Posts Tagged ‘hospital’

MEDICARE OPEN ENROLLMENT

Wednesday, October 25th, 2017

MEDICARE OPEN ENROLLMENT

ARE YOU AWARE OF YOUR CHOICES?

Charles Clarkson, Esq. Jewish Family Services of Middlesex County, Project Director/VP, Senior Medicare Patrol of New Jersey

 

Every year between October 15 and December 7, during a period known as ?¢‚Ǩ?ìOpen Enrollment,?¢‚Ǩ¬ù Medicare beneficiaries can make changes in their Medicare coverage. The Senior Medicare Patrol of New Jersey (SMP), a Federally funded program of the U.S. Administration for Aging, believes that if you know your options you can avoid being scammed and make the right choices giving you the best coverage at the least cost.

Why make a change?  Whether you have Original Medicare (Part A and/or B), Part D (prescription drug plan), or a Part C Medicare Advantage Plan, your plan can change.  Premiums, deductibles  and coverages can all change.  Even if they remain the same, your health or finances may have changed. SMP encourages all beneficiaries to re-visit their coverage and decide whether or not to change during Open Enrollment.

Beneficiaries have these choices:

  1. If you are enrolled in Original Medicare, you can change to a Medicare Advantage plan with or without drug coverage. These plans are private companies approved by Medicare and give you the services of Original Medicare. If you join a Medicare Advantage plan, you do not need (and are not permitted) to have a Medicare supplement insurance plan (also known as a Medigap policy) and if your Medicare Advantage plan has drug coverage, you will not need a Part D plan.

 

  1. If you are in a Medicare Advantage Plan, you can switch to another Medicare Advantage plan or drop your Medicare Advantage Plan.  If you decide to drop a plan and not switch to another plan, you will be enrolled in Original Medicare.  You should then consider enrolling in a Medicare supplement insurance plan to cover the costs that Original Medicare does not pay for and enroll in a Part D plan for drug coverage.

 

  1. If you are in Original Medicare with a Part D plan, you can stay in Original Medicare and switch your Part D plan.

 

  1. If you are in Original Medicare and do not have a Part D plan, you can enroll in a Part D plan.¬† If you join a Part D plan because you did not do so when you were first eligible for Part D and you did not have other coverage that was, on average, at least as good as standard Medicare drug coverage (known as creditable coverage), your premium cost will be penalized 1% for every month that you did not enroll in Part D.¬† You will have to pay this penalty for as long as you have a drug plan.¬† The penalty is based on the national average of monthly premiums multiplied by the number of months you are without coverage and this amount can increase every year.¬† If you qualify for extra help (low income subsidy), you won’t be charged a penalty.

Why change Part D plans?

Beneficiaries may want to change Part D prescription drug plans (PDPs) for a number of reasons:¬† (i) the PDP has notified the beneficiary that it plans to drop one or more of their drugs from their formulary (list of available medications); (ii) the beneficiary is reaching the coverage gap (donut hole) sooner than anticipated and may want to purchase a PDP with coverage through the coverage gap, if one is available; (iii) the PDP has notified the beneficiary that it will no longer participate in the Medicare Part D program;¬† (iv) the PDP will increase its premium or co-pays higher than the beneficiary wants to pay and a less expensive plan may be available and (v) a beneficiary is not happy with the PDP’s quality of service or the plan has received low rankings for a number of years.¬† For 2018 beneficiaries in New Jersey can expect to choose from a number of¬† PDPs. The plans are announced in late September or early October, 2017.

Compare plans each year.

Beneficiaries should remember that PDPs change every year and it is recommended that beneficiaries compare plans to insure that they are in the plan that best suits their needs.  When comparing plans, keep in mind to look at the estimated annual drug costs, i.e. what it will cost you out of pocket for the entire year, from January 1 through December 31 of each year.  Plans can be compared at the Medicare web site:  www.medicare.gov.  If you do not have access to a computer, call Medicare at 1-800-Medicare to assist in researching and enrolling in a new plan. Medicare can enroll a beneficiary over the telephone.  When you call, make sure you have a list of all your medications, including dosages.  Another resource for Medicare beneficiaries is the State Health Insurance Assistance Program (known as SHIP), telephone 1-800-792-8820.  SHIP is federally funded and can provide beneficiaries with unbiased advice.  Call SHIP to make an appointment with a counselor. You do not need to use a broker or agent who may not be looking out for your best interest. Brokers and agents are usually being paid to enroll you in certain plans.  Beneficiaries can also call the Senior Medicare Patrol of New Jersey at 732-777-1940.

Medicare Open Enrollment can also be a time of fraudulent schemes that can cost you money. The SMP wants you to be on the alert for scams involving new Medicare cards.¬† Back in the spring of 2015, Congress passed the “Doc Fix”¬ù bill which mainly dealt with the long standing problem of the Physician Fee Schedule.¬† At the same time, Congress sought to remedy the problem caused by having Social Security numbers on the red, white and blue Medicare ID cards.

