Tag Archives: elderly

Medicare Part B Benefits

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Part B Medicare Benefits cover a variety of procedures that are not covered under Part A Benefits. Like other Medicare Benefits, those who are working are able to put off enrolling for Part B Benefits, which are optional, however those who are not working and do not enroll will face a 10% increase in premiums each year.

To Enroll in Medicare, including Part B Benefits, you can visit their site here.

While Part C is used to cover prescription medicine, Part B will cover medication that is given by a doctor. It also covers some doctors visits, x-rays, blood tests, chemotherapy, ambulance transportation, and a number of other outpatient treatments, such as vaccination for the flu.


Durable Medical Equipment

One of the most important parts of Part B Benefits, however, is the coverage of Durable Medical Equipment. Durable Medical Equipment refers to a number of different types of home medical equipment, such as hospital beds and wheelchairs, as well as things like eye glasses, oxygen equipment, and prosthetics.

In most cases, Medicare will cover 80% of the cost of the equipment, with the insured being responsible for the remaining 20%. It is almost always necessary to have a doctors prescription and certain types of equipment will also require a Certificate of Medical Necessity, which is simply a much more detailed prescription that outlines the specific conditions the patient has. Certain equipment will have some extra requirements that the patient must meet, such as someone who wants to have their mobility scooter covered would need to use it all of the time, both at home and away, and not merely when away from home.

While the majority of medical equipment covered under Part B Benefits is covered up to 80%, this is not the case with all types. Lift Chairs, which are basically recliners that act as a standing aid, are one example, as they are only partially covered. They also require a Certificate of Medical Necessity, which among other things, requires that the patient can not stand from any chair in their home. Usually Medicare will be reimbursed for about $300, which covers the cost of the lifting mechanism, but the entire chair is not covered. Getting reimbursement is not always easy either.

Other items, specifically those that involve home modification are not usually covered under Medicare Part B. For example, widening the doorways for a wheelchair user or installing an elevator would not be covered.

Cost of Part B Benefits

A monthly premium is required for those wishing to use Part B Benefits, which is usually around $100. However, since 2007, the premium is also based off of income and whether the insured is married, with a higher income meaning a higher premium and can be as high as $300.

In addition to a monthly premium, the patient must also pay a yearly deductible if they use these benefits, which was around $130 in 2009. There is also a copay required for most items, which is usually 20% of the cost of the item, with Medicare paying the other 80%. However, as stated above, some items, like lift chairs Medicare, are only partially covered under Medicare. However, blood work and other laboratory services are often covered completely. A 15% surcharge is added if the physician is not certified by Medicare.

Part A Medicare Benefits

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Medicare is an insurance program that is offered and run by the Federal Government, primarily intended for those over 65, although people with certain medical conditions, like acute renal failure, are also covered. Medicare Benefits are divided into 4 Parts, with Part A covering hospital related costs.

Part A Medicare Benefits are primarily intended to cover the cost of overnight hospital stays. The amount of the cost that is covered varies, depending on the length of the hospital stay and will also sometimes cover the cost of temporary stays at a nursing home.

While I the hospital, Part A Benefits extend to all costs, including medical tests, doctors costs, and incidentals, like food and board.

Requirements for Coverage of Semi-Long Term Care
In order for an extended stay at a nursing home or assisted care facility to be covered, it is necessary for the patient to have had a previous hospital stay for the same problem, which lasted at least full days, not including the day the patient was released. Also, the treatment must be for rehabilitation or to help manage a disease in order to be covered. Further, it is imperative that the assisted living facility offers skilled care, meaning that the workers must be registered nurses.

Length of Stay Covered By Medicare

Medicare will usually cover stays of up to 100 days, providing the above requirements have been met. The first 20 days are paid for by Medicare, with the following 80 days requiring a copay of around $134 per day.

If the patient uses their Part A Benefits, even partially, they must wait 60 days before they ca receive another full 100 day hospital stay.

Premiums and Deductibles

Providing the Medicare Recipient has paid payroll taxes for more than 13 years, there is monthly premium to receive Part A Benefits. However, those who have only paid in between 10 and 13 years will need to pay a deductible of $233 and those with less than 10 years paid into Medicare must pay $423 a month to receive Part A Benefits.

The required deductible, however, is the same for both and depends on how long the senior is in the hospital. For example, hospital stays between 1 and 60 days require a deductible of around $1000. After that, it drops down to about $260 per-day for the next 30 days. Then, stays between 91 and 150 days require a $534 deductible per-day. After 150 days, the patient will no longer be able to receive benefits.

If a stay at a skilled nursing facility is required, the patient’s first 20 days are covered by Medicare and there is a $133 deductible after that. Stays must be no longer than 100 days at a skilled-nursing home.

Determine Eligibility for Part A Benefits

To determine if you are eligible for Part A Benefits, you can visit Medicare Site and use their Part A Benefits Eligibility Tool

Falls Disseases and Medicares Role in Treating these Conditions

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In seniors who experience diseases such as arthritis and osteoporosis, it is very important to prevent falls from occurring. This is because a fall, even a very small one, can end up being very serious and result in a fracture. If this happens, it can be very difficult for the senior to recover from the accident and in many cases, it will mean a move to an assisted living situation or nursing home. Often, these stays will be covered by Medicare, but this depends on the patients Medicare Eligibility ad what types of benefits they receive.

With such serious ramifications from even a very small fall, protecting against these types of accidents is very serious.

Why Osteoporosis Can Be Dangerous

Osteoporosis is a disease that is most common among the elderly, but can affect those of all ages. However, usually in younger people, it is caused after some sort of injury. Osteoporosis causes the bones to loose some of their density, which makes them very brittle and prone to fracture. It is caused by a lack of calcium and vitamin D and is much more common in post-menopausal women, although it can also affect males.

Osteoporosis is not itself does not cause injuries, but because the bones begin to become more brittle and loose their density, it is more likely for them to break or fracture, even after a very small fall.

Why Arthritis Can Be Dangerous

Arthritis can cause a number of problems and is not actually just one disease, but rather more than 100 different disorders that primarily affect the bodies joints. While, depending on the kind of arthritis, the effects can greatly vary, typically, arthritis causes the joints to become damaged, inflamed, and tender. This can mean that bending the joints becomes much more difficult and even painful.

Unlike osteoporosis, arthritis by itself can cause the affected person to experience dramatic losses to maneuverability and often results in disability. Arthritis can also greatly increase the risk of a fall and if the senior also has osteoporosis, this means that there will be a much bigger chance of injury.

Protecting Against Falls

To protect against falls, there are several options, but often it is important to first take measures to treat the arthritis and osteoporosis. For osteoporosis, maintaining a healthy diet of foods that contain calcium and vitamin D is important, with most seniors also taking vitamin supplements.

In the case of arthritis, treatment is not always as straightforward and depends on what type of arthritis the patient has. Many times, proper diet and exercise are as important as taking medication when it comes to treating arthritis. It is also very important to find ways to make life easier for the patient, as there is no way to work backwards and reverse the effects of arthritis.

In addition to assuring that there is proper treatment, there are also a number of helper aids that are used by seniors with arthritis and osteoporosis. This includes a number of different types of home medical equipment that is designed to either make life easier or safer for the senior. Having a proper pair of shoes with non-skid soles is very important, as is using a walker or rolling walker, and ensuring that all areas of the home can be easily accessed. Lift chairs are also often used, which are like recliners, but are designed to make it easier for the senior to stand.

Medicare’s Role in Treating Osteoporosis and Arthritis

In addition to actually being important for providing treatment, such as covering the cost of medicine and doctors visits, Medicare also covers the cost of a number of different types of home medical equipment. These items are covered under Medicare Part B Benefits and covers a wide variety of medical equipment, including wheelchairs, walkers, mobility scooters, eye glasses, and much more.

Usually, Medicare will provide 80% reimbursement for these items, but this is not always the case. For example, lift chairs Medicare do not qualify for full reimbursement and instead only part of the cost of the device is covered.

Usually for a device to be covered by Medicare, it must, of course, be on their approved list of items (PDF), but it will also require that the individual has a doctors prescription and sometimes also a Certificate of Medical Necessity. A Certificate of Medical Necessity is similar to traditional prescription, but is more detailed and must describe the reasons the senior needs the type of equipment. Usually, if a doctor feels there is a need to offer the patient a prescription for the device, it is not a problem for them to also fill out a certificate of medical necessity.

What is Medicare?

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Medicare is a health insurance program that was established by the federal government in 1965. It was part of the Social Security Act of 1965, which was signed by President Lyndon Johnson on 30 July, 1965. Arguably, Medicare is a type of socialized medicine, which is administered by the Government, but since the actual medicine and treatment is preformed by private doctors and the governments role is more of as a supervisor, Medicare would technically be a Social Insurance Program.

Those that qualify for Medicare are able to receive reimbursement for their medical costs, including doctors visits and medical equipment, but as of recently, also prescription medication.

How is Medicare Funded

Medicare is paid for by taxes, which are taken out of workers paychecks. Currently, 2.9 percent of a persons income is taken for Social Security taxes, with the employee paying half of this and the employer paying the other half.

Part of the requirements for participating in Medicare, or at least participating without paying extra fees, is that the person has paid enough money into Medicare throughout their life.

Requirements for Medicare Coverage

Medicare is designed primarily to help cover the medical costs of those who are over 65, legal residents of the United States, and have been paying taxes for at least 10 years. However, in certain cases, usually due to disability, Lou Gehrig’s Disease, or renal failure, it may be possible to receive Medicare Benefits before the age of 65.

Currently, congress is discussing allowing those who are over 55 to buy into Medicare Early, as part of the current health care reform that is taking place in Congress. This is, however, still under wraps, so it remains to be seen if this will make it into the final bill and what the buy in cost will actually be.

What is Covered By Medicare?

This is something that I will go into further in my later posts and will update this one as well, but Medicare covers doctors visits, certain hospital stays, many types of home medical equipment, as well as prescription medicine.

However, when you sign up for Medicare, you are given the opportunity to decide what type of coverage you would like to receive. The different types are decided into Parts, such as Part A Medicare and Part B Medicare, and you will usually be given the opportunity to enroll in whichever parts you qualify for.

Those who have insurance through an employer can usually wait on deciding without penalty, but otherwise, adding on coverage later, especially prescription medicine coverage, will have a few hurdles.

In addition to Government Run Plans, it is also possible to sign up for a Medicare Advantage Plan, which is actually run by a private insurance company, but because these are allowed to be slightly different from traditional Medicare, it is imperative to carefully read the plan and compare it to regular Medicare.

How can I Find Out More Information About Medicare?

I would encourage you to check back at this blog regularly, as we will be updating it with more information about how Medicare Works, what Medicare Covers, and current news events.

With that said, one of the best places to find out about Medicare is to visit the official Medicare site. They have a tremendous amount of information for those on Medicare or curious about how it works, including sections to find out Your Medicare Coverage.