JustCare

Category: Medicare

  • Medicare covers depression screenings

    Medicare covers depression screenings

    Depression can be crippling, disrupting people’s daily lives and normal functioning. But it is generally treatable if diagnosed. Depression is a common condition for older adults, too often undiagnosed and unreported. To help ensure older adults are correctly diagnosed and treated, Medicare covers depression screenings. (Click here for a list of preventive care screenings Medicare covers.)

    Keep in mind that big life changes such as the passing of a loved one, retirement, or a serious illness will naturally cause stress, anxiety and sadness. These feelings generally will pass with time and do not mean you are depressed. But, they can also become all-consuming.

    Your doctor should determine your risk factors for depression if you go for a Welcome to Medicare visit or a Medicare Wellness visit. However, your doctor need not do a depression screening. If you’d like one, you should ask  for it.

    For Medicare to cover depression screenings, a doctor must conduct the screening in a primary care setting. Medicare will not cover a depression screening conducted in an emergency room, inpatient hospital setting, or skilled nursing facility.

    The depression screening includes a questionnaire that you must complete on your own or with help from your doctor. Your responses will indicate whether you suffer from depression or are at risk. If you have symptoms of depression, your may receive a more extensive exam.

    Whether you have traditional Medicare and see a doctor who takes assignment or a Medicare Advantage plan and see an in-network doctor, Medicare covers the full cost of your annual screening–no deductible, coinsurance or copays.

    If you are diagnosed as suffering from depression, Medicare will cover your treatment from a mental health professional. But, you will be responsible for meeting any deductible you have and any coinsurance or copays.  In eight out of ten cases, depression can be treated.

    Click here for a summary of the different preventive care services Medicare covers, and here’s more detailed information on Medicare coverage of weight-loss counseling, smoking cessation and nutrition counseling. For more information on depression screenings, visit Medicare Interactive.

  • Health plan networks limit access to care

    Health plan networks limit access to care

    One of the biggest problems with health insurance companies is that they generally offer health plans that limit coverage to doctors and hospitals in their networks. And, too often their networks of doctors and hospitals are inadequate, even though they may seem adequate at first glance. So, what you see is not what you get, and people have access to care problems. Two recent reports reveal problems with the adequacy of health plan networks, as well as a high frequency of people in private Medicare Advantage plans switching to traditional Medicare when they need costly care because access to care is so much easier.

    Traditional Medicare offers people the choice of coverage from virtually any doctor or hospital in the United States. That’s why about seven out of 10 people with Medicare are enrolled in traditional Medicare.  People with employer coverage or enrolled in a state health exchange plan do not have the choice of a plan like traditional Medicare. (Bernie Sanders is proposing to give everyone that option.)

    People  in HMOs and other commercial health plans face four key problems with in-network care.

    1. Many of the doctors listed in their network may no longer be in their network or, if they are, they may not be taking new patients. So, protect yourself, and don’t trust your health plan’s provider directory;
    2. The doctors listed may have offices that are difficult to access;
    3. The doctors listed may not have the skills to treat people with a range of serious and complex conditions; and,
    4.  Doctors in network at the start of the year may leave the network any time during the year. (Notice is required.)

    Moreover, a recent study from the Government Accountability Office (GAO) found that the Centers for Medicare and Medicaid Services does not do a good job of ensuring that the Medicare Advantage plans have adequate networks.  For example, while there are standards to help ensure Medicare Advantage plans have adequate networks, CMS has approved 90 percent of requests from these health plans to be relieved of the responsibility of ensuring that people do not have to travel more than five miles (10 minutes) to see a doctor or use a hospital.

    Why are Medicare Advantage and other commercial health plan networks often inadequate? Another Health Affairs study by Rahman, Keohane, Trivedi and Mor, High-Cost Patients Had Substantial Rates of Leaving Medicare Advantage and Joining Traditional Medicare, explains that commercial health plans that contract with Medicare have a financial incentive to keep patients with costly needs from both joining their plans and remaining in their plans. As a result, their networks are likely not to meet the needs of high-cost patients, particularly patients needing home health care, skilled nursing care and acute inpatient care.

    People with costly health care needs enrolled in Medicare Advantage plans are more likely to leave a Medicare Advantage plan for traditional Medicare. Fortunately, they can switch plans. (Here’s how to choose.) But, unfortunately, they can only do so once a year during open enrollment season. So, if they need specialty services that they cannot get from their Medicare commercial health plan, they will either need to pay out of pocket for the care or forego it until they are able to switch to traditional Medicare.

