Medicare Reminders

August 4th, 2016

Medicare Reminders

Some of us do not want to think about summer coming to an end, but surely it will soon. Before we know it, we’ll be talking about Medicare Open Enrollment (October 15-December 7).

In the meantime, we want to remind you about some of the Medicare benefits you should be taking advantage of.

First, don’t forget that you get a free Welcome to Medicare Wellness Visit.

If you are new to Medicare you get an Annual Wellness Visit at no cost to Medicare beneficiaries.  As part of that visit, beneficiaries and their physicians can review the patient’s health and develop a personalized wellness plan.  Over 780,000 beneficiaries received an Annual Wellness Visit between January 1 and June 10. Additionally, more seniors have used the Welcome to Medicare Exam this year. The Welcome to Medicare is a one-time preventive health exam available to enrollees in the first 12 months they have Part B.

The new annual wellness visit can help spark the beginning of an ongoing conversation between patients and their doctors on how to prevent disease and disability.  Patients should take advantage of this time by reviewing their histories and making sure their primary care doctor knows about their other providers and prescriptions. They can also talk about the pros and cons of getting an influenza, pneumococcal or hepatitis B vaccination, or find out whether a diabetes test, a bone mass measurement, or any of several cancer screenings would be right for them.

You can find additional information on prevention benefits on line at www.Medicare.gov

Second, don’t forget you can go paperless with Medicare.

Get your copy of the “Medicare & You” handbook or your Medicare Summary Notices (MSNs) electronically.

“Medicare & You” handbook

The Medicare & You handbook is a valuable resource. In an effort to save paper, Medicare is urging you to use the online version instead of the printed one.

You can do that by following 3 simple steps.  First go to https://www.medicare.gov/gopaperless/home.aspx  to sign up for the “go paperless” option of the “Medicare & You” handbook, you will see the three steps, which include entering your personal information (remember medicare.gov is a secure site, even more so if you have an mymedicare.gov account), confirming it and completing the request of the electronic version. Every year in the fall, they’ll send you an email with a link to the new online “Medicare & You.”

Have an eReader (like an iPad, NOOK, Sony Reader, or Kindle)?

Visit Medicare.gov/publications to download a free digital version of this handbook to your eReader. This option is available for all eReader devices. You can get the same important information that’s included in the printed version in an easy-to-read format that you can take anywhere you go. You’ll still get a printed copy of the handbook in the mail if you choose to download the digital version.

Medicare Summary Notices (MSNs)

You can get your MSNs delivered as electronic MSNs (eMSNs).

How to sign-up for eMSNs

You’ll need a MyMedicare.gov account to sign up for eMSNs. If you don’t have an account, visit MyMedicare.gov and select “Create an Account”.

Once you’ve signed up for your MyMedicare.gov account (or if you already have an account), complete these 5 steps between 6 a.m. and 10 p.m. (Eastern Time):

  1. Visit MyMedicare.gov, and login to your account.
  2. Select “My Account” from the menu.
  3. In the “User information” tab, select “Email and Correspondence Settings.”
  4. In the “Electronic Medicare Summary Notices (eMSNs)” area, select “Edit.”
  5. Select “Yes” and then “Submit” and you’re done.

Always remember to visit www.medicare.gov or call 1-800-MEDICARE to get answers to all your Medicare questions.

Stay tuned to NJFA’s blog, Renaissance magazine and the Aging Insights TV program for Medicare Open Enrollment information.

medicare

 

ATM Safety

July 13th, 2016

ATM Safety

Despite all the advancements in credit/debit card protections- like the new chip system- scammers are still targeting consumers in one of the most vulnerable transactions- the ATM.

You may have noticed when you got a new credit or debit card or noticed at the store that they have a new machine. It’s all for this chip technology, where you insert your credit card and that machine reads the chip instead of the magnetic strip on the back on the card. This technology is more difficult for thieves to counterfeit, hopefully protecting you from theft or fraud.

