Paying For Home Health Care – What Do Medicare and Medigap Cover?
July 30th, 2010 -- Posted in Home And Family | No Comments »
Prescribed only by a physician, home health care is skilled nursing care that aids in the recovery from illness, injury, or surgery in the patient’s home. And fortunately for many seniors who are now opting for care at home, Medicare insurance covers most costs related to home health care.
The government, however, has set some limitations on payouts – you are only eligible if you need intermittent care (usually defined as seven days a week or less than eight hours a day over 21 days or less) (1), physical/occupational therapy or speech language pathology; you are homebound; and the home health care agency providing care is approved by your Medicare insurance program.
In addition to medication administration, general supervision, and therapy services, the Medicare home health benefit covers a number of other necessities, including medical aids and supplies to aid in recuperation. On the occasion, though, you may be required to cover some of the costs associated with home health care. But what can you expect to pay out-of-pocket that’s not covered by Medicare dollars?
Medicare Insurance: Part A and Part B
Hospital Insurance (Medicare Part A) helps cover the costs of your inpatient care at hospitals, skilled nursing facilities, or religious non-medical health care establishments. Part A can also help cover hospice and home health care services. Individuals aged 65 and older are usually automatically enrolled in Medicare Part A and do not have to pay a monthly premium if Medicare taxes were paid while working. If you did not pay taxes, you are still eligible, but you will be required to pay a monthly premium.
Medical Insurance (Medicare Part B) helps cover services such as those offered by your physician and outpatient care. Many seniors maintain their enrollment in Part A, but elect not to use Part B, which requires a monthly premium that is dependent upon income, the requirements of which change yearly. Unfortunately, if you didn’t sign up for Part B when you were first eligible for insurance, your premium may be slightly higher (2).
For questions on your Medicare insurance benefits, you should contact 1-800-MEDICARE or read the handbook mailed to you each year entitled “Medicare and You.”
What’s Covered and What’s Not
Medicare insurance pays for physical and occupational therapy and speech language pathology services, counseling, some medical supplies, durable medical equipment (which must meet coverage criteria), as well as general assistance with daily activities which include dressing, bathing, eating, and toileting. For most other medical equipment, Medicare insurance will cover 80% of its cost (3).
However, Medicare will not cover twenty-four hour care at home, meals delivered to your home, and services unrelated to your care such as housekeeping. Of course, as mentioned above, you will be required to pay 20% for medical equipment not fully covered by Medicare insurance such as wheelchairs, walkers, and oxygen tanks (4).
In some cases, your home health care agency may present you with a Home Health Advance Beneficiary Notice (HHABN), which, simply put, means if your agency is ceasing your care services, you will be presented with a written statement outlining the supplies and services the agency believes your Medicare insurance benefits will not cover as well as a detailed explanation of why. Should this situation arise, you do have recourse – the HHABN lists directions on acquiring the final decision on payment issues or filing an appeal if Medicare refuses to cover costs for home health care. In the meantime, you should continue receiving home health care services, but keep in mind that you will be paying for these services out-of-pocket until Medicare accepts your claims and remits past expenses.
Medigap and Other Out-of-Pocket Expenses
Medigap, a supplemental insurance policy, is sold privately and covers the services and supplies not paid for by Medicare insurance. When used in conjunction, Medigap and Medicare can often cover a large majority of the costs of your home health care. Insurance companies offer a variety of different Medigap policies (A through L), but since each one comes with specific benefits, you’ll need to compare the highlights closely. Medigap policies vary by cost, and many insurance companies require you to have both Medicare Parts A and B in order to purchase a supplemental plan (5).
For seniors with both Part A and Part B Medicare, your home health care situation is usually covered, save for the 20% out-of-pocket expenses for medical equipment. Just remember to keep track of your Medicare insurance benefits (and Medigap if applicable) by verifying with your physician, home health care agency, and insurance representative. Paying for home health care does not have to cost you an arm and a leg, but do be prepared for the occasional (but necessary) out-of-pocket medical expenses.
Sources
1. Centers for Medicare and Medicaid Services, Medicare and Home Health Care, page 6
2. Medicare website: “Your Medicare Benefits.”
3. Ibid.
4. Ibid.
5. Medicare website: “Medigap (Supplemental Insurance) Policies.”
By: Jill Gilbert
Health Care For Golden Boomers
July 29th, 2010 -- Posted in Home And Family | No Comments »
The Baby Boomer generation is about to become the Golden Boomer generation. For the most part these Americans are active and healthy as they enter their golden years, but they may be hard pressed to find healthcare providers and health professionals that are able to meet the demands of the large numbers that are becoming eligible for Medicare and becoming a growing burden on an already over-taxed healthcare system.
To top it off, now they have to worry about ObamaCare and a questionable economy that has put them all at risk of being unable to enjoy their retirement to its fullest. Add to that the increase in life expectancy and the number of relatively older American citizens will continue to multiply. And while the numbers of the aged continue to rise, the number of geriatricians, those who take care of the elderly, is declining, which may possibly result in a healthcare crisis for our aging Baby Boomers that will be intolerable.
So, what is the answer to this looming problem? How in the world can Boomers expect to deal with these growing problems when the policy makers have waited far too long to address a failing healthcare system, only to ram it down America’s throats in a desperate effort to keep a campaign promise? Did anyone hear anything in regard to ObamaCare about how the needs of an aging America will be met? We obviously need to at least train the healthcare workforce in the needs of an aging populace, but how do you make that happen when so many doctors will suffer the negative repercussions of health care reform? How do you keep doctors from leaving and how do you attract new doctors, when those who have depended upon the Medicare system, and have therefore catered to the elderly, are faced with a decline in Medicare reimbursement? Instead of an increase in geriatricians, Boomers can expect to see a marked decrease in the number of specialists in this area, which is already mightily stressed and understaffed.
Unfortunately, with the advent of the new health care bill, the future is unpredictable when it comes to medical care for the Golden Boomers. They can only hope that with the coming elections their representatives in congress will hear their pleas and will understand that as this remarkably substantial number of Americans age and as their health fails that the economy of this United States may fail right along with the Boomers. The number of Boomers is not insignificant, nor have their numbers ever been so. They have shaped the world and the decline of the U.S. population of Boomers, if that is allowed to happen, will also be felt worldwide.
By: Joseph Stutzman
Improving Senior Health Care
June 29th, 2010 -- Posted in Home And Family | No Comments »
On May 11, 2009, Colorado Senator Michael Bennett introduced a new health care bill aimed to improve patient care and save money on health care costs. This new bill, the Medicare Transitions Act of 2009, is designed to improve patient care by ensuring that Medicare patients receive timely and effective follow-up care after they check-out of the hospital.
The Medicare Transitions Act of 2009 bill aims to provide a nationwide network of local transitional care coaches that would help Medicare patients recover and self-manage their condition. Personal follow-up care would be offered in order to ensure that elderly patients were effectively self-managing their condition and properly administering medications.
The bill would reduce costs by dramatically lowering patient readmission rates. Too many seniors are being readmitted into hospitals everyday even though it could have been prevented. For every five Medicare patients who are released from the hospital, one is readmitted within 1 month. This statistic can be prevented with proper follow-up treatment. Personal follow-up care would assess each patient’s condition and provide necessary treatment or further instructions for self-care.
The cost of Medicare and Medicaid are two of the biggest deficits facing the nation today. Cutting costs on Medicare and Medicaid and improving senior care are exceedingly important in times of economic recession. Health care reform is essential to protect our elderly and secure our future.
President Obama recently announced the introduced of the American Recovery and Reinvestment Act (ARRA), http://www.globalaging.org/health/us/2009/improve.htm a stimulus package designed to make health care affordable to all Americans. The ARRA allows $2 billion to be invested into community care centers, increase the quality of care provided to our elderly, and jumpstart our economy, among other things. These health centers will provide quality care for those who are in need, even for people who don’t have insurance.
Unfortunately, many seniors cannot afford quality health care, and because of that our nation is suffering. Taking care of the elderly by offering quality, affordable health care coverage can positively impact society in many ways. Not only can it help promote longevity, but it can also help lower America’s large deficit.
By: Natalie Rich
Baby Health Care – Which Vaccinations You Should Consider
June 29th, 2010 -- Posted in Home And Family | No Comments »
Babies are prone in acquiring diseases because they have not yet developed resistance to certain diseases. They are easily infected by harmful microorganisms because of poor immune resistance. You as a parent will always want the best for your precious baby. You always give your best in giving your baby the best care and attention. Immunization can greatly help you in making your baby healthier as they boost your baby’s immune resistance to specific diseases. Here are some of the immunizations that you will need for your precious baby:
HEPATITIS B VACCINE
You have to know that Hepatitis B is a deadly disease of the liver caused by a virus. You can be infected with this through sexual contact, blood transfusions and needle pricks. As of today there is no known cure for Hepatitis B. But you can prevent the occurrence of this disease by having your infant immunized with Hepatitis B Vaccine after he is born.
DTaP VACCINE
This vaccine will protect your precious baby against three serious illnesses such as diphtheria, pertussis and tetanus. Diphtheria is a disease that damages your nervous and cardiovascular system while tetanus can damage your muscles and nervous system. Tetanus is also known as lock jaw and can be acquired though open wounds infected with tetanus toxins. Pertussis on the other hand is also known as whooping cough and can endanger your baby’s life. There is one vaccine that can protect your baby against these illnesses and it is known as DTaP.
HIB VACCINE
Haemophilus Influenzae Type B vaccine can also help your baby prevent the occurrence of flu caused by a certain strain of virus. You have to realize that babies who will not undergo this immunization will be at risk of having meningitis and respiratory infection. You can visit your physician for this vaccination.
POLIO VACCINE
Poliomyelitis is a dangerous disease that may lead to irreversible paralysis of certain parts of your body. You can prevent this to happen on your baby by having immunization. Polio vaccine comes in two forms such as Inactivated Polio Vaccine (IPV) or Oral Polio Vaccine. There are series of immunization schedules that you can follow for this vaccine.
MMR VACCINE
This vaccine can protect your child against three diseases such as mumps, measles and rubella. Mumps is the inflammation of parotid gland and is often accompanied by fever and pain. Measles is an infection that can produce distinctive red spots and high grade fever while rubella is just like measles but is often more serious and life threatening.
VARICELLA VACCINE
This vaccine can protect your baby against chicken pox which is a highly infectious disease. Chicken pox will produce blister like rashes on skin that can be very uncomfortable. You can prevent this to happen in your precious baby by having an immunization against it.
Always try your best in giving your baby the best care and attention. Make him more resistant with various diseases by going to your health care provider for his immunization schedule. Do not risk your baby’s health. Give him your best care and love.
By: Anna Holmes
Infant Health Care
June 28th, 2010 -- Posted in Home And Family | No Comments »
Understanding infants health is very helpful for a parent of a child.
Infants easily pick up viruses and illnesses. Their immune system is not well developed and it seems every little illness that is around, they get. Having the basic knowledge can help save on stress, time and money. It will also help a parent make sure they are doing everything possible to ensure their kids health.
It can be difficult for a parent to know exactly when an illness is serious enough to require medical attention. A parent should discuss with their doctor the signs and symptoms to look for when their child is in need of a visit to the office.
Infants health can be a scary thing. When a child is under the age of two it can be quite difficult for a parent to know exactly how to access and treat their kids health issues. There are some things that are very helpful for a parent to know when it comes to the health of their infant.
Fevers are quite scary in an child. A fever that would not be considered high for an older child can be dangerous for an infant. Parents should ask their doctor what temperature should be a concern for their kid. Complicating matters when it comes to a fever is treatment. In an older child a parent would simply give them ibuprofen or acetaminophen. However, in an infant the dosage amounts are not listed on the bottle, so a parent needs to contact their doctor to find out what it is.
http://www.preferedforms.com
By: Bob Taylor
10 Top Questions to Ask an in Home Health Care Agency
June 28th, 2010 -- Posted in Home And Family | No Comments »
About Senior Care
Finding the right in home health care agency that provides senior home care can cause stress and anxiety to a family caregiver. Many times the home health care provider is set up by the discharge planner or social worker at the hospital. There are also times when a family care giver wants to make arrangements for in home health care.
Many family members providing care for elderly in home settings find a need for outside help. Family caregivers are often reluctant to have inside help, because they fear that they will not be able to find good help. I think that it is important for family caregiver to understand that in home health care can be a blessing and give you peace of mind. Everything that has so many pluses also has some minuses. Education is the key to preventing mistake.
I am here to help you prevent making mistakes and enjoy the benefits of senior home care. I have created a list of over 30 questions to ask, I will share 10 of them with you today. I feeI I must first address that there are two categories of in home health care as determined by Medicare guidelines.They are skilled care or custodial care.
Skilled care requires a doctor’s order and refers to a medical or more intense need such as nursing, social services and therapy (physical, occupational or speech). Custodial care refers to help with bathing, dressing, and cooking, cleaning and shopping or even companionship. There is a different type of home health care provider for each level of service needed.
How is the agency licensed or accredited? I like to ask this question because accreditations are the organizations that set the standards for the industry. Many organizations must have these accreditations in order to receive reimbursement by long term care insurance providers. I will tell you not all agencies are accredited even though they meet all the requirements. Some agencies choose not to go through the process as it is time consuming and very expensive. I would not rule an organization out if the rest of the interview goes well.
More of the top 10 questions to ask an in home health care agency about senior home care
How long has the in home health care agency been in business? It is important that you deal with an organization that has a solid reputation and the people that work in that organization are individuals that belong and are know to the community.
What kind of criminal background checks are performed for prospective employees? Are employee references checked? How many? Are personnel files updated annually? These are very important questions. Too many times agencies hire employees and allow them to start work before their background checks have come back to meet the demands of the industry. This can be disastrous.
Are the employees bonded and insured? Does that protect the family in case of theft or accidents? What type of training does the company provide to employees? This is an important question if you have an aging senior with a disease specific diagnosis such as dementia, vision or hearing impaired, diabetes etc.
Does the agency offer a free home health care consultation by a registered nurse prior to start of service? If you are considering custodial services this may not be considered part of the services offered. When it is, consider it an extra bonus. A professional nurse adds a different perspective and may be able to recommend a higher level of care when needed.
Does the agency provide a plan of care in writing for clients? How much say does the family have in the plan of care? These two questions are very important on many levels. A written plan of care gives everyone goals and expectations. The family involvement in developing the plan of care gives the aging senior and caregiver a sense of control over the situation. This also gives the family a clear understanding of the expectations of the duties that will be preformed and something to refer to so that there is no confusion about those duties.
There are many questions to ask an in home health care agency about senior home care. Asking those questions Taking the time and investigating resources can keep the aging senior in your life at home for as long as possible.
By: Diane Carbo
Hiring a Home Health Care Employee
June 26th, 2010 -- Posted in Home And Family | No Comments »
Choosing a Health Care Provider For Your Pregnancy
June 25th, 2010 -- Posted in Home And Family | No Comments »
When searching for a health care provider to manage your pregnancy you want someone who is well-qualified, has clinical experience and has a good reputation among those who you trust the most. With this being said, there are still some additional (personal) factors that one should consider when selecting a provider for prenatal care. The prenatal care experience lasts close to one year (including postpartum follow-up) so you want to be sure the relationship you have with your provider is well-suited.
Very simply, you should make sure you share the same philosophy about a few fundamental issues relating to prenatal care. You do not want to be in conflict with your provider as you approach your delivery date. Often times there can be more than one management option and what is decided upon is largely based on one’s personal preferences and a mutual understanding of the risks and benefits of a particular clinical approach.
The options available to you might be defined by the services offered within a particular clinical setting (hospital, birthing center etc.). Be sure your provider’s decisions regarding your care are not determined by what services are available when the services you want might be available at another health care facility.
If a provider is busy and has a loyal patient following, you should feel confident that your treatment will be based on what you desire.
There are two main topics most often at the center of any discussion surrounding the choice of a prenatal care provider. It is crucial to address these topics right up front to secure a good relationship. You do not want to ever feel you were misunderstood or deceived about what your expectations were at the time of your delivery (assuming there were no unusual circumstances).
The topics I am referring to are: “natural” childbirth and pain management options.
Whether you choose a midwife or an obstetrician as your primary provider the same holds true. In either case, providers can still vary tremendously regarding these topics. It is simply about being on the same page with your prenatal care provider at the start.
The definition of what natural childbirth is and what adequate pain management is, can differ depending on who you talk to and what resources you read. It is very easy to put these topics aside at first as there is so much excitement about the pregnancy and the fact that your delivery seems so far off in the future. My suggestion is to initially discuss these subjects thoroughly and do not gloss over them.
I think pain control in labor is a crucial topic you should discuss with your provider from the start. I can think of nothing more upsetting to a patient than to not be in control of her options for pain control particularly if she is not aware of what the options are.
This article is certainly not the place to define natural childbirth or discuss pain management during labor. I simply want to bring this important topic to your attention.
The last question to consider when choosing a provider has to do with who is anticipated to be there for your delivery. As a result of the tremendous overhead (medical practice expenses) and lifestyle issues for practitioners, it is virtually impossible, in this day and age, to be assured that you will have your provider at your delivery. As a result , it is important for you to be aware of your provider’s arrangement for on-call coverage. Cross-covering with other providers at the same health care facility is not unusual and may be necessary depending on the size of the medical group you are seeing for your care. It is simply about having this discussion with your provider at the start. Discussing these issues is what maintains a trusting relationship with your provider.
The timing of events surrounding labor and delivery is not always foreseeable and there is not a perfect solution every time. What is important and acceptable to most patients is that a reasonable effort is made to fulfill one’s expectations.
By: Douglas Penta M.D.
Controlling Health Care Costs in Retirement
June 25th, 2010 -- Posted in Home And Family | No Comments »
If you’re a Boomer, as I am, you should know by now that nothing our federal government promises can be counted on. They sent us into wars like Vietnam for reasons that never made any sense–and still don’t. They gave our veterans disgraceful treatment in the Walter Reed Army Medical Hospital. They have run our Social Security Trust Fund like it was their personal slush fund — any private business that spent, rather than invested, such a fund would be called a Ponzi Scheme and prosecuted.
In this economic “recession,” it’s a big question mark whether Social Security and Medicare will even pay us back the money we’ve paid in.
My point is that depending on the folks in Washington to control and actually reduce the health care costs for the average American is totally absurd. I don’t have to read the bill that’s being debated in Congress now to be able to tell you with full confidence: “It ain’t gonna happen!”
So, what are you going to do to limit your own need for expensive and possibly rationed health care services in the years of your retirement? Pray? Hope for the best? Move to some foreign country that offers reasonably-priced medical care?
You probably have heard that health care expenses are rising faster than any other cost you will face in retirement — and since the value of your stock portfolio and your home and your business are going down — how are you going to make ends meet?
Here are some tips to help you cut your health care expenses, if you can’t or won’t move to another country:
* Get serious about improving your health: Quit smoking, lose weight, manage stress, end toxic relationships
* Start a regular exercise program, such as taking a brisk walk for 30-45 minutes each day
* Look into converting to a vegetarian or vegan diet: Vegetarians live longer with less chronic disease
* Learn to use high-quality nutritional supplements to take the place of expensive drugs, under the care of a doctor familiar with nutritional medicine
* Find something to do that makes you happy
It’s not too late to make improvements in your health, if you’re still breathing. The very act of making an effort will make you feel better. Small improvements made daily can snowball into something significant over the many more years you have to live.
You can’t control health care costs. You can, however, influence your personal health from here on out. Don’t count on someone out there in Washington, DC, to miraculously make it all more affordable again. You will likely be disappointed.
Get busy on your own Health Care Plan B. Start today!
By: Paul H Kemp
Home Health Care of Elderly Family Members
June 25th, 2010 -- Posted in Home And Family | No Comments »
Home Health Care is a supportive kind of care that is provided to the patient in his own home by insured and bonded health care professionals. It is a skilled care that can also be given by the family members, friends, primary caregivers, or voluntary caregivers. The term Home Health Care refers to the care that is offered to the patient by licensed personnel. It is a skilled nursing care.
The primary aim if Home Health Care is to make it possible for the person to remain in his home setting instead of using institutional-based, long-term or residential nursing care. The health care professionals render the health services to the client in their own home. These services are generally a combination of life assistance services and professional health care services.
The life assistance services incorporate help with the regular tasks like laundry, meal preparation, light housekeeping, medication reminders, shopping, transportation, errands and activities of daily living (ADL). ADL refers to six basic activities of your regular routine that features: bathing, dressing, eating, transferring, walking and using the toilet. It reflects the patient’s capacity for self-care. The professional home health services contains psychological or medical assessment, pain management, wound care, physical therapy, medication teaching, disease education as well as management, occupational and speech therapy.
We are aware that many a times people like to receive care in a familiar atmosphere with the love, patience and understanding of the friends and family that surround them. The elderly care professionals design services that specifically help the patients increase and strengthen their ability to care for themselves in their homes. Good health and well-being, no doubt, begins at home with an understanding that illness can affect the loved ones as well as the patient’s hopes and aspirations.
Helping the patients to become independent is extremely important for us. A number of Home Senior Care services are offered for the patients who experience illness, surgery or hospitalization or the ones who are facing a new health diagnosis that needs a consistent change in their daily lifestyle. In the centers, they use unique care plans, medical treatments, comprehensive assessments, medication management and effective symptom control. The physical rehabilitation services helps to restore the functions that are impaired because of surgery, illness or accident.
Elderly Health Care also caters to the newly diagnosed disease like heart failure, diabetes, or pulmonary disease. They guide the patients to combine the self-management skills in their daily lifestyle. Nowadays, the Senior Health Care services specialize in caring for the patients having a number of medical conditions that demands infusion therapy or IV. Through the advancements in the Home Health Care technology, the hospital stays of these patients are often reduced considerably, and the treatