If you are a Medicare recipient or a caregiver who helps an aging parent with medical, financial or care needs, it is important that you understand Medicare coverage, options, restrictions, etc. We talk to many family members who care for aging parents and are surprised by needs that Medicare does not cover. To get a concise overview of the various parts of Medicare and what each covers, start with our Medicare Fact Sheet (with 2012 Medicare co-pays and deductible information). Contact us for printed copies of this information and Medicare educational materials or seminars, if you have a support group, community group, or clients with whom you'd like to share this information.

We are currently in one of Medicare's annual open enrollment periods. This year, from October 15th to December 7th, Medicare recipients can switch Medicare drug plans (Part D) and switch to or from a Medicare Advantage plan. Each Medicare recipient or caregiver should review their current coverage during this period. Plans make changes and it is likely you or your loved one has had some health changes, which may cause a different plan to be more appropriate for you. The changes you make become effective on January 1st. Additionally, from January 1st-February 14th, those enrolled in a Medicare Advantage plan can disenroll and switch back to regular Medicare (this is the only change that can be made during that period).

Medicare Advantage Plans are an option for receiving various Medicare benefits via a private insurance company. Typically, these plans will have preferred providers or networks (or providers may not accept the coverage due to the reimbursement rates) and may require a primary care physician or have other restrictions. They may also include additional benefits such as eye or dental care or gym memberships, and the deductibles, co-pays, etc. are usually less expensive for the recipient. If a person is enrolled in a Medicare Advantage Plan and is not pleased with the plan's coverage and choices, there are several special enrollment periods to make changes.

You may, for example, be caring for an aging parent who is enrolled in a Medicare Advantage plan and becomes hospitalized. After the hospital stay, he/she may need inpatient rehabilitation care at a Skilled Nursing Facility. However, the Medicare Advantage Plan may have limited skilled nursing facilities within the network and you may not be pleased with the options. In that situation, there is what is known as the OEPI (Open Enrollment Period for Institutionalized Individuals). Persons “institutionalized” (i.e. residing in or moving in and out of a skilled nursing facility and other eligible institutions) have a continual enrollment period. The person can disenroll from a Medicare Advantage plan while in the facility and return to regular Medicare (or a different MA if accepting enrollment) the beginning of the next month.

There are other special enrollment periods for those wishing to switch plans, including a "trial period" when you first sign up for a Medicare Advantage Plan of 12 months, in which you can disenroll and switch back to standard Medicare at any time during that period. If you are concerned about coverage under any plan or do not understand a plan's coverage decision, it is important to learn about your Medicare rights, including the right to appeal. Medicare and health insurance can be complicated to navigate, so it is vital to be your loved one's advocate as a caregiver and to seek outside help when you have questions or difficulties.

We will be covering a number of the key issues that surprise caregivers about Medicare coverage in upcoming blog posts so stay tuned, or sign up for the Aging Wisely blog feed to get updates.

On November 17th, we are offering a free educational seminar, The Ins and Outs of Medicare, in honor of National Family Caregivers Month. Come learn more about Medicare coverage, questions to ask and how to better understand your coverage. We navigate the healthcare system every day with our clients, so let our expertise benefit your family.

If you would like help analyzing your Medicare plan during this year's open enrollment period, or you are preparing to retire and want a complete analysis of your options and what you need to do regarding Medicare coverage, call us today at 727-447-5845 or fill out our contact form to discuss our Medicare Analysis services.

In addition to assisting clients with analysis of their best health insurance and Medicare options, we try to keep our readers informed of Medicare changes and important news in the healthcare field, including insurance and coverage options.

We do not sell insurance, but offer our clients an analysis of options based on our expertise and experience day in and day out in the healthcare system. We provide analysis, troubleshooting and advocacy.

As you are probably aware, a large number of changes to our healthcare system were passed in 2010. Do you know about the provisions of this law? Do you know about those that are already in effect and how they might impact you? While there are uncertainties about future changes and challenges to these laws, there is some important information for you to know about today.

We will use the term Affordable Care Act (ACA) to refer to The Patient Protection and Affordable Care Act, H.R. 3590, P.L.111-148 and the Health Care and Education Reconciliation Act, H.R. 4872, P.L. 111-152, signed by President Obama on March 30, 2010 (which amended #1). These acts made many changes, ranging from the eventual abolishing of pre-existing condition clauses in insurance to requiring individual coverage for those not covered under various programs.

Some of the first changes that have taken effect are in the Medicare program. Starting in 2011, the "doughnut hole" in the Medicare D prescription drug program will be phased out. This year, individuals who reach the doughnut hole will receive a 50% discount on covered brand name drugs while in the gap. Additionally, sections 4103 & 4104 updated the preventative care benefits under Medicare, so that now an annual wellness visit is covered at 100% along with screenings for colon, breast and prostate cancer.

As part of the requirement for all individuals to have coverage by 2014, certain programs have been implemented to phase in coverage for different groups traditionally at a disadvantage in securing coverage. One such program, which began last year, is the Pre-Existing Condition Insurance Program (PCIP). Sec. 1101. Immediate access to insurance for people with a preexisting condition: Provides up to $5 billion for this program, which terminates when the American Health Benefit Exchanges are operational in 2014. Also establishes a transition to the Exchanges for eligible individuals.

To be eligible for this program the individual must: 1. Be a citizen or lawful resident. 2. Have been uninsured for at least the last 6 months. 3. Show proof of the pre-existing condition (such as letter from doctor, insurance denial because of it, or insurance coverage turned down with rider excluding the condition. There is an online application and there are no financial qualifications. There are no waiting periods (if you sign up by the 15th of the month, coverage will begin at the beginning of the coming month). Recipients have three plan options: a standard plan, an extended plan and a Health Savings Account plan. The rates are very competitive and were actually reduced in July of 2011. For more information, please visit www.pcip.gov.

Come back to visit us for more information and continued updates on healthcare reform, Medicare changes and information on Florida Medicaid and eldercare resources. You can sign up for our newsletter for monthly updates delivered right to your inbox!

CONTACT US TODAY for a Medicare Analysis appointment or consultation on your healthcare and eldercare options.

As of April 1st, Medicare implements new regulations for covering skilled home health care under Medicare Part A. In order for Medicare to pay for covered home health services, the patient will need a face to face visit with the ordering physician within a specific time frame. You can read more about these new regulations on EasyLiving’s Home Care Blog.

Do you know when Medicare pays for home health care? Medicare covers skilled home health services, such as physical therapy or R.N. services, when the following conditions are met:

• The patient must be homebound and under a doctor’s care.

• The patient must need skilled nursing care, or occupational, physical or speech therapy, on at least an intermittent basis (that is, regularly but not continuously).

• The services provided must be under a doctor’s supervision and performed as part of a home health care plan written specifically for that patient.

• The patient must be eligible for the Medicare program and the services ordered must be “medically reasonable and necessary”.

• The home health care agency providing the services must be certified by the Medicare program.

Medicare generally does not cover custodial care (also known as long term care services). Licensed Florida home care companies like EasyLiving typically provide day to day care, help around the house, and assistance with activities of daily living, which are paid for on a fee for service basis or via long term care insurance.

Read more Medicare 2011 Facts and Numbers and contact us for help navigating your Medicare and eldercare options.

Aging Wisely’s geriatric care managers can help you navigate your Medicare and long term care insurance coverage, understand eldercare costs and options, as well as identify public benefits and Florida senior resources for which you might be eligible.

We’re here to help with senior care resources and eldercare consultations.

There are some significant changes coming to Medicare in 2011, as a result of healthcare reform and a number of initiatives. Here is a brief summary of the key changes:

Preventative Services:

Next year, all Medicare preventive services, such as screenings for colon, prostate and breast cancer, will be free. Annual wellness visits will also be free starting in 2011. *In the past, Medicare allowed for a one time "welcome to Medicare" wellness/physical only.

Durable Medical Equipment:

In certain areas, recipients will be required to go through specific providers.

“Doughnut hole” changes/Medicare Prescription Drug Benefit:

2010: Anyone who fell in to the "doughnut hole" received a $250 rebate check to assist with those costs. This doesn’t apply to those receiving “special assistance” with costs through Social Security. Be aware that there have been several scams related to this rebate, as well as continued scams where clients are asked for their Medicare # or contacted via phone to sign up for a new plan.

2011: 50% discount on covered brand name drugs in doughnut hole period

2012-2020 and beyond: This discount incrementally increases until eventually the coverage gap is eliminated.

New open enrollment periods/dates to change plans:

1/1/11-2/14/11: If you’re in a Medicare Advantage Plan, you can leave your plan and switch back to original Medicare (and join a prescription drug plan)-coverage effective 1st day of month after the plan gets your enrollment.

10/15/11-12/7/11: New Open Enrollment period for switching Medicare health & prescription drug plans (effective 1/1/12). This is the period that has previously been 11/15-12/31 each year (including 2010)—the purpose is to allow more time for decisions, as well as processing before the effective date.

Healthcare Information Technology:

There is a big push towards use of information technology to streamline and improve healthcare, such as electronic prescribing and personal health records. Medicare has information and resources on their site, though there remains no universal system at this time.

Income Adjusted Premiums:

Currently, Part B premiums are income adjusted for higher income individuals. Sarting in 2011, higher income individuals (those making more than $85,000 filing an individual return and $170,000 filing jointly) will also pay an income-related monthly adjustment to Part D premiums. This will be deducted from the recipient’s Social Security check, no matter how they usually pay the Part D premium.

Medicare Advantage Plans:

Subsidies to these plans will be phased out. This may mean plans reduce extra benefits, or even decide to no longer participate in this market, but those will be business decisions by the insurance companies so the impact is unclear at this point.

The Medicare and You 2011 Guidebook is currently available on Personal Medicare Analysis provides you the best, unbiased information so that you can make wise decisions and save money on healthcare in retirement.