However, even with this technology, there is still one area where criminals have success and that is stealing information right from the ATM as you use it. According to the FICO Card Alert Service, the number of ATMs compromised rose more than 500 percent last year over 2014. Just as credit card companies and banks are developing new technology, so are scammers and thieves. There has been an increase in the number of sophisticated (and cheap) devices out there that make it easier for criminals to access your protected information. ATMs are susceptible to these devices known as skimmers. The skimmers are card-reading devices that fit over the existing ATM slot. When you put your card in the skimmer reads the information and copies the magnetic strip. In addition, the thieves usually install a hidden video camera installed the records you entering your pin. There are even devices available that can read the new chip technology, these are known a shimmers and work in a similar way as the skimmers.

The average thief takes $650 from each skimmed account. Getting your money back is possible, however it is important to report the crime quickly.

Here are some ways to protect yourself from skimming or shimming.

Use the ATM at your bank. The ATM at your bank is less likely to have been tampered with. And often have their own 24/7 camera surveillance for your protection.

Be alert. Take a look at any ATM before you use it. Is the card slot a different color than the rest of the machine? Are any parts of the machine off? Is the light obscured? Is something off center or hanging over the keypad? These are all signs the machine could have been tampered with. If the machine doesn’t take your card easily or anything looks off about the ATM, do not use it.

Take extra caution to guard your PIN. Use your hand to cover the keypad, be cautious of anyone standing too close. If something or someone feels suspicious, walk away.

Sign up for alerts and monitor your account. Checking with your bank about programs that provide transaction alerts. And be sure to check your statement on a regular basis to make sure all transactions were authorized by you.

To prevent big losses- you could create another account specifically for ATM withdraws and keep a low balance in that account. This way if your account is compromised the thief won’t walk away with all of your money.

You can also ask the bank to lower your daily limit for ATM withdrawals. A lot of these scams involve multiple withdrawals within minutes, having a low limit, like $100 a day, means the scammers wouldn’t be able to drain your account.

However, if you do fall victim to an ATM scam make sure you report it. It is important to do so immediately. Acting fast limits your liability for charges you didn’t authorize. Report the loss or theft of your card to the card issuer as quickly as possible. Many companies have toll-free numbers and 24-hour service for such emergencies. Once you report the loss of your ATM or debit card, federal law says you cannot be held liable for unauthorized transfers that occur after that time.

Hot Enough for Ya? Make sure it’s safe enough for ya!

July 7th, 2016

During the summer months, you should be careful when temperatures rise. We can expect several heat waves this summer and you’ll want to know how to stay cool. When temperatures hit the 90’s it can be dangerous to be outdoors for too long.   Children, older adults, people with disabilities and pets are most at risk during excessive temperatures.

High temperatures and humid conditions have the possibility of making outdoor activities and non-air-conditioned facilities extremely dangerous and uncomfortable. Be mindful of the threats that heat waves pose such as heat cramps, heat exhaustion, heat stroke and sometimes death. These threats can be minimized and eliminated if we practice heat-related precautions and guidelines. Hot, dry skin, an absence of sweat and a rapid and strong pulse, are all signs of heat stroke. If you have elderly family members, friends or neighbors, be sure to check in on them to make sure they are keeping cool, especially if they live alone. Here are some heat related emergency safety tips:

  • Stay indoors in air conditioning as much as possible
  • If you do go outside stay in the shade
  • If your home is not air conditioned, spend at least two hours daily at an air conditioned mall, library or other public place
  • Wear sunscreen outside, along with loose fitting light colored clothes that cover as much skin as possible
  • Drink water regularly even if you are not thirsty. Limit alcohol, and sugary drinks which speeds dehydration
  • Never leave children or pets alone in the car
  • Avoid exertion during the hottest part of the day
  • Take a cool shower or bath
  • Be a good neighbor, check on elderly and people with disabilities in your community who may need assistance keeping cool

Additionally, residents should contact their local and/or county offices of emergency management regarding any open air-conditioned senior centers or cooling stations, or call  2-1-1.  According to the U.S. Center for Disease Control and Prevention, older adults and people with disabilities are more at risk for heat because they do not adjust as well as young people to sudden changes in temperature; they are more likely to have a chronic medical condition that changes normal body responses to heat; and they are more likely to take prescription medicines that impair the body’s ability to regulate its temperature or that inhibit perspiration.    The CDC also offers the following tips for older adults, persons with disabilities and/or their caregivers:

  • Visit older adults who are at risk at least twice a day and watch them for signs of heat exhaustion or heat stroke.
  • Encourage them to increase their fluid intake by drinking cool, nonalcoholic beverages regardless of their activity level. Warning: If their doctor generally limits the amount of fluid they drink or they are on water pills, they will need to ask their doctor how much they should drink while the weather is hot.
  • Take them to air-conditioned locations, if they have transportation problems.

