United Healthcare Oxford Medicare Advantage Denies Coverage
ABC NEWS/GOOD MORNING AMERICA: Senior With Fractured Back Battles UnitedHealthcare Oxford Health Insurance Company Medicare Advantage Plan GMA segment shows UnitedHealthcare/Oxford’s Medicare Advantage Plan would not authorize woman’s care due to alleged age discrimination. Audit shows Medicare Advantage providers with backlogs of unanswered patient complaints, plans that improperly denied claims, and concerns about marketing practices which do not follow government guidelines.
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The Importance of Maternity Coverage
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Home Page > News and Society > Women’s Issues > The Importance of Maternity Coverage
The Importance of Maternity Coverage
Posted: Nov 18, 2008 |Comments: 0
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The Importance of Maternity Coverage
By: Sarah Martin
About the Author
Sarah Martin is a freelance marketing writer based out of San Diego, CA. She specializes in business, finance, and different types of life insurance. For affordable life insurance, please visit http://www.equote.com/.
(ArticlesBase SC #647735)
Article Source: http://www.articlesbase.com/ – The Importance of Maternity Coverage
Maternity coverage is a really good idea if you are pregnant. Check your existing insurance policies. You will probably discover that you are not covered. It’s great to be expecting but many people are not expecting the huge expenses that come with having a child. Many Americans who are pregnant have not even thought of getting such a thing as maternity coverage. It is just an extra expense.
They face the risk of getting lousy prenatal care. Without this type of coverage they have to find the money to pay for their prenatal costs and also they may be in big trouble if there is a medical emergency that they cannot afford to address. This is why health and affordable life insurance (http://www.equote.com/li/term-life-insurance-quote.html) is so critical-family breadwinners do not want to put their family in a position where they will be a financial burden should something unexpected occur.
Another problem is that a lot of women think they are covered on their regular insurance policy but maternity coverage often has to be added specifically. If you are not sure it is best to check with your insurance provider who may tell you something insane sounding such as “you are covered but your fetus is not.” It is just a good idea to cover all of your bases as so much actually can go wrong with either the mom or the baby during a pregnancy.
Maternity coverage is a bit of a hot button issue with insurers as well. Some don’t offer it all and instead perceive it as a preexisting medical condition. This means that if something happens you are not covered even if you have regular health insurance. Even though this is illegal the insurance companies seem to get away with it all of the time.
There are many group insurance plans that do have maternity coverage for their members. However if you are a member of this type of plan you should still check to see that you are actually covered because sometimes there are clauses that say that there must be a waiting period.
For instance some maternity coverage clauses will state that you must wait two years after you have enrolled in the plan before your coverage kicks in. Of course Murphy’s Law states that you will get pregnant one year after enrolling in that case. This dilemma is similar to many life insurance policyholders-there are stipulations on when policyholders can actually cash in on their different types of life insurance (http://www.equote.com/info/life-insurance-info.html).
Sometimes you can be carrying extended coverage from a previous employer which can be of great assistance to you if your current employer does not have the maternity coverage in place. If you are really stuck there are also low income programs like Medicaid but the problems with that health service are well known. They are just not as good as those natal care services provided by the more expensive private doctors who love to be paid via your maternity coverage premiums through the insurance company.
If maternity coverage is prohibitively expensive than you can get maternity cards that help you defray the costs of some of your pre-natal examinations and other needs. It is less costly than regular insurance. Almost every maternity package that you can apply for will have that thirty day waiting period before it kicks and you are reimbursed for your expenses. Always study the package that is offered before accepting it to make sure that it fits in time-wise with the term of your pregnancy.
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(ArticlesBase SC #647735)
Sarah Martin -
About the Author:
Sarah Martin is a freelance marketing writer based out of San Diego, CA. She specializes in business, finance, and different types of life insurance. For affordable life insurance, please visit http://www.equote.com/.
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Source: http://www.articlesbase.com/womens-issues-articles/the-importance-of-maternity-coverage-647735.html
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Sarah Martin is a freelance marketing writer based out of San Diego, CA. She specializes in business, finance, and different types of life insurance. For affordable life insurance, please visit http://www.equote.com/.
