Elderly Pharmaceutical Insurance Coverage
EPIC, administered by the New York State Department of Health, helps many older New Yorkers pay for prescription drugs. It covers those who do not have adequate insurance coverage for prescription drugs and who are not eligible for Medicaid. EPIC is coordinated with Medicare Part D prescription coverage to provide services with additional coverage for prescription medication.
For additional information:
Home Health Care Services Covered By Medicare
As opposed to standard in-home care, home health care is considered skilled nursing care and thus is covered by Medicare. A range of home care services falls under the benefit. Some of the covered home health care services include:
- Skilled Nursing Care: This includes all care services that must be carried out by registered or licensed nurses, such as medication administration and monitoring of your vital signs. Medicare only covers intermittent nursing services, which means part-time. There are time limits on how many hours per week and/or days per month of care that Medicare will cover.
- Therapy Services: Often needed when recovering from an illness or injury, this includesrehabilitation services such as physical and occupational therapy and speech-language pathology.
- Medical Social Services: Medical social services involve counseling to help seniors deal with the emotional and social impact of their illness or injury.
- Medical Supplies: Any medical supplies related to the condition for which youre being treated, such as catheters and wound dressings, are covered by Medicare. Durable medical equipment like wheelchairs may be partially covered.
Its important to note that even when the above criteria are met, Medicare never covers full-time home health care. If you need around-the-clock care and cannot financially support full-time, in-home health care without Medicare, a skilled nursing community may be a better option.
Technology Help For Seniors
Many seniors are insecure about their technological prowess. In fact, in a Pew Research Center survey, only 26 percent of Internet users over age 65 said they felt very confident when it came to using smartphones and computers. And almost three-quarters of the 65-plus crowd said they needed other people to show them how to use a new electronic device. But there are plenty of ways that seniors can expand their technological skills.
SeniorNet provides computer help for seniors over 55. It’s a non-profit organization that offers computer and Internet training in learning centers all over the country. Courses cover topics like how to use tablets, send email, download applications, and take digital photos. A yearly membership fee is required.
TechBoomers is a free website that teaches older adults how to navigate and use popular sites related to education, shopping, entertainment, and social media. Tutorials are aimed at those with basic computer skills.
Free technology training workshops are also available from AARP TEK. Topics focus on the use of smartphones and tablets. You don’t have to be an AARP member to take advantage of these workshops they are open to everyone.
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New York State Partnerships For Long
The New York State Partnership for Long-Term Care combines private long-term care insurance with Medicaid to help people prepare financially for possible nursing home care, home care or other long-term care services as specified under the policy. It allows New Yorkers to protect assets while remaining eligible for Medicaid extended coverage if their long-term care needs exceed the period covered by their private partnership insurance policy. For an application, contact your local office for the aging.
For additional information:
Does Medicare Pay For Caregivers
A person must meet specific eligibility rules to get home care services, and sometimes, extra costs may apply that Medicare does not cover.
This article discusses the different types of caregivers, what Medicare pays for, and help with out-of-pocket costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
There are different types of in-home caregivers. Some help with nonmedical personal care, while others offer medical services.
Common types of caregivers include:
Medicare pays for caregivers when:
- a person is under the care of a doctor
- a doctor has certified a person as homebound
- the care delivered is through a written plan that the doctor regularly reviews
- part-time skilled nursing care
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Additional Advantages Of Medicare Advantage Plans
Its crucial to be aware of the many august benefits you might receive with the private Medicare program besides the appealing feature of flex cards. Among the popular advantages provided by Medicare Advantage Plans are:
- Discounts on over-the-counter medicines plan
- Free meals upon hospitalization plan
- Free transportation for medical emergencies plan
- Dental protection plan
- Hearing protection plan
- Benefits of telehealth plan
You can also look for Medicare Advantage plans with Zero-premium plans, gym memberships, access to medical facilities, and health programs are among the additional features that Medicare Advantage often provides. For more information on the benefits of the Flex Card, you can check out our article What are the benefits of a flex card?.
Long Term Care Benefits
Medicare is the primary medical care insurance for a large number of seniors. Many are shocked to discover that Original Medicare , also called Traditional Medicare, does not cover costs for most types of long-term care, including Alzheimers and dementia care. When it does pay, it is only in a very limited capacity. While Traditional Medicare is not a long-term care solution, there are benefits for seniors with recoverable conditions on a short-term basis. Also, as mentioned previously, some Medicare Advantage Plans now offer some home and community based long-term care benefits under specific circumstances.
Skilled Nursing FacilitiesMedicare will pay for 100% of the cost of care up to 20 days at a skilled nursing facility and approximately 80% of the cost up to 80 more days. The care must be for recovery following an in-patient hospital stay.
Assisted Living CommunitiesMedicare does not cover any cost of assisted living. It will pay for most medical costs incurred while the senior is in assisted living, but will pay nothing toward custodial care or the room and board cost of assisted living. Some Medicare Advantage plans may pay for personal care assistance for persons residing in assisted living or memory care, but will not contribute towards the cost of room and board.
Adult Day CareOriginal Medicare does not pay for adult day care services, but some Medicare Advantage plans may cover the cost.
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Questions & Answers About Smp
What do I do if I have been scammed?If you have detected suspicious or erroneous activity on your Medicare Summary Notice or Part D Explanation of Benefits, you should contact your provider or plan. If you are not comfortable calling your provider or plan or you are not satisfied with the response you get, call your local Arizona SMP Helpline at 1-800-432-4040.
How do SMPs prevent health care fraud?SMPs conduct outreach in their communities by presenting to groups, hosting exhibits and community events, providing one-on-one counseling, and answering calls to the SMP help lines. SMP volunteers also help Medicare and Medicaid beneficiaries who are unable to address fraud by themselves, and, if necessary, SMPs will refer beneficiaries to outside organizations that can investigate.
How can I protect myself against Medicare fraud?Protect your personal information. Dont give sensitive information to someone you dont know. Your Social Security, Medicare, and bank account numbers can be used to defraud you. You also should avoid sending personal information on the phone or over an unsecure Internet connection. Never purchase items from a website that youve found from and e-mail link. If you know the name of an organization you want to do business with, go to the website on your own.
How can I detect fraud and identify errors?Here are a few simple steps you can take to detect possible fraud.
Integration Of Sunshine Health And Wellcares Provider Relations Teams
We are excited to announce the integration of Sunshine Health and WellCares Provider Relations teams.
This means you will have one Provider Relations Representative to assist you in serving both Sunshine Health and WellCare of Florida members, including our Medicaid, Medicare and Ambetter members and our specialty health plan members in Sunshine Healths Child Welfare Specialty Plan, Staywells Serious Mental Illness Specialty Plan and the Florida Department of Healths Childrens Medical Services Health Plan . This change will be effective Aug. 3, 2020.
We expect to fully integrate our two companies in the second half of 2021. We are taking this step now to provide you with more streamlined and efficient service.
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Are Providers Required To Obtain Authorization For Patients Covered By An Ltc Plan
Providers do not need to obtain authorizations for LTC covered services. Service authorizations are coordinated between the member and the members POA. LTC Case Managers submit authorization requests to our LTC Utilization Management team to review processes and initiate the service authorizations.
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Where Should I Go To Update My Payspan Account
- Go to payspanhealth.com/nps and click User Login.
- Once logged in, update the Payer IDs:
- Sunshine Health is 68069
- Ambetter is 68068
How Does Medicare Affect Low
Access to care, financial protection, and satisfaction with the cost of medical care are all significantly higher among the elderly low-income population who are jointly covered by Medicare and Medicaid than among the elderly low-income population who are solely covered by Medicare or who rely on Medicaid.
How To Save On Shingrix
If you need to lower your out-of-pocket cost for Shingrix, consider coupons, manufacturer rebates, and patient assistance programs. You can use a SingleCare discount card, which can help you save up to 80% off drug prices, or one of our coupons for Shingrix to pay $187.91 for 1, 50MCG/0.5ML Suspension Reconstituted.
There isnt a Shingrix manufacturer coupon currently available, but eligible patients can still benefit from a Shingrix patient assistance program provided by the GSK Patient Assistance Program. Check with this programs provider to find out whether youre eligible for these benefits.
Also Check: Is Shingrix The New Shingles Vaccine
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Who Qualifies For Medicaid
Your first step in qualifying for Medicaid is to be a U.S. citizen or a lawful permanent resident to be eligible for full benefits. Qualification for Medicaid is based on income. Whether you have a disability, the size of your family, and your age also factor into your eligibility. Though the qualifications vary by state, both your assets and your income are taken into consideration. Some older adults may qualify for both Medicare and Medicaid.
Quick Tip: Visit our guide to the Medicaid look-back period to learn how this policy can impact your eligibility for Medicaid.
Medicaid qualifications change year to year, so even if you didn’t qualify in the past, it doesn’t mean you never will. If your financial situation changes or your state expands Medicaid, you may qualify in the future. Unsure if you meet the eligibility requirements for Medicaid? Help is just a phone call away through your state’s Medicaid agency.
How To Sign Up For Medicare
Many people are automatically enrolled in Medicare parts A and B when they turn 65 and start getting Social Security benefits. If you want extra coverage, you also have the option of signing up for a Medicare Supplement or Medicare Advantage plan. You can sign up for those plans directly with the insurance provider . Note that while Medicare Supplements and Medicare Advantage offer more coverage, youll have to pay an additional monthly premium.
If you werent automatically enrolled in Medicare upon turning 65, you can sign up during your Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after. Each year, there is also a General Enrollment Period from January 1st to March 31st, when all eligible adults can enroll in Medicare.
If youre eligible for Medicare but not currently enrolled, you can easily sign up online via the Social Security Administration website during an enrollment period. You can learn more about the process on the official Medicare website.
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Whats The Cost Of The Shingles Vaccine
According to GlaxoSmithKline, manufacturer of Shingrix, the two-shot series costs people with Medicare Part D an average of $50 per shot.15
As of October 2021, discount-coupon company GoodRx lists Shingrix at around $160, which is about 23% off its reported average retail price of $206.73.16 It indicates that Medicare plans list Shingrix typically in Tier 3 of their formulary. 17
Ultimately, how much your vaccine costs depends on the Medicare prescription plan or Medicare Advantage plan you choose, the vaccine you get and the pharmacy or doctors office where you have it administered.
If the shingles vaccine cost is unaffordable for you, GlaxoSmithKline has a Patient Assistance Program GSK for You that may be able to help you with the cost.
Medicare Coverage By Part
- any age and have a disability
- any age and have end stage renal disease
However, there are also some specific Medicare plans that people with dementia may be eligible for. In these cases, a diagnosis of dementia may be required:
- Special needs plans :SNPs are a special group of Advantage plans that specifically address the needs of people with specific health conditions, including dementia. Coordination of care is also often included.
- Chronic care management services : If you have dementia and at least one more chronic condition, you may be eligible for CCMR. CCMR includes development of a care plan, coordination of care and medications, and 24/7 access to a qualified healthcare professional for health needs.
Dementia happens when you lose cognitive abilities like memory, thinking, and decision-making. This can significantly impact social function and activities of daily living. For example, a person with dementia may have difficulty:
- recalling people, old memories, or directions
- carrying out daily tasks independently
- communicating or finding the right words
- solving problems
- paying attention
- controlling their emotions
There isnt just one type of dementia. There are actually several types, each with different characteristics. They include:
How Does Medicare Work
With Medicare, you have options in how you get your coverage. Once you enroll, youll need to decide how youll get your Medicare coverage. There are 2 main ways:
- Original Medicare
Original Medicare includes Medicare Part A and Medicare Part B . You pay for services as you get them. When you get services, youll pay a
at the start of each year, and you usually pay 20% of the cost of the Medicare-approved service, called coinsurance. If you want drug coverage, you can add a separate drug plan .
Original Medicare pays for much, but not all, of the cost for covered health care services and supplies. A Medicare Supplement Insurance policy can help pay some of the remaining health care costs, like copayments, coinsurance, and deductibles. Some Medigap policies also cover services that Original Medicare doesn’t cover, like emergency medical care when you travel outside the U.S.
Supplemental Health Insurance For Seniors Called Medigap
While Medicare provides coverage for most health care needs, there are still some obvious gaps that arent covered unless you opt for Medicare Supplement Insurance, which is popularly referred to as Medigap.
Medigap policies help pay out-of-pocket expenses for deductibles, co-payments and coinsurance that Medicare does not. Medigap policies are sold by private insurance companies and are applied after Medicare pays its share of the approved amount for covered health care costs.
Medigap policies are not the same as the Medicare Advantage Plan, which provides benefits. Medigap policies supplement the benefits in your original Medicare plan.
Medigap policies do not cover long-term care dental or vision care, eyeglasses, hearing aids, or private duty nursing.
Plans bought since 2006, are not permitted to cover prescription drugs.
Some other notes to remember about Medigap:
- Medigap policies are only available to people who have Medicare Part A and Part B .
- You should sign up for Medigap coverage in the six months following your 65th If you dont, you could be denied coverage by insurers because of a pre-existing condition or pay a higher premium.
- Standard Medigap policies are guaranteed renewable.
- Medigap policy only covers one person. If you and your spouse want Medigap coverage, you each must buy separate policies.
- The Medigap coverage is paid directly to an insurance company in addition to the coverage you bought for Medicare Part B.
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