You can contact your County Office on Aging to find out about help such as cooling centers (call 1-877-222-3737 or see this list http://www.njfoundationforaging.org/services/). For more information regarding heat related emergencies, please log on to www.ready.nj.gov, visit the National Weather Service Heat Safety Page (http://www.weather.gov/om/heat/index.shtml), or log on to NJ  2-1-1 (www.nj211.org).

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Water, creating a balance is essential.

May 10th, 2016

Water, creating a balance is essential.

In the NY Times Science Section’s Well, Personal Health column on May 10, Jane Brody shares her experience with mild dehydration after two very physically active days.  She cites Professor Barry Popkin who talks about things we do not truly know about water, like how hydration impacts our health and well-being, or how much is really required. While there are suggested guidelines, it can be difficult to know exactly how much water you need to drink. The Institute of Medicine determined that an adequate intake (AI) for men is roughly about 13 cups (3 liters) of total beverages a day. The AI for women is about 9 cups (2.2 liters) of total beverages a day. This can vary depending on your health issues, activity level, the weather, etc.  We probably need to drink somewhere within the suggested guidelines in order to be sufficiently hydrated each day.  This may be difficult since as we age the mechanism of thirst becomes a less effective trigger for reminding us to drink water.

How can you remember to drink enough water? Have a glass at the same time and in the same place during your routine every day. Get in the habit of drinking a glass of water right after you get out of the shower, or right before you wash your face at night, put a glass of water on your nightstand so you see it before you go to bed or have a glass waiting by the coffee maker so you remember to have a glass while your coffee brews.

Cheers.

Beverages-Ice-Water

 

 

Preventing Falls at Home

April 5th, 2016

Preventing Falls at Home

Falls are not inevitable; it isn’t something that just happens as you get older. Falls are linked to a specific cause.  It could be that more than one underlying cause or risk factor is involved in a fall.

Falls can be linked to a person’s physical condition or a medical problem, such as a chronic disease. Other causes could be safety hazards in the person’s home or community environment.

What are some Risk Factors for falls?

  • Muscle weakness, especially in the legs, is one of the most important risk factors. People with weak muscles are more likely to fall than are those who maintain their muscle strength, as well as their flexibility and endurance.
  • Your balance and your gait — how you walk — are other key factors. Older adults who have poor balance or difficulty walking are more likely than others to fall. These problems may be linked to a lack of exercise or to a neurological cause, arthritis, or other medical conditions and their treatments.
  • Blood pressure that drops after you have been lying down or sitting can increase your chance of falling. This condition — called postural hypotension — might result from dehydration, or certain medications. It might also be linked to diabetes, neurological conditions such as Parkinson’s disease, or an infection.
  • Your reflexes may also be slower than when you were younger. The increased amount of time it takes you to react may make it harder to catch your balance if you start to fall.
  • Foot problems that cause painful feet, and wearing unsafe footwear can increase your chance of falling. Backless shoes and slippers, high-heeled shoes, and shoes with smooth leather soles are examples of unsafe footwear that could cause a fall.
  • Sensory problems can cause falls, too. If your senses don’t work well, you might be less aware of your environment. For instance, having numbness in your feet may mean you don’t sense where you are stepping.
  • Not seeing well or other vision problems can also result in falls. It may take a while for your eyes to adjust to see clearly when you move between darkness and light. Other vision problems contributing to falls include poor depth perception, cataracts, and glaucoma. Having poor lighting around your home can also lead to falls.
  • Confusion, even for a short while, can sometimes lead to falls. For example, if you wake up in an unfamiliar environment, you might feel unsure of where you are. If you feel confused, wait for your mind to clear or until someone comes to help you before trying to get up and walk around.
  • Some medications can increase a person’s risk of falling because they cause side effects like dizziness or confusion. The health problems for which the person takes the medications may also contribute to the risk of falls.