 

The new cards will be rolled out starting in April of ?Ǭ†2018.?Ǭ† Since it will take a period of time to mail new Medicare cards to all Medicare beneficiaries, there will be a transition period through December 31, 2018 when beneficiaries will be able to use either card.¬† All cards should be issued by April of 2019.?Ǭ† You should start using the new Medicare card once you receive it.¬† Make sure that the Social Security Administration and Medicare have your current address to insure that you get your new card.

 

This card change is both a blessing and a curse for Medicare beneficiaries.¬† By removing Social Security numbers, the change greatly decreases the financial havoc that a stolen Medicare card can cause, but it opens the door to scammers¬† presenting a golden opportunity to take advantage of Medicare beneficiaries.¬† Remember, there is never a charge for the new Medicare card.¬† Scammers already are calling¬† and scaring seniors into paying $300 or more for a new Medicare card and asking for their checking account information to pay for the new card’s fee.

What do you do when you realize that a scammer is calling?  Just hang up.  Do not be polite and just hang up.  Also, do not open any emails about the new Medicare cards even if they appear to be coming from a legitimate source, such as Medicare.  They are most likely scams.  Any questions about the new Medicare cards, call the Senior Medicare Patrol of New Jersey at 732-777-1940.

 

 

 

 

 

 

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.

Medicare Coverage

Tuesday, 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

Announcing NJFA’s 17th Annual Conference!

Thursday, March 26th, 2015

Announcing NJFA’s 17th Annual Conference!

NJFA will hold its 17th Annual Conference on Wednesday, June 3rd at the Crowne Plaza Monroe. The 2015 Keynote Speakers are James Firman, CEO of NCOA and Nora Dowd Eisenhower, Assistant Director of the Consumer Finance Protection Bureau Office of Financial Protection for Older Americans. Jim Firman will address the crowd in the morning. Heis recognized leader and advocate in the field of aging. Mr. Firman will discuss a variety of topics including key aspects of the political and legislative landscape, such as the White House Conference on Aging and the Affordable Care Act. He will also talk about NCOA’s work on Elder Justice, Economic Security, Benefits Check-up, Senior Hunger and evidence based programs.

Ms. Dowd Eisenhower will be the luncheon keynote speaker and will discuss the mission and structure of the Consumer Finance Protection Bureau (CFPB) and the specific role of the Office for Older Americans. She will also talk about CFPB tools/guides on financial decisions such as reverse mortgages or choosing a financial advisor. This will include two programs from CFPB that look at preventing elder financial exploitation and guides created for powers of attorney, etc.

The 2015 conference workshop speakers will include policy makers, direct care & clinical practice specialists. Topics include Dental Health and Oral Cancer Screenings, Addiction and Gambling in Older Adults, New Models of Care, Elder Bullying and more.

More information and registration can be found on NJFA‚Äôs website at www.njfoundationforaging.org Limited vendor space and sponsorships remain, call us at 609-421-0206, email at [email protected] 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.slide_01

Encore Presentation!

Wednesday, October 22nd, 2014

 Encore Presentation!

 NJFA is pleased to announce that we will be hosting an Encore Presentation of two sessions offered at our June conference. If you were unable to attend in June or if you did attend and did not get to these sessions, now is your chance!

 Also, please send this along to any colleagues who may have missed out on our June conference.

 Space is limited! Register today!

 NJFA Fall Seminar Series

Monday, November 10th

8:30 am to 12 pm

Crowne Plaza Monroe

Aging in Place for All

Land Use and Complete Streets- Considerations for age friendly communities.

Karen Alexander, MPA, Managing Director, NJTIP @ Rutgers

Tim Evans, MS, MCRP from NJ Future

Recognizing and Adjusting Attitudes to Serve LGBT Seniors

Carolyn Bradley, Ph.D, LCSW, LCADC, Associate Professor Monmouth University.

 2 CEUS for Social Workers, LNHA/CALA, Activity/Recreation Professionals

 8:30 am        Registration and Continental Breakfast

9:00 am        Welcome

9:30 am        Program Begins

 Registration: $45

Please RSVP by November 3rd.

Name:______________________________ Organization:________________________________

Email:_______________________   Phone#:___________________

Payment:

?Check

Please make check payable to NJ Foundation for Aging, 145 W. Hanover St. Trenton, NJ 08618

?Credit Card

(Visa/Mastercard/Discover Only)

Name (as appears on Card) _____________________

CC #________________________________________

Security Code(3 digit # on back of card)___ Exp Date___

Billing Zip Code ____________

This program has been sponsored by The Reinvestment Fund

Questions? For more information, contact the New Jersey Foundation for Aging at 609-421-0206 or email [email protected]

Please return this form by November 3, 2014 to the email above or fax to 609-421-2006

Space is limited, register early!

 

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http://www.njfoundationforaging.org/