  • Observation care: What you need to know

    Observation care: What you need to know

    For the last couple of decades, instead of admitting all Medicare patients who stay overnight as inpatients, hospitals have been providing some patients with “observation” care and treating them as outpatients. Patients are generally unaware of the difference. But, getting observation care leave Medicare patients with huge health care bills without their knowledge.

    A new federal law, which takes effect at the end of 2016, will require hospitals to notify patients if they are not admitting them but rather providing them only with observation care. The NOTICE Act or the Notice of Observation Treatment and Implication for Care Eligibility requires that hospitals let patients know within 24 hours that they are receiving observation care, explain the reasons for this care, and advise them of the possible financial consequences.

    You should talk to your doctor if you or someone you love is going to the hospital overnight to make sure the doctor ensures you are admitted for inpatient care and, if not, why not; you should also plan ahead for the visit by following these seven simple steps.

    Hospital patients who are not admitted as inpatients can end up paying a lot more for their care.  Medicare’s hospital benefit, which only kicks in for inpatients, is more generous than Medicare’s medical insurance coverage, which applies to people getting observation care. Among other things, inpatients have their drugs fully covered. Moreover, Medicare patients needing rehabilitation care or skilled nursing care only qualify for coverage if they have been inpatients for at least three days in the thirty days prior to admission.

    Observation care is a classification hospitals use for patients they claim are not sick enough to be admitted and not well enough to be sent home. But, hospital incentives are such that they may take a more liberal view of what constitutes observation care than appropriate. For example, they may want to make it seem that their hospital readmission rates are low to improve their quality ratings and payments from Medicare.

    There’s compelling evidence that hospitals may be manipulating the observation care classification for their benefit. It’s otherwise hard to explain how the percentage of patients receiving observation care in 2013 is so much greater than in 2006.

    Several states, including New York, Connecticut, Maryland, Virginia and Pennsylvania, already have passed laws according similar rights to patients receiving observation care as the NOTICE Act.

    For more reading on this topic, see this article in Health Affairs.

  • Be sure to get your cancer screenings

    Be sure to get your cancer screenings

    Recent data from the Centers for Disease Control reveals that we need to do a better job of getting cancer screening tests.  Screenings for breast, cervical and colorectal cancer were below targets in 2013. Some twenty percent or more of women are still not getting one or more of these tests.

    The CDC in fact found no improvement in cancer screening rates between 2010 and 2013.

    1. Only about three out of four women (73 percent) between the ages of 50 and 74 received a mammography screening.  The recommendation is a screening every two years for people in that age group. (For more information, check out “Do mammograms do more harm than good?“)
    2. Four out of five women (80 percent) reported getting a Pap smear to test for cervical cancer, fewer than in previous years.
    3. Fewer then six out of ten women (58.2 percent) between 50 and 74 reported getting a screening for colorectal cancer.

    If you have Medicare, it will cover these screenings in full.  It also covers several other preventive tests in full if you qualify, including nutrition counseling, weight-loss counseling, smoking cessation counseling.

  • Glaucoma: See a doctor if you experience loss of vision or have a family history

    Glaucoma: See a doctor if you experience loss of vision or have a family history

    Almost one in 50 people over 40 are diagnosed with glaucoma. Glaucoma is a disease that hurts the eye’s optic nerve, leading to loss of vision or blindness. Early treatment, however, generally can prevent significant vision loss.

    You should see a doctor if you think you may have glaucoma. People over 60 are at highest risk for glaucoma. African Americans over 40 are at risk as well, along with diabetics and people with a family history of glaucoma.

    Although Medicare does not pay for standard vision tests, it does cover glaucoma screenings in some instances. Traditional Medicare covers 80 percent of the cost of a glaucoma test annually if you are at high-risk. Supplemental insurance, including Medicaid, should cover the remainder. In order to have coverage, you must visit a Medicare approved eye doctor. Medicare Advantage plans also cover the test if you see a network provider.

    Your eye doctor can detect glaucoma through a comprehensive dilated eye exam. And, if you have glaucoma, it usually can be treated with medications, laser surgery or standard surgery. Unfortunately, lost vision cannot be restored.

    You can read about other preventive services Medicare covers and that you might want to discuss with your doctor on Just Care.