Most Falls Happen at Home

Although falls can happen anywhere, well over half of all falls happen at home. Falls at home often happen while a person is doing normal daily activities. Some of these falls are caused by factors in the person’s living environment. For instance, a slick floor or a poorly lit stairway may lead to a fall.

Other factors that can lead to falls at home include

  • loose rugs
  • clutter on the floor or stairs
  • carrying heavy or bulky things up or down stairs
  • not having stair railings
  • not having grab bars in the bathroom

Simple changes can help make your home safer.

If you do fall, what should you do?

Well, be sure to talk with your doctor if you fall. A fall could be a sign of a new medical problem that needs attention, such as an infection or a cardiovascular disorder. It could also suggest that a treatment for a chronic ailment, such as Parkinson’s disease or dementia, needs to be changed.

For the time immediately after a fall, here are some tips:

While you are still on the ground:

  1. Take several deep breaths to try to relax.
  2. Remain still on the floor or ground for a few moments. This will help you get over the shock of falling.
  3. Decide if you’re hurt before getting up. Getting up too quickly or in the wrong way could make an injury worse.

Once you are ready to get up:

  1. If you think you can get up safely without help, roll over onto your side.
  2. Rest again while your body and blood pressure adjust. Slowly get up on your hands and knees, and crawl to a sturdy chair.
  3. Put your hands on the chair seat and slide one foot forward so that it is flat on the floor. Keep the other leg bent so the knee is on the floor.
  4. From this kneeling position, slowly rise and turn your body to sit in the chair.

If you’re hurt or can’t get up, ask someone for help or call 911. If you’re alone, try to get into a comfortable position and wait for help to arrive.

For more information and resources, visit the NJ Dept of Human Services website: http://www.state.nj.us/humanservices/doas/services/fallprev/

 

 

Take the American Medicine Chest 5 Step Challenge

March 29th, 2016

Prescription Drug Safety and Disposal

Take the American Medicine Chest 5 Step Challenge

By: Angelo M. Valente

The American Medicine Chest Challenge (AMCC) is a community based public health initiative, with law enforcement partnership, designed to raise awareness about the dangers of prescription drug abuse and provide a nationwide day of disposal – at a collection site or in the home – of unused, unwanted, and expired medicine. AMCC provides a unified national, statewide, and local focus on the issue of children and teens abusing prescription medicine. It is designed to generate unprecedented media attention and challenge all Americans to take the 5 Step American Chest Challenge.

It is important for households across the state of New Jersey to understand how easy it is for children and teens to abuse prescription drugs. “AMCC encourages families throughout the state of New Jersey to take the 5-Step Challenge,” said AMCC CEO, Angelo M. Valente. “We have come so far and so much has been achieved – hundreds of permanent disposal sites have been installed and thousands of tons of prescription drugs have been collected. Yet, we are still in the midst of an opiate abuse epidemic and the need for this initiative has continued to expand ever since New Jersey held the first statewide day of disposal in the nation.”

“When AMCC began addressing this issue several years ago, the answer seemed simple, dispose of the unused medicine in your home and prevent it from being diverted and abused by the young people in your life. Safe disposal opportunities have expanded in New Jersey, and now, residents in over 200 communities from across our state have safe and convenient access to a medicine disposal location,” said Valente. “The DEA recently reinstated their Drug-Take Back Day to provide additional opportunities, and the partners we have in the media are working hard to get the message out about the dangers of abusing prescription drugs. We still know that these efforts are key steps in preventing prescription drug abuse, but now we must address the epidemic of opioid abuse on all fronts. Heroin overdoses are on the rise across the country and New Jersey is ground zero.”

According to a report released in 2015 by the Centers for Disease Control and Prevention (CDC), heroin use has increased across the US among men and women, most age groups, and all income levels. The report found that the strongest risk factor for heroin use is a history of prescription drug abuse. The greatest increases in heroin abuse have occurred in groups with historically lower rates of heroin use, including women, people with private insurance and higher incomes.

New Jersey has worked to address the issue in a 21 bill package, introduced by Senate Health, Human Services and Senior Citizens Committee Chairman, Joseph F. Vitale, to tackle the heroin and prescription drug epidemic that is sweeping our state. One measure requires practitioners to have a conversation with their patient about the risks of developing a physical or psychological dependence before prescribing. Another, which is now law, requires physicians to utilize the Prescription Drug Monitoring Program.

There are many ways we can work together to prevent opiate abuse, and stem the tide of this epidemic; we can start in our own homes. “Please encourage all of those in your community, workplace, family, and home to take the 5-Step Challenge,” said Valente.

  1. Take inventory of your prescription and over-the-counter medicine.
  2. Secure your medicine.
  3. Dispose of your unused, unwanted, and expired medicine at an American Medicine Chest Challenge Disposal site.
  4. Take your medicine(s) exactly as prescribed.
  5. Talk to your children about the dangers of prescription drug abuse… they are listening.

Information on locations to safely dispose of unused, unwanted, and expired medicine can be found on the American Medicine Chest Challenge website: www.americanmedicinechest.com or by downloading the AMCC Rx Drop mobile app.

This initiative is provided without cost to any community, government, or law enforcement agency in the country.

 

Income Taxes and Your Social Security Benefits

March 7th, 2016

It’s tax season, perhaps you know this because there is an accountant in your life who just got super busy or you’ve seen the increase in TV ads for Turbo Tax. Either way, we thought this timely information from our friends at the Social Security Administration might be useful.

Income Taxes and Your Social Security Benefits

Join the Millions! Create your own my Social Security account

at www.socialsecurity.gov/myaccount.

With tax season upon us, many of you have asked about Income Taxes And Your Social Security Benefits. Some people have to pay federal income taxes on their Social Security benefits. This usually happens only if you have other substantial income (such as wages, self-employment, interest, dividends and other taxable income that must be reported on your tax return) in addition to your benefits.

Note: No one pays federal income tax on more than 85 percent of his or her Social Security benefits based on Internal Revenue Service (IRS) rules. If you:

  • file a federal tax return as an “individual” and your combined income* is
  • between $25,000 and $34,000, you may have to pay income tax on up to 50 percent of your benefits.
  • more than $34,000, up to 85 percent of your benefits may be taxable.
  • file a joint return, and you and your spouse have a combined income* that is
  • between $32,000 and $44,000, you may have to pay income tax on up to 50 percent of your benefits
  • more than $44,000, up to 85 percent of your benefits may be taxable.
  • are married and file a separate tax return, you probably will pay taxes on your benefits.
  • Each January you will receive a Social Security Benefit Statement (Form SSA-1099) showing the amount of benefits you received in the previous year. You can use this Benefit Statement when you complete your federal income tax return to find out if your benefits are subject to tax.
  • If you currently live in the United States and you need a replacement form SSA-1099 or SSA-1042S, we have a new way for you to get an instant replacement quickly and easily. Using your online my Social Security account. If you don’t already have an account, you can create one online. Go to Sign In or Create an Account. Once you are logged in to your account, select the “Replacement Documents” tab.

Withholding Income Tax From Your Social Security Benefits

You can ask us to withhold federal taxes from your Social Security when you apply for benefits.

If you are already receiving benefits or if you want to change or stop your withholding, you’ll need a form W-4V from the Internal Revenue Service (IRS).

You can download the form, or call the IRS toll-free number 1-800-829-3676 and ask for Form W-4V, Voluntary Withholding Request. (If you are deaf or hard of hearing, call the IRS TTY number, 1-800-829-4059.)

When you complete the form, you will need to select the percentage of your monthly benefit amount you want withheld. You can have 7%, 10%, 15% or 25% of your monthly benefit withheld for taxes.

Note: Only these percentages can be withheld. Flat dollar amounts are not accepted.

