Posts Tagged ‘health plan’

Medicare Hospice Benefit

Monday, 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.

 

Affordable Care Act: Fact 4

Thursday, April 7th, 2011

Affordable Care Act (ACA) Facts: Follow this Series

This is part 4 of our ongoing series, so please see Fact # 1 in a post dated, Feb 8, 2011, Fact # 2 in the post dated 2/24/11 and Fact # 3 in a post dated 3/8/11.

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and their families.

Fact # 4: The law will improve care for older adults in other ways besides changes to Medicare.

There are improvements beyond Medicare that will help you and your family.  In a previous blog post we discussed the long term care changes that will improve for older adults such as changes to Medicaid that will allow people the choice of home and community based care and regulations that will prevent a spouse from becoming impoverished if their spouse is receiving home and community based care through the Medicaid Program.

There are also measures written in the Affordable Care Act (ACA) that will help early retirees. To help offset the cost of employer-based retiree health plans, the new law creates a program to preserve those plans and help people who retire before age 65 get the affordable care they need. By providing financial relief to businesses that provide health coverage to early retirees, health reform will make it easier for early retirees to obtain health care coverage. Health insurance reform will guarantee that you will always have choices of quality, affordable health insurance even if you retire early and lose access to employer-sponsored insurance. It will create a health insurance exchange so you can compare prices and health plans and decide which quality affordable option is right for you.

The ACA also sets up protections for people with pre-existing conditions. The new law provides affordable health insurance through a transitional high-risk pool program for people without insurance due to a pre-existing condition. The Dept. of Banking and Insurance in NJ as already begun working on the high-risk pool program. Insurance companies will be prohibited from denying coverage due to a pre-existing condition for children starting in September, and for adults in 2014. Insurance companies will be banned from establishing lifetime limits on your coverage, and use of annual limits will be limited starting in September.

And if you are concerned for the young people in your life who may be struggling to find a job in this economy, the ACA didn’t forget them either. According to the Law, young people up to age 26 can remain on their parents’ health insurance policy starting in September of 2011.

Information in this blog was gathered from the Affordable Care Act, Centers for Medicaid and Medicare and the National Council on Aging.

Healthcare Reform information from

The White House:

http://www.whitehouse.gov/assets/documents/Pages_from_Health_Insurance_Reform_PDF-4.pdf

Medicare

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

National Council on Aging

http://www.ncoa.org/public-policy/health-care-reform/straight-talk-for-seniors-on.html