    Here’s more from Just Care:

  • Preventive care: Bone density tests and osteoporosis

    Preventive care: Bone density tests and osteoporosis

    Preventive care is recommended to ensure you stay healthy. Bone density tests or bone mass measurements are a type of preventive care doctors often recommend to diagnose osteoporosis. Patients with osteoporosis have brittle bones and a high likelihood of breaking their bones.

    According to the CDC, 16 percent of women over 50 and 4 percent of men over 50 have osteoporosis of the femur, neck or lumbar spine. The percentage grows significantly for people over 65—24.8 percent of women and 5.6 percent of men.

    Medicare covers the full costs of a bone density test every two years if the doctor prescribes it because:

    1. You are estrogen-deficient at risk for osteoporosis based on medical history or other evidence;
    2. An X-ray shows vertebral abnormalities;
    3. You have been getting steroid treatments for at least three months;
    4. You are diagnosed with hyperparathyroidism;
    5. You are on a drug for osteoporosis.

    For full Medicare coverage, you must see a doctor who takes assignment—accepts Medicare’s rate in full if you have traditional Medicare or an in-network provider if you are in a Medicare Advantage plan. However, if you take the test at the same time as you are getting examined for a range of issues, you will still bear the deductible and coinsurance costs of your doctor’s exam if they are applicable.

    Medicare covers follow-up bone mass measurement or more frequent screenings for osteoporosis if your doctor prescribes them.

    Provided you meet the qualifying criteria, Medicare also covers a range of other preventive care services, including an annual wellness visit, the flu shot, weight counseling, nutrition counseling, smoking cessation, a cardiovascular screening and a diabetes screening.

  • Social Security and Medicare benefits for people with disabilities

    Social Security and Medicare benefits for people with disabilities

    About 10 million people qualify for Social Security and Medicare on the basis of a disability.  Here’s what you need to know about Social Security and Medicare benefits for people with disabilities:

    Apply for Social Security Disability Income at your local Social Security office or online. Call Social Security at 1-800-772-1213 to find out where to go. If you qualify for railroad disability annuity income, go to your local Railroad Retirement Board. (To learn more about Social Security disability policy and how it relates to the recent budget deal, click here.)

    Medicare: You automatically qualify for Medicare when you are under 65 once you have been receiving Social Security Disability Income for 24 months or railroad disability annuity checks. And, there is a five-month waiting period before your Medicare benefits kick in. You do not need to do anything to get Medicare Part A and B.  Your Part B premium will be deducted from your Social Security check. You should not turn down Part B unless you have primary insurance coverage through your or your partner’s current job and you confirm that with the employer offering the coverage and Social Security. You want to avoid being without medical coverage or paying a premium penalty for Part B. (And, keep in mind that Medicare covers only about half your health care costs, so you’ll need supplemental coverage. If your income is low, there are several programs that can help.)

    If you have ALS or Lou Gehrig’s disease, you will automatically be enrolled in Medicare the first month you receive Social Security Disability Income or railroad disability annuity income. There is a five-month waiting period after you are determined to be disabled until you begin receiving benefits. Be sure to make clear that you have ALS to avoid the additional 24-month waiting period for Medicare.

    If you have End Stage Renal Disease (ESRD), you should apply for Medicare through your Social Security office, even if you are a railroad worker. Social Security will need supporting documentation about your disease from your doctor and dialysis center. When Medicare begins depends on your treatment.

    • If you are in a self-dialysis training program, Medicare begins on the first day of the month you begin the program. You must begin the program before the third month of your dialysis and you will need support from your doctor that you will complete the training program and do self-dialysis. Otherwise, Medicare begins the first day of fourth month of your dialysis.
    • If you are receiving a kidney transplant, Medicare begins when you begin receiving health care services for the transplant. Medicare coverage begins no sooner than the two months before the month you receive the transplant.
  • Beware of Medicare and Medicaid fraud and, if you see it, report it

    Beware of Medicare and Medicaid fraud and, if you see it, report it

    Medicare fraud is prevalent. It wastes billions of dollars and drives up health care costs. It comes in all varieties but generally involves bills to Medicare for services that were never provided. You can help identify and report it to the Office of the Inspector General or Medicare if your doctor or hospital bills reflect services you never received.

    Earlier this year, the Justice Department and the U.S. Department of Health and Human Services announced charges against 243 people, including more than three dozen doctors and nurses, for participating in $712 million in Medicare and Medicaid fraud through inappropriate billings. In some cases, services were unnecessary and in others they were never performed.

    In this instance, fraud schemes involved a range of services, including home care, psychotherapy, physical therapy, durable medical equipment and pharmacy fraud.

    Since the inception of the Health Care Fraud Prevention & Enforcement Action Team (HEAT) in 2007, the Medicare Fraud Strike Force operations have charged more than 2,300 people with falsely billing Medicare for more than $7 billion.

  • Medicare covers oxygen equipment and supplies

    Medicare covers oxygen equipment and supplies

    Medicare covers the rental of oxygen equipment and supplies if you meet the qualifying criteria—you must have a doctor’s visit, and your doctor must sign a written order for the equipment, explaining why it is medically necessary. You must also use a Medicare-certified supplier.  If you have traditional Medicare, you can call Medicare for a list of suppliers or visit this link:  www.medicare.gov/supplier. If you are in a Medicare Advantage plan, call the plan to find out which suppliers you can use.

    Medicare will not pay for you to own the equipment.  Here’s how it works:

    • Medicare covers 80 percent of the cost of a five-year rental term for oxygen equipment, oxygen and supplies under Part B.  You are responsible for the 20 percent, which a Medigap plan or retiree insurance should cover.
    • Medicare will pay its share of the cost of the rental for three years.  At that point, both Medicare and you have no financial obligations for the equipment during the next two years. While the supplier still owns the equipment during those two years, you can keep it. You will only need to cover the 20 percent of the cost of the liquid or gaseous oxygen you use each month.
    • After five years, if you still need oxygen you can choose whether to stick with your current supplier or switch to a different Medicare-certified supplier.
    • If you stop needing oxygen before the five-year rental term ends, you can simply let the supplier know it can be picked up.
  • Two tips to help you choose a health plan

    Two tips to help you choose a health plan

    During open enrollment season, many of us struggle to figure out which health plan to choose. People typically remain in their current health plans because that’s generally the easiest choice to make (it may also be our only choice).  But, it may not be the wisest. Your plan costs and benefits may be changing. And, there may be a better, less expensive plan, available to you.

    How do you choose a health plan? If you have Medicare, most people choose traditional Medicare, the public health plan administered by the federal government, because it covers your care from virtually any doctor or hospital in the U.S. And, so long as you have supplemental coverage, almost all of your costs are covered. Here are four tips to consider before choosing between traditional Medicare and a Medicare Advantage or private Medicare plan. If you are choosing among different private health plans–employer plans, exchange plans or Medicare Advantage plans–because you generally will not know your future health care needs or what services the health plan will cover and what you will need to pay out of pocket, it’s really not possible to choose a health plan that you can be sure will meet your needs.

    Here are two factors to consider:

    1. Your doctors and hospital: If you have doctors you know and trust, you likely want to call them to find out which health plans they are enrolled in and narrow down your options to those health plans. Keep in mind that doctors may switch from one health plan to another at any time during the year, so don’t assume that your doctor will remain in your health plan.  Also, if you travel a lot or live in different places at different times of the year, you probably want a health plan that will cover your care wherever you are. Traditional Medicare covers your care anywhere in the United States. Commercial (private) health insurance often limits your coverage to a particular geographic network and does not usually cover out-of-network care, except in emergencies. If you have Medicare, here are two questions to answer during the open enrollment period.
    2. The premium, deductible and copays: When you compare health plans based on costs, be sure to look at the deductible—the amount you pay out of pocket before coverage begins—as well as the premium and copays. Often health plans with low premiums have high deductibles and, if you do end up needing health care services, your costs can be far higher in one of those plans than in a health plan with a higher premium and a lower deductible. For example, a health plan with a $200 monthly premium and a $2500 deductible is effectively charging you $4900 for the year ($2400 plus $2500) if you need a bunch of health care services. A health plan with a $250 monthly premium and a $1000 deductible will cost you $4,000 for the year ($3000 plus $1000). Copays, the amount you pay out of pocket for a doctor’s visit can also add significantly to your costs if they are high and you have a complex condition that needs a lot of care. Keep in mind that your annual out-of-pocket cap can be quite high–it’s as much as $6,850 in a Medicare Advantage plan in 2016. For a crash course on five important health insurance terms, click here.

    Note: If you are enrolled in a Medicare Advantage Plan and would like to switch to traditional Medicare, you can until February 14. To learn more and get free advice, call your State Health Insurance Assistance Program.

    Here’s more from Just Care: