needs to understand the “medical necessity” of a prescription.  Once the idea is communicated effectively, things can happen.

List of Medicare Approved Skilled Nursing Facilities

The fourth ingredient is that a doctor, or another appropriate medical professional, certifies that the patient needs the type of daily therapy that can only be performed in a skilled nursing facility.  The skilled nursing facility must also be a Medicare-certified skilled nursing facility.  You can go to Medicare.gov to find certified sites and Medicare the star ratings for Skilled Nursing Facilities.

The fifth and final requirement can be confusing.  The skilled nursing care must be for the reason the patient was in the hospital for the three days.

Imagine John goes to the hospital because of a broken hip.  While John was in the hospital, he has a stroke.  The doctor certifieMedicare skilled nursing facility requirementss John for treatment at a skilled nursing facility for the stroke, not the hip issue.  The skilled nursing recommendation does not have to be based on the reason the person was admitted to the hospital, but it does need to be because of something he was treated for during the 3-day hospital stay.

As you can see, Medicare coverage for skilled nursing facilities can be complex.  It’s important to have some understanding so that you know what to expect, or not to expect, when it comes to Medicare coverage of skilled nursing facility care, and how to navigate the processes to your benefit and the benefit of loved ones.  Medicare Part A covers the Skilled Nursing Facility, but the rule must be followed for Skilled Nursing Facility Medicare reimbursement to happen.

 

 

The chances are you or someone in your family will require skilled nursing care because of a serious injury, stroke, or surgery.  How Long Does Medicare Pay For Skilled Nursing Care?Twenty-five percent of skilled nursing stays are less than three months.  Many, however, are longer.  Nursing home care costs vary from state to state and location to location.    The questions my clients ask are: how long does Medicare pay for skilled nursing care?

Skilled Nursing Care Costs Are High

How Long Does Medicare Pay For Skilled Nursing Care?Depending upon the state in which you reside, the daily costs associated with nursing home care vary widely between $140 and $771 per day for a semi-private room in 2017. The average cost was $235 per day for a semi-private room. Multiplying that out the monthly cost associated with skilled nursing care ran anywhere between $4,258 and $23,451 per month for a semi-private room, with the average being closer to $7,148 each month for a semi-private room.  For most people, those are prohibitive costs!

How Much Skilled Nursing Does Medicare Pay For?

Many of my clients will call when faced with the possibility of going into a skilled nursing facility.  Illness is scary enough.  You don’t want to worry about overwhelming medical bills.  My people want to know they’re covered.  They want to know how much skilled nursing does Medicare pay for.  Do Medicare Advantage plans cover skilled nursing facilities?  Do Medicare Supplements cover skilled nursing facilities? So, the big question is: who pays?

Medicare Skill Nursing Benefit Period Is 100-Days

So, how many days does Medicare cover skilled nursing facility care?  The Medicare Skilled Nursing Facility (SNF) benefit period, or “Spell of care,” is 100 days.  The benefit period ends when the patient leaves the SNF for 3o days, and a new 100 day benefit period is available after 60 days.

Skilled Nursing Facility’s Legal Obligations

When a patient leaves a hospital and moves to a nursing home that provides Medicare coverage, the nursing home must give the patient written notice of whether the How much does Medicare Pay for skilled nursing nursing home believes that the patient requires a skilled level of care and thus merits Medicare coverage. Even in cases where the SNF initially treats the patient as a Medicare recipient, after two or more weeks, often, the SNF will determine that the patient no longer needs a skilled level of care and will issue a “Notice of Non-Coverage” terminating the Medicare coverage.

Whether the non-coverage determination is made on entering the SNF or after a period of treatment, the patient can submit or not to Medicare. The patient (or his or her representative) should always ask for the bill to be submitted. This requires the nursing home to submit the patient’s medical records for review to the fiscal intermediary, an insurance company hired by Medicare, which reviews the facility’s determination.  The review costs the patient nothing and may result in more Medicare coverage. While the review is being conducted, the patient is not obligated to pay the nursing home. However, if the appeal is denied, the patient will owe the facility retroactively for the period under review.elder law

If the fiscal intermediary agrees with the nursing home that the patient no longer requires a skilled level of care, the next level of appeal is to an Administrative Law Judge. This appeal can take a year and involves hiring a lawyer. It should be pursued only if, after reviewing the patient’s medical records, the lawyer believes that the patient was receiving a skilled level of care that should have been covered by Medicare. If you are turned down at this appeal level, there are subsequent appeals to the Appeals Council in Washington, and then to federal court.

Day 101 You Pay

How Long Does Medicare Pay For Skilled Nursing Care?If you need more than 100 days of SNF care in a benefit period, how many days will Medicare pay for skilled nursing care?  Nothing.  SNF is meant to be short term.  You will need to pay out of pocket if your care ends because you are run out of days.  The SNF is not required to provide written notice. It is important that you or a caregiver keep track of how many days you spend in a SNF to avoid unexpected costs after Medicare coverage ends.

How Else to Pay For Skilled Nursing Care

If you are receiving medically necessary physical, occupational, or speech therapy, Medicare may continue to cover those skilled therapy services even when you haveOccupational Therapy used up your SNF days in a benefit period, but Medicare will not pay for your room and board, meaning you may face high costs.

Medicare does not cover long term care or custodial care.  You may wish to move to a home health care situation at that point.  Medicare pays for home health care, and the costs are much less.  If you have long-term care insurance, it may cover your SNF stay after your Medicare coverage ends. If your income is low enough, you may be eligible for Medicaid to cover the cost of your stay.

Unlimited Skilled Nursing Benefit Periods

Once you are out of skilled nursing for 60 days, your SNF benefit period ends, but you may become eligible again for another SNF benefit period after a qualifying hospital stay of 3-days.  There is no limit on the number of benefit periods available to a Medicare beneficiary as long as the Medicare requirements are met.

In other words, a person could potentially keep going into Medicare covered skilled nursing care every 100 days after a 60-day break as long as it is preceded by a qualifying hospital stay of 3-days.  While repeat 100 day stays in a skilled nursing facility are not likely, that does give an idea of the level of incredible care available to a Medicare beneficiary.

NO Insurance: $176 Per Day

Medicare Supplements and Medicare Advantage plans pick up large portions of the 100-benefit period.  The amount covered depends on the type of Medicare Supplement plan and Advantage plan.  If the patients has neither, just Original Medicare, she is responsible for 21-100 days.  The per day cost is currently $176 (2020).

30 Or 60 Days

Physical TherapyAn important note on the number of days out of a Skilled Nursing Facility approved stay.  If a patient has left the SNF for 30-days or less, she may return without a 3-day inpatient hospital stay to initial the stay, but the 100-day count continues from where it left off.  If the patient has been out of the SNF for 60-days for less, but more than 30-days, she will need another 3-day hospital stay for Medicare to pay for the time in the Skilled Nursing Facility.  And the 100-day count continues from where it left off.  After 60 consecutive days without SNF care, a new benefit may begin.  There is no limit to the number of benefit periods.

Dave’s Scenario

Let’s layout some common scenarios.  You might need your calculator or at least your fingers and toes to keep track.

Imagine David is in the hospital for 4 days because of a stroke.  He is then admitted to a skilled nursing facility for 20 days.  Dave leaves the skilled nursing facility for 28 days, but he has a complication.  Dave falls going to the bathroom.  The doctor readmitted him into the nursing home.  He is within the 30-day window.  No problem.  Medicare will pay for that.

If, however, David was out of the nursing home 31 days, and he fell, he would need another 3-day stay in the hospital to be readmitted to the skilled nursing facility so Medicare would pay.  Dave’s doctor may or may not be able to get him re-admitted to the hospital based upon his medical condition.Skilled Nursing Care

Summary

Skilled Nursing Facilities (SNF) are incredibly expensive.  How long does Medicare pay for Skilled Nursing Care?  Medicare does cover a 100-day benefit period.  Medicare Supplements and Medicare Advantage plans cover large portions of the stay, depending on the plan.  The cost, however, starting day 21 is $176 per day to patients without any additional coverage.  The 100-day benefit period has very strict rules when it begins and ends.  There are rules to which you need to be attentive to avoid unexpected and large bills, and it is worth talking with your insurance agent to make sure you have the maximum amount of coverage you can afford.

What Are Skilled Nursing Facilities?

Skilled Nursing Facility

All of us have strong memories of visiting the “old folks’ home.”  Whether grandparents, relatives, or friends, we recall the smells, linoleum, long hallways, and institutional dormitory rooms.  “Old folks’ homes” or nursing homes fall under the category of Skilled Nursing Facilities (SNF).  Medicare covers skilled nursing facilities within limits.

Patients go to the SNF after surgeries to recover, from illnesses to heal, and from injuries to recover and strengthen.  Skilled Nursing Facilities are for temporary treatment, not long term residential care or custodial care, like memory care.  Other facilities, like senior living communities, assisted living, or senior care centers describe other types of facilities that assist seniors.

A skilled nursing facility provides highly skilled professionals, such as occupational therapists, physical therapists, registered nurses, speech therapists.  The advantage of an SNF is these professions are available 24 hours a day for the patients.  The level of care is very high but short term.

Post-Acute & Skill Rehab Services

Skilled Nursing FacilitySkilled Nursing Facilities are institutions that provide post-acute skilled nursing care and rehabilitation services.  People sometimes confuse skilled nursing care with nursing home care because most of the time skill nursing usually takes place in a nursing home location.  Medicare, however, doesn’t pay for “nursing home care”.

Medicare covers skilled nursing facilities within specific parameters.  Nursing home care is for individuals who have reached a point in life when they can no longer perform activities of daily living.  This is referred to as custodial care.  In other words, they cannot bath, feed, and dress themselves.  Medicare will not pay for those services to be provided exclusively.

Skilled Nursing is for after surgery or acute illness, for example, hip surgery for a fractured hip or a stroke.  A skilled nursing facility admits patients for a short period of time after being in the hospital to aid in their healing and/or rehabilitation.  Hospitals are incredibly expensive, and a skilled nursing facility can provide the necessary treatment at a lower cost.

Medicare Criteria For Skilled Nursing Facilities

The tricky part about skilled nursing facilities is admittance.  A skilled nursing facility requires patients to meet certain essential criteria for admittance and for Medicare to pay.  This is the complex checklist:

  1. The patient must be admitted to a hospital as an “inpatient” for at least three consecutive days, not including the day of dismissal. She can’t be in the Skilled Nursing Facilityhospital for “observation” for it to count for Medicare to pay.
  2. Medicare mandates patient admittance to the skilled nursing facility within 30 days of discharge from the hospital. If problems arise later—past 30 days—the patient cannot go to the skilled nursing facility and have Medicare pay for it.
  3. Only a skilled nursing facility can provide the type of care necessary for the patient’s recovery.   A skilled nursing facility would provide intense physical therapy for a hip injury or occupational therapy after a stroke. Going to the physical therapist’s office a couple of times a week would not be sufficient in those cases.
  4. A doctor, or appropriate medical professional, must certify that skilled nursing care is required for recovery.
  5. The patient must be treated for the same condition for which she was in the hospital.

There are nuances and exceptions to some of these rules.  The list gives you a good idea about how skilled nursing fits into your Medicare health insurance.  The Omaha, NE area has many quality Medicare certified facilities, and  You can find them on the Medicare.gov website.

10050MPeople constantly ask me, ‘What should I do about Medicare?’  They are overwhelmed with all the brochures from insurance companies.  They look through the 162 pages of the Official Medicare Handbook and are further confused.  Some go to the Medicare.gov website, and are confounded in attempts to navigate through the endless ocean of information.  They simply ask in bewilderment, “What does everyone else do?’  A huge number of people choose a Medicare supplement, or Medigap plan, as the solution, but more of an answer is needed than just ‘everyone is doing it.’  Some thoughtful consideration is required.

Part A Deductible

Medicare is a generous health plan.  It covers a majority of the hospital and doctor costs, but there is some important exposure to be aware of.  Medicare Part A covers the hospital, but only after you pay the deductible of $1,288.  That deductible is not an annual deductible.  It is per event within a 60 day period.  While you would have to be very unlucky, very sick, or both, you could pay that deductible an endless number of times.  That is your exposure.

Part B Co-Insurance

Medicare Part B covers 80% of the doctor and outpatient procedures.  While that is quite generous, 20% of a big number is still a big number.  Heart attacks, strokes, cancer treatment can run into the hundreds of thousands of dollars.  Twenty percent of a $200,000 bill is $40,000.  Most people would find that beyond the family budget.

MOOP

And with Part A & B, there is NO maximum-out-of-pocket (MOOP).  In other words, you continue to pay as the bills roll in.  You do not stop paying on deductibles and co-insurance if all you have is Original Medicare without anything else.

So comes the questions from clients: ‘What should I do about Medicare?’  Medicare supplements or Medigap plans fill in those gaps in Medicare.  They cover the hospital deductibles and 20% co-insurance for doctor and outpatient use.  Depending on how much you wish to cover, the Medigap plan can cover everything 100%, most of everything, or a potion.  You choose.  There are ten plans available.

12,200,000 Satisfied Medigap Clients

The fact that 22% of people on Medicare choose a supplement and stay on a supplement for 20-30 years tells you the level of satisfaction.  There are currently 55,200,000 Medicare beneficiaries.  Of that number 12,200,000 chose a supplement.  That number grows each year: 9.7 million in 2010 to 12.2 million in 2015.  The key number is that 9 out of 10 Medigap beneficiaries say that they are satisfied with their coverage and keep their coverage.  Med Sup Conference Stats

While Medicare is a wonderful health insurance program for seniors, it doesn’t cover everything.  You still have exposure to significant financial loss if you only have Medicare alone.

innerOne of the things that holds people back from purchasing a Medicare supplement is that they don’t know.  That is, they don’t investigate what Medigap plans are, what the costs are, how much or little they cover.  It is simple as making a phone call 402-614-3389.  A quote will not cost you anything, but you will have some real, solid information for your decision making process.  Take a couple minutes, answer a few questions, and you will be surprised how easily you can find out what you should do about your Medicare @ OmahaInsuranceSolutions.com.

The year Medicare approved tranquilizer coverage, it spent an estimated $377 million on prescriptions for the drugs. While congress originally outlawed the coverage of these drugs, pressure from patients and medical societies caused the reversal of this law in 2013 under Medicare Part D.

Although these drugs were not covered until recently, it is evident that patients were simply finding other ways to pay for the prescriptions. For example, Xanax, Ativan and Klonopin were among the most common prescribed medications in 2013.

As seniors represent the largest demographic on Medicare, the fact that they are on these tranquilizers is cause for concern among some health professionals. Although the drugs are fast-acting, they are habit-forming and have lasting effects in older users. The American Geriatrics Society discourages their use among seniors for symptoms such as insomnia, delirium, or agitation because of the risks involved. Instead, these tranquilizers are intended for use to treat seizures, end-of-life care, withdrawal, and severe anxiety.

Dr. Brent Forester, a geriatric psychiatrist at McLean Hospital in Massachusetts, claimed that he doesn’t use tranquilizers, or benzodiazepines as a “first-, second- or third-line treatment because we see more of a downside than the good side.” Forester states that in reference to the wrongful, long-term use of tranquilizers as a replacement of anti-psychotics and to sedate patients.

What’s more, researchers recently found that the risk of being diagnosed with Alzheimer’s disease increased the longer the patient took benzodiazepines. Bear in mind, experts remind you that these drugs are meant to be taken for a short period of time, not long term.

Benzodiazepines were among the highest prescribed in Florida and Alabama with 158 and 136 doctors, respectively. Each doctor on the list represents a physician who wrote at least one thousand prescriptions of benzodiazepines. The combination of narcotics and these drugs can potentially be deadly.

As a new or seasoned Medicare patient, you likely have many questions about what your plan does or does not cover, and what updates will affect you. Please contact your licensed insurance agent at Omaha Insurance Solutions at (855) 367-3631 for answers to your pressing concerns.

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