Categories: Doctors who accept medicaid Tags: Coverage, Importance, Maternity
Medicare supplement benefits for better Medicare coverage
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Besides that there are also some other things that should also be kept in mind in respect of using the benefits of the Medicare supplement plans. Among these the most primary fact is that to get enrolled to the Medicare supplement plans an individual must be first of all be a beneficiary of the Original Medicare Part A and B. This is the basic requirement of being enrolled to the Medigap plans. On the other hand it is also important to note that if anyone switches over to any other plan other than the original Medicare he or she cannot use the benefits of these plans unless he or she switches back to the original Medicare.
The main benefit of the Medicare supplement Insurance plans as mentioned above is to cover up the gap left behind by the Original Medicare plans but along with that some of these plans also provide some extra benefits which are not enlisted in the coverage of the original Medicare. The Medigap offerings or the Medicare supplement plans were standardized by the Centers of Medicare and Medicaid Services (CMS) in 1992. since then there had been 12 standard Medicare supplement plans named A through L. These plans have been put under the administration of the private health insurance companies and are also sold by these companies only. In 2006 it had been clearly stated that the Medigap Plans H, I, and J, cannot be sold to people with prescription to drug benefits, although there is a relaxation of this rule for those who already own these plans prior to that.
However it should always be kept in mind that though the Medicare Supplement Insurance Plans can only be sold by the private insurance companies only and are under their administration still no single company possess the power to bring in any changes in the standard plans. Therefore if you want to purchase a Medicare supplement plan from any company, you can rest assured of the fact that you will get the same benefits as being mentioned by the standardization rules. But in this context it should also be kept in mind that the premium rates for these plans may differ from company to company.
To cover the gap left behind by the original Medicare it is essential to get the Medicare Supplemental Plans and also to get the maximum benefits out of Medicare Supplement it is essential to learn the Medicare Insurance Rates.
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Need Health Insurance Coverage?
Four Steps to Help You Get the Most from Your Health insurance Coverage Finding, buying, and understanding health insurance coverage options aren’t always easy tasks. Here are some easy tips to follow on how to start your journey through all of the online healthcare madness.
Step One – Make a list of your current health conditions, medications, and any other current health related issues. You’ll also want to make a note of your primary concerns and questions about choosing adequate health insurance.
Step Two – Get information from several health insurance providers. Not all health care plans are the same. It’s well worth the time and effort to review more than once health insurance policy. It can save you time, money, and improve the quality of your healthcare in the future.
Some of the big names in Health insurance may be a great place to start your comparisons such as: Golden Rule Insurance, Celtic Insurance, American Medical Security Insurance, Time Insurance, UNICARE Insurance, Humana Insurance and Blue Cross Blue Shield of Michigan Insurance just to name a few.
Those of you looking for Michigan Medicaid and Medicare help must first meet the requirements for qualifications. Each county may have different requirements such as income and more. Check with your local health department for more information.
Step Three – Review each health insurance plan making notes of benefits provided for these basic coverage sections: physical exams, specialists’ care, hospitalization, prescription drugs, dental care, vision care, emergency care Ob-Gyn care, preventative care, and alternative care coverage. Remember to evaluate using the notes you made in step one.
Pay careful attention to co-pays, spending limits, and deductible amounts in each section for each health insurance plan you’re reviewing. The goal is to do what’s called “comparison shopping.” As you go through this process, most likely one or two health care policies will seem to meet your needs better than the others.
Step Four – Once you’ve picked out two or three possible health insurance plans, make notes of questions and concerns about each. Now it’s time to get your questions answered and make your decision.
It’s important to make sure you’re speaking with a qualified, licensed health insurance agent. Don’t hesitate to continue to ask questions until you feel you have all the information you need to make a good choice.
Other Helpful Information
Compare Health insurance Plans Online and Save Time
Take your time to find what you need at a price you can afford. What is great about looking for Health insurance options online is you can compare plans and benefits first on your own, without talking to different representatives. Most Health insurance companies offer FREE online services and FREE online instant rate quotes. All that is required is for you to quickly fill out a secured application. In the matter of minutes you should have your results in front of you. Just in case you have questions these companies have licensed Health insurance professionals waiting for your call.
Keep it Going! Who Can Benefit From Temporary Health insurance?
Temporary health insurance or short-term medical insurance is also available in Michigan and will allow you to have coverage for a temporary amount of time. This type of insurance isn’t right for everyone. Inquiries of this form of health care usually comes from those who are between jobs, seasonal employees, laid-off and can even benefit young adults recently coming off of their parents’ health plan. Plans tend to last somewhere between six months but some have been known to go twelve months.
Temporary Health insurance forms are much more simple than permanent insurance. Coverage on a short-term plan can begin as quickly as twenty-four hours. This insurance caters to unseen accidents and illness. Because it is temporary, they do not typically cover preventive care, vision, dental or pre-existing conditions. For pre-existing conditions you may want to check your COBRA benefits. There Are Other Ways to Keep Your Health insurance after Losing Your Job
Don’t let recent un-employment keep you from the care that you need! For instance if a loved one is expecting, the last thing you want is to lose your maternity insurance. There is another alternative called consolidated Omnibus Budget Reconciliation Act or COBRA. This type of insurance normally last longer than temporary or short-term insurance but it is still a type of temporary insurance. Normally COBRA policies can last for approximately eighteen months. For more detailed information on COBRA’s extended policy plans talk to your employer about their specific Health insurance carrier’s plan. Many people don’t know about temporary Health insurance coverage. In fact, people take chances between coverage all the time because of lack of knowledge. The advantage of temporary Health insurance coverage is to fill a gap in coverage. Although this is temporary coverage is great to have, it does not replace permanent coverage. Michigan HIPAA Laws and How They Could Effect You
If you currently have pre-existing conditions and are looking into short-term Health insurance coverage WAIT! You may be buying health coverage that will not cover you and then make you ineligible for the care that you need. HIPAA stands for Health Insurance Portability and Accountability Act. HIPAA plans are mainly for those who have pre-existing conditions and may have trouble getting health insurance. These plans can be extremely expensive. The HIPAA Federal law gives a person immediate access to comparable coverage when leaving employment that provided coverage.
Get familiar with your rights and consult your benefits advisor to discuss the best options for you. You can take back your health with Health insurance companies where there is a plan to fit everyone’s need. Reading up and doing your homework on plans that pertain to your needs can help eliminate useless information and help you find the right Health insurance plan much faster.
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Categories: Medicaid qualification Tags: Coverage, Health, Insurance, NEED
Historic Measure Expands Health Coverage
This is the VOA Special English Economics Report, from voaspecialenglish.com The United States has a new health care reform law. The main goal is to insure about thirty-two million additional people. That is about ninety-five percent of Americans who are not already covered by Medicare, the government insurance program for older people. About sixteen million people will be added to Medicaid, the government health plan for the poor. The law will require Americans to have health insurance, with a few exceptions, or pay a fine starting in four years. Also, in four years, employers with more than fifty workers will have to offer their employees a health insurance plan. Employers will pay a fine for each uninsured worker. Smaller businesses will receive tax credits to help pay for health plans. People not covered by employer plans, Medicaid or Medicare could buy health insurance in marketplaces called exchanges. The idea is that competition among plans will drive down costs. States will provide these exchanges by twenty fourteen. The law is the biggest change in American health care since nineteen sixty-five. But it is not a government operated health care system like the ones in other countries. President Obama said it provides limited reform. He said So this is not radical reform. But it is major reform. This legislation will not fix everything that ails our health care system. But it moves us decisively in the right direction. Barry Arbuckle is chief executive of the non …
View full post on Medicare & Medicare Programs
N.J. gets $4.2M for enrolling children in health coverage program
The federal Centers for Medicare & Medicaid Services has awarded New Jersey a $4.2 million performance bonus for increasing NJ FamilyCare health insurance enrollment among eligible, uninsured, children in the state, Gov. Jon Corzine announced Thursday.
Only eight other states – Alabama, Alaska, Illinois, Louisiana, Michigan, New Mexico, Oregon and Washington – qualified for the bonus.
“Access to health insurance for children has been a touchstone of my administration,” Corzine said. “This bonus is a much appreciated honor for our state and a testament to the commitment we’ve exercised in insuring more than 100,000 new children over four years.”
“With our governmental and not-for-profit partners, the Department of Human Services has been working incredibly hard to find and insure eligible children using innovative programs, including presumptive eligibility in hospitals and clinics, and school-based outreach facilitators,” Commissioner Jennifer Velez said. “This award proves that, while there are many children still in need of health care coverage, New Jersey is making great headway.”
In order to receive the bonus, the federal CMS rated states on two areas: Implementing at least five of eight specific programs to promote enrollment and retention for children, and increasing enrollment above a formulaic target set by the Children’s Health Insurance Program Reauthorization Act of 2009.
New Jersey exceeded CMS’ minimum requirements by successfully increasing accessibility to children’s enrollment in six program areas: Continuous 12-month eligibility, eliminating the financial asset test, eliminating in-person interview at application and renewal, instituting single, unified, form for application and renewal, instituting automatic verification at renewal, and instituting presumptive eligibility for coverage.
New Jersey also achieved a 4.2 percent enrollment increase above baseline enrollment for federal fiscal year that ended Sept. 30.
Presently, NJ FamilyCare, the state’s program for low-income families, insures more than 614,197 children and provides a free or low-cost health care coverage for income-eligible families. For example, a family of four earning up to $77,175 – or 350 percent of the federal poverty level – can qualify to insure their children for $133 a month in the state- and federally-funded program.
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Medigap insurance plans the Supplemental Medicare Plans for better coverage
If you have any insurance then it can not be said that the insurance will provide you all the spending or requirement that you would need at that time of your necessity. You simply can not say that. Here we will discuss about health insurance plans. Even best Medicare insurance plan can not assure you with that. Medigap Health Insurance Plans or Medicare health insurance plans are that type of insurance plans which can cover the gap between the Medicare health insurance and original spending at hospital and in buying medicines and doctor’s fees. Supplemental Medicare insurance plans are there only to help you to pay your excess medical bill that makes you worried. These types of bills are left aside by the main or principal medical bill. So to pay this bill you can use medigap insurance plans as your helping aid. As the name suggests, it is a supplement plan that is bought along with an original Medicare plan. In an original plan there always remains a gap and it cannot pay for the total bill charged. Therefore there is the need for a supplement plan to clear off your dues. Medicare supplemental plans are therefore very much needed if you want that you will not spend a penny from your pocket and will have the full coverage of your original Medicare health insurance plans.
Medicare policy coverage starts from the age of 65 of the insurance owner. Actually if you have purchased a Medicare policy then in normal state your Medicare coverage would start on the 1st day of the month you turn 65. So it means that if you reach the age of 65 on 20th of May your policy coverage would start on 1st of the same month. As we have said all the left aside costs by the original Medicare plans are paid by this medigap insurance plans. This pays the extra medical bill and cost of doctors not paid by the Medicare plans. And this is because they are not the part of your policy coverage. These costs are added in bill for the services that you receive. Therefore you need to pay for that extra money from your own pocket even if you are having an Original Medicare plan. As this supplemental plan makes the gap complete or bridge the gap therefore this is called medigap insurance plans. The name itself signifies its purpose. These are supplementary plans having close relationship with the Original Medicare plans. The supplemental Medicare insurance Plans are totally administered and sold by the private insurance companies and there are 12 standard Medigap plans that are to be sold by them. Though there are total 12 plans in this supplemental plan but the buzz is that there two more 2 plans which are likely to be introduced by the Medicare supplement insurance companies and those are plan M and plan N.
And among all these medigap companies medigap California is the one that is appropriate and best Medicare supplement plan available in the market.
The Medigap insurance, Medigap insurance plans and Medigap Health Insurance Plans available here.
Medicare Coverage For Mental Health And Alzheimer’s Care
What coverage does Medicare provide for inpatient hospital care for mental illness?
Modern medicine recognizes that many mental and emotional problems are in fact physical illnesses or related to them. So, with either Medicare Part A hospital insurance plus Medicare Part B medical insurance, or with a Part C Medicare Advantage managed care plan, participants have extensive coverage for treatment of mental or emotional illness, including depression, Alzheimer’s disease, and other forms of dementia. This includes both inpatient and outpatient care, and treatment not only by doctors but also by other Medicare-certified healthcare providers.
The amount of coverage Medicare provides depends on the kind of hospital where the person receives care.
Care in a general hospital. If the inpatient care she receives is in a general, nonpsychiatric hospital that treats patients for all types of illness, the rules of coverage are the same as for any other hospital stay. That is, under Medicare Part A, she must pay a deductible, plus daily co-payments for a stay of more than 60 days within any one benefit period. If she’s in the hospital for more than 90 days in any one benefit period, Medicare Part A pays part of the cost of up to 60 more once-in-a-lifetime “reserve days”. However, there’s no lifetime limit on the number of hospitalizations that Medicare Part A will pay for. If she has a Part C Medicare Advantage managed care plan, it pays for at least this same amount of inpatient care, and some plans pay more of the cost.
Care in a psychiatric hospital. If she’s an inpatient in a psychiatric hospital — meaning one that accepts patients only for mental health care — the rules of payment are the same as for a general hospital but the total amount of coverage is different. Medicare Part A covers only a total of 190 days in a patient’s lifetime for inpatient care in a psychiatric hospital.
Does Medicare cover nursing facility care or home healthcare for mental illness, Alzheimer’s, or other forms of dementia?
Nursing facility care.
The single most important thing to understand about Medicare and nursing facilities is that Medicare does not pay for long-term care. However, under limited circumstances and for a short time, Medicare Part A or a Medicare Advantage managed care plan can cover a stay in a skilled nursing facility while the person is recovering from a severe mental health episode that landed her in the hospital. The nursing facility stay must follow, within 30 days, a hospital stay of at least three days. And the nursing facility stay must be medically required and prescribed by her doctor to provide her with daily skilled nursing or rehabilitation services while she’s recovering from the medical event that put her in the hospital. The coverage can last for up to 100 days, with Medicare paying the full amount for the first 20 days and your family member having to make a co-payment of $133.50 (in 2009) per day for days 21 through 100. For more details about Medicare Part A nursing facility coverage, see our article Understanding Medicare Part A (Hospital Insurance).
Home care.
Home care is available under Medicare Part A, Part B, or Part C (managed care) if it’s medically necessary for any illness or condition, including mental illness, Alzheimer’s, and other forms of dementia. But the rules under which Medicare coverage is available for home care are quite strict, and coverage usually lasts only a short time.
The key thing about Medicare coverage for home care is that it applies only to home healthcare. That means your family member must need skilled nursing care or rehabilitation therapy while she’s confined to home because of an injury or illness. It doesn’t cover assistance with the activities of daily living such as dressing, bathing, walking, or eating unless these are provided incidentally, alongside required skilled medical care. A doctor must prescribe the home care and it must be provided by a Medicare-certified home healthcare agency.
If the person in your care qualifies, Medicare pays 100 percent of the agency’s costs. But the care can continue only as long as the skilled nursing or therapy is required, while she’s actually recovering. Home healthcare is covered by Medicare Part A following a hospital stay, or by Medicare Part B if there has been no prior three-day hospital stay. If she’s enrolled in a Part C Medicare Advantage managed care plan, that plan provides home care under the same rules, except that the home care agency must be associated with the specific managed care plan.
Is care from a psychologist or adult daycare covered by Medicare?
Psychological care.
Psychological counseling is not technically medical care. But under some circumstances, Medicare Part B or Medicare Part C managed care will cover counseling by a clinical psychologist. The person’s doctor must prescribe the treatment. The psychologist must be certified by Medicare. And the psychological care must relate to a problem — such as depression or anxiety — arising out of a medical condition for which the doctor is treating her. If she’s suffering emotionally from the strain of a physical illness, suggest that she discuss the problem with her doctor. If she and the doctor believe she might benefit from psychological counseling, Medicare Part B or her Medicare Advantage managed care plan might cover the care. The office of the psychologist she’s referred to can find out in advance from Medicare whether it would cover her treatment there.
Adult daycare.
In general, adult daycare provides personal monitoring and attention with structured activity in a secure environment. Medicare usually considers this type of care “custodial” rather than medical and so usually doesn’t cover it. Medicare can cover services from an adult daycare center only in very limited circumstances. Medicare might cover actual mental health treatment, prescribed by a physician, provided at an outpatient mental health clinic. If this clinic is also an adult daycare center, the patient can get the benefit of the center’s other care services while receiving treatment there. Medicare will cover this kind of care only if, and for as long as, it involves actual medical treatment — administration and monitoring of medication, for example, or help with recovery from a medical crisis.
Also, some Part C Medicare Advantage managed care plans offer limited adult daycare coverage as part of their comprehensive home care services. Medicare doesn’t require that these plans offer this, so the nature and extent of what they cover depends entirely on the plans themselves.
Finally, Medicare partners with Medicaid to sponsor what’s called the Program of All-Inclusive Care for the Elderly (PACE). This provides comprehensive home and community care, including adult daycare, for frail elders who would otherwise require nursing home care. PACE is only available in certain states, however. And in those states, it may be available only to those who are eligible for both Medicare and Medicaid. See Medicare’s official website at www.medicare.gov for a list of PACE programs.
Does Medicare cover therapeutic services for Alzheimer’s patients or medications for anyone’s mental health conditions?
Therapeutic services for Alzheimer’s patients.
For a long while, Medicare didn’t consider various therapies for people who had been formally diagnosed with Alzheimer’s disease medically necessary, and so did not cover them.
This policy has changed. If the person in your care has been diagnosed with Alzheimer’s, Medicare Part B can now cover physical, occupational, and speech therapy for her, as well as psychological counseling and other mental health services. Her doctor must prescribe the treatment, however, and it must be provided by a Medicare-certified therapist or mental health provider.
Medications for mental health conditions.
Any medication administered to someone when she’s a hospital or nursing facility inpatient, whether or not she’s an Alzheimer’s patient, is covered by Medicare Part A. Any medication given to her at her doctor’s office or at any outpatient health facility is covered by Medicare Part B. Things get much trickier with prescription drugs taken at home. The only coverage Medicare provides for at-home medications is through a Medicare Part D prescription drug plan. Coverage for specific drugs the doctor may prescribe for mental health issues depends on the formulary — the covered list of drugs — that her plan maintains.
There’s a special prohibition, however, on certain drugs that are often prescribed to cope with mental health issues. Medicare doesn’t permit a Part D prescription drug plan to cover any medication within the categories of barbiturates (certain sedatives) and benzodiazepines (certain tranquilizers), even if a physician has prescribed it. So if she’s taking one of these drugs, and she’d like to have coverage from her Part D drug plan, ask her doctor whether a similarly effective drug might be available that does not technically fall into either of these categories.
Caring.com Editorial Team
Caring.com features original content focused exclusively on eldercare matters. Our 20+ editors and writers research and fact-check every article meticulously, and our advisory board reviews the site regularly to assure the accuracy and relevance of the material we publish. We have hundreds of articles and checklists on health, housing, finance, legal and family issues, and other caregiving concerns, and we’re adding new articles and other resources every day.
View full post on Social Security Network
Categories: Social Security Tags: Alzheimer’s, Care, Coverage, Health, Medicare, Mental
Medicare Coverage For Mental Health And Alzheimer’s Care
What coverage does Medicare provide for inpatient hospital care for mental illness?
Modern medicine recognizes that many mental and emotional problems are in fact physical illnesses or related to them. So, with either Medicare Part A hospital insurance plus Medicare Part B medical insurance, or with a Part C Medicare Advantage managed care plan, participants have extensive coverage for treatment of mental or emotional illness, including depression, Alzheimer’s disease, and other forms of dementia. This includes both inpatient and outpatient care, and treatment not only by doctors but also by other Medicare-certified healthcare providers.
The amount of coverage Medicare provides depends on the kind of hospital where the person receives care.
Care in a general hospital. If the inpatient care she receives is in a general, nonpsychiatric hospital that treats patients for all types of illness, the rules of coverage are the same as for any other hospital stay. That is, under Medicare Part A, she must pay a deductible, plus daily co-payments for a stay of more than 60 days within any one benefit period. If she’s in the hospital for more than 90 days in any one benefit period, Medicare Part A pays part of the cost of up to 60 more once-in-a-lifetime “reserve days”. However, there’s no lifetime limit on the number of hospitalizations that Medicare Part A will pay for. If she has a Part C Medicare Advantage managed care plan, it pays for at least this same amount of inpatient care, and some plans pay more of the cost.
Care in a psychiatric hospital. If she’s an inpatient in a psychiatric hospital — meaning one that accepts patients only for mental health care — the rules of payment are the same as for a general hospital but the total amount of coverage is different. Medicare Part A covers only a total of 190 days in a patient’s lifetime for inpatient care in a psychiatric hospital.
Does Medicare cover nursing facility care or home healthcare for mental illness, Alzheimer’s, or other forms of dementia?
Nursing facility care.
The single most important thing to understand about Medicare and nursing facilities is that Medicare does not pay for long-term care. However, under limited circumstances and for a short time, Medicare Part A or a Medicare Advantage managed care plan can cover a stay in a skilled nursing facility while the person is recovering from a severe mental health episode that landed her in the hospital. The nursing facility stay must follow, within 30 days, a hospital stay of at least three days. And the nursing facility stay must be medically required and prescribed by her doctor to provide her with daily skilled nursing or rehabilitation services while she’s recovering from the medical event that put her in the hospital. The coverage can last for up to 100 days, with Medicare paying the full amount for the first 20 days and your family member having to make a co-payment of $133.50 (in 2009) per day for days 21 through 100. For more details about Medicare Part A nursing facility coverage, see our article Understanding Medicare Part A (Hospital Insurance).
Home care.
Home care is available under Medicare Part A, Part B, or Part C (managed care) if it’s medically necessary for any illness or condition, including mental illness, Alzheimer’s, and other forms of dementia. But the rules under which Medicare coverage is available for home care are quite strict, and coverage usually lasts only a short time.
The key thing about Medicare coverage for home care is that it applies only to home healthcare. That means your family member must need skilled nursing care or rehabilitation therapy while she’s confined to home because of an injury or illness. It doesn’t cover assistance with the activities of daily living such as dressing, bathing, walking, or eating unless these are provided incidentally, alongside required skilled medical care. A doctor must prescribe the home care and it must be provided by a Medicare-certified home healthcare agency.
If the person in your care qualifies, Medicare pays 100 percent of the agency’s costs. But the care can continue only as long as the skilled nursing or therapy is required, while she’s actually recovering. Home healthcare is covered by Medicare Part A following a hospital stay, or by Medicare Part B if there has been no prior three-day hospital stay. If she’s enrolled in a Part C Medicare Advantage managed care plan, that plan provides home care under the same rules, except that the home care agency must be associated with the specific managed care plan.
Is care from a psychologist or adult daycare covered by Medicare?
Psychological care.
Psychological counseling is not technically medical care. But under some circumstances, Medicare Part B or Medicare Part C managed care will cover counseling by a clinical psychologist. The person’s doctor must prescribe the treatment. The psychologist must be certified by Medicare. And the psychological care must relate to a problem — such as depression or anxiety — arising out of a medical condition for which the doctor is treating her. If she’s suffering emotionally from the strain of a physical illness, suggest that she discuss the problem with her doctor. If she and the doctor believe she might benefit from psychological counseling, Medicare Part B or her Medicare Advantage managed care plan might cover the care. The office of the psychologist she’s referred to can find out in advance from Medicare whether it would cover her treatment there.
Adult daycare.
In general, adult daycare provides personal monitoring and attention with structured activity in a secure environment. Medicare usually considers this type of care “custodial” rather than medical and so usually doesn’t cover it. Medicare can cover services from an adult daycare center only in very limited circumstances. Medicare might cover actual mental health treatment, prescribed by a physician, provided at an outpatient mental health clinic. If this clinic is also an adult daycare center, the patient can get the benefit of the center’s other care services while receiving treatment there. Medicare will cover this kind of care only if, and for as long as, it involves actual medical treatment — administration and monitoring of medication, for example, or help with recovery from a medical crisis.
Also, some Part C Medicare Advantage managed care plans offer limited adult daycare coverage as part of their comprehensive home care services. Medicare doesn’t require that these plans offer this, so the nature and extent of what they cover depends entirely on the plans themselves.
Finally, Medicare partners with Medicaid to sponsor what’s called the Program of All-Inclusive Care for the Elderly (PACE). This provides comprehensive home and community care, including adult daycare, for frail elders who would otherwise require nursing home care. PACE is only available in certain states, however. And in those states, it may be available only to those who are eligible for both Medicare and Medicaid. See Medicare’s official website at www.medicare.gov for a list of PACE programs.
Does Medicare cover therapeutic services for Alzheimer’s patients or medications for anyone’s mental health conditions?
Therapeutic services for Alzheimer’s patients.
For a long while, Medicare didn’t consider various therapies for people who had been formally diagnosed with Alzheimer’s disease medically necessary, and so did not cover them.
This policy has changed. If the person in your care has been diagnosed with Alzheimer’s, Medicare Part B can now cover physical, occupational, and speech therapy for her, as well as psychological counseling and other mental health services. Her doctor must prescribe the treatment, however, and it must be provided by a Medicare-certified therapist or mental health provider.
Medications for mental health conditions.
Any medication administered to someone when she’s a hospital or nursing facility inpatient, whether or not she’s an Alzheimer’s patient, is covered by Medicare Part A. Any medication given to her at her doctor’s office or at any outpatient health facility is covered by Medicare Part B. Things get much trickier with prescription drugs taken at home. The only coverage Medicare provides for at-home medications is through a Medicare Part D prescription drug plan. Coverage for specific drugs the doctor may prescribe for mental health issues depends on the formulary — the covered list of drugs — that her plan maintains.
There’s a special prohibition, however, on certain drugs that are often prescribed to cope with mental health issues. Medicare doesn’t permit a Part D prescription drug plan to cover any medication within the categories of barbiturates (certain sedatives) and benzodiazepines (certain tranquilizers), even if a physician has prescribed it. So if she’s taking one of these drugs, and she’d like to have coverage from her Part D drug plan, ask her doctor whether a similarly effective drug might be available that does not technically fall into either of these categories.
Caring.com Editorial Team
Caring.com features original content focused exclusively on eldercare matters. Our 20+ editors and writers research and fact-check every article meticulously, and our advisory board reviews the site regularly to assure the accuracy and relevance of the material we publish. We have hundreds of articles and checklists on health, housing, finance, legal and family issues, and other caregiving concerns, and we’re adding new articles and other resources every day.
Categories: Doctors who accept medicaid Tags: Alzheimer's, Care, Coverage, Health, Medicare, Mental
Medicare Part D prescription coverage
As seen on The Doctors As a caregiver for an elderly loved one, it can be difficult to determine the right Medicare Part D prescription plan a person needs. A few things to do to help figure out the best coverage include: • Assess the person’s healthcare and prescription needs • Gather social security and coverage policy providers/numbers • Create a contact list for the person’s health care professionals (primary doctor, specialists, pharmacist, etc.) • List their current prescriptions, including dosages and history of past health problems By doing a cost comparison of each prescription across the various Medicare Part D plans, it is possible to identify the plan that will deliver the most savings. This assessment of costs should be done each year during the Medicare open enrollment in November/December. Asking your pharmacist about the generic version of your name-brand medications is another way the pharmacy can help you save money on your loved one’s prescriptions. Featuring CVS pharmacist Jeff McClusky (original airdate: 12/1/09) To see more of The Doctors, check out The Doctors TV channel here on YouTube www.youtube.com or click here to find TV listings for the show in your area: www.thedoctorstv.com
View full post on Medicare and Medicare Programs
Categories: Medicare Tags: Coverage, Medicare, Part, Prescription