Sign the form and return it to your local Social Security office by mail or in person.

If you need more information

If you need more information about tax withholding, read IRS Publication 554, Tax Guide for Seniors, and Publication 915, Social Security and Equivalent Railroad Retirement Benefits.

If you have questions about your tax liability or want to request a Form W-4V, you can also call the IRS at 1-800-829-3676 (TTY 1-800-829-4059).

 

Announcing NJFA’s 18th Annual Conference!

February 29th, 2016

Announcing NJFA’s 18th Annual Conference!

NJFA will hold its 18th Annual Conference on Thursday, June 2nd at the Crowne Plaza Monroe. The 2016 Morning Keynote Speaker will be Ruth Finkelstein, ScD, who is an internationally recognized leader of inspiring and creating strategies for aging friendly communities. She is Assistant Professor of Health Policy and Management at Columbia University Mailman School of Public Health where she also serves as the Associate Director of the International Longevity Center-Columbia Aging Center (ILC-CAC). At the Columbia Aging Center she currently leads the translation of interdisciplinary scientific knowledge on aging and its implications for societies into policy-focused practice in order to maximize productivity, quality of life, and health across the life course. The Luncheon Keynote is Karin Price Mueller. She writes the Bamboozled consumer affairs column for The Star-Ledger which often addresses senior scams. Karen is also the founder of a personal finance web site that offers smart and objective advice on everything money, NJMoneyHelp.com. She is the recipient of many national and local journalism awards.

The 2016 conference workshop speakers will include policy makers, direct care & clinical practice specialists. Topics include Hearing Loss, Dementia, Older Worker Programs and more.

More information and registration can be found on NJFA’s website at www.njfoundationforaging.org Limited vendor space and sponsorships remain, call us at 609-421-0206, email at office@njfoundationforaging.org  or check out the website for details.

The New Jersey Foundation for Aging (NJFA) is a public charity with the primary goal to empower elders to live in the community with independence and dignity.

 

To learn more about the work of the Foundation visit www.njfoundationforaging.org or call 609-421-0206. The New Jersey Foundation for Aging was established in 1998, its mission is promote policy and services that enable older adults to live in the community with independence and dignity.

Medicare Hospice Benefit

February 1st, 2016

Medicare Hospice Benefit

Hospice and other end of life issues are not things we often want to talk about. However, being prepared and knowing all your options is a good idea.

We should start by describing hospice. Hospice is a program of care and support for people who are terminally ill. The focus is usually on providing comfort instead of treatment. It is a choice a patient needs to make with their doctor and family. Hospice programs also offer assistance and services to family members during the process of caring for the patient.

If you have Medicare it will cover hospice services. The Medicare hospice benefit covers your care and you shouldn’t have to go outside of hospice to get care (except in very rare situations).

Once you choose hospice care, your hospice benefit should cover everything you need. All Medicare-covered services you get while in hospice care are covered under Original Medicare, even if you were previously in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan.

Medicare Part A (Hospital Insurance) covers Hospice care if you meet these conditions:

Your hospice doctor and your regular doctor certify that you’re terminally ill (with a life expectancy of 6 months or less).

You accept palliative care (for comfort) instead of care to cure your illness.

You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

Palliative care means that the medical team will focus on relieving the patient’s pain and any other symptoms, including mental stress. Only your hospice doctor and your regular doctor can certify that you’re terminally ill and have 6 months or less to live.

To start the process you meet with your doctor to discuss all options. Medicare covers a one-time only hospice consultation with a hospice medical director or doctor to discuss your care options and management of your pain and symptoms. This one-time consultation is available to you, even if you decide not to get hospice care.

Medicare will cover the hospice care you get for your terminal illness and related conditions, but the care you get must be from a Medicare-approved hospice program.

Hospice care is can be given in your home. Although depending on your needs and wishes, there are also inpatient programs available. That is one of the things you will discuss with the hospice program (and your loved ones). Together you will create a plan of care that can include any or all of these services:

Doctor services

Nursing care

Medical equipment (like wheelchairs or walkers)

Medical supplies (like bandages and catheters)

Prescription drugs

Hospice aide and homemaker services

Physical and occupational therapy

Speech-language pathology services

Social worker services

Dietary counseling

Grief and loss counseling for you and your family

Short-term inpatient care (for pain and symptom management)

Short-term respite care

Any other Medicare-covered services needed to manage your terminal illness and related conditions, as recommended by your hospice team

You can find out more information at medicare.gov or by calling them at 1-800-Medicare. Hospice specific information and resources are available at https://www.medicare.gov/coverage/hospice-and-respite-care.html

You can also talk to your physician about your options and care available in your area.

This information is meant to inform you of coverage available to you should you need it. Don’t be afraid to talk openly with your family about end of life decisions.

 

Medicare Coverage

January 12th, 2016

Medicare coverage

What does Medicare cover? It’s a common, but also complex question. Medicare has 2 basic parts, Part A, which is known as hospital insurance (we’ll define that in a minute) and Part B, which covers services, such as lab tests, doctor visits, etc. Part A and Part B together are known as Original Medicare.

Medicare recipients also have the choice to enroll in a Medicare Advantage plan (also known as Part C) which is delivered by an HMO. This coverage differs from Original Medicare not only in the delivery of benefits but also what is covered. There are many different plan options under Medicare Advantage and you can learn more at medicare.gov

When it comes to Original Medicare, coverage works like this:

Medicare Part A (Hospital Insurance) covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. To sum it up, Part A covers:

  • Hospital care
  • Skilled nursing facility care or Nursing home care (as long as custodial care isn’t the only care you need)*
  • Hospice (provided by a Medicare approved program, either at home or an inpatient setting)**
  • Home health services

**Keep a look out for a blog post on Medicare Coverage of Hospice Services coming soon.

*This is where some of the complexity of Medicare comes in. When a patient is sent to a nursing home/rehab facility for rehabilitation, Medicare covers your stay on a short term basis. Medicare does not pay for “long term care” or “custodial care”. If needed, Medicare will cover your rehab stay for 20 days at 100%, on day 21 (should you still need to be there) you will be responsible for a 20% copay. The maximum amount of rehab time Medicare will pay for is 100 days, so from day 21 to day 100 you would pay 20% of the cost. If you or a loved one are in a situation where you have to be in a rehab facility for more than 20 days, you should definitely be thinking about your options and what your plan for long term care is. At that point you should have already had a meeting with the discharge planner if not an interdisciplinary team at the facility.

Medicare Part B (Medical Insurance) covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Part B covers 2 types of services:

  • Medically necessary services: Services or supplies that are needed to diagnose or treat your medical condition and that meet accepted standards of medical practice.
  • Preventive services: Health care to prevent illness (like the flu) or detect it at an early stage, when treatment is most likely to work best.

Preventive services include screenings such as, mammograms, colonoscopies, bone mass measurements, and other cancer screenings, if your doctor thinks you are at risk. You also get a Welcome to Medicare visit within your first 12 months of enrollment, during this visit you can talk to your doctor about screenings and review your medical history. In addition to the Welcome to Medicare visit, you are entitled to an Annual Wellness visit. You pay nothing for most preventive services if you get the services from a health care provider who accepts assignment.

Part B covers things like:

  • Ambulance services
  • Durable medical equipment (DME)
  • Mental health
    • Inpatient
    • Outpatient
    • Partial hospitalization
  • Getting a second opinion before surgery
  • Limited outpatient prescription drugs

The fourth part of Medicare is Part D, which is prescription drug coverage. With Original Medicare prescriptions are not paid for, therefore you should obtain a separate Medicare Part D plan.

To learn more about all the parts of Medicare and to explore your options, such as, Original Medicare (Part A & B), Medicare Advantage (Part C) and Prescription Drug Coverage (Part D) visit https://www.medicare.gov/ or call 1-800-MEDICARE (1-800-633-4227).

You can also contact your local SHIP (State Health Insurance Assistance Program) through you County- find their contact information at: http://www.state.nj.us/humanservices/doas/home/sashipsite.html or call the SHIP Information Center at 1-800-792-8820.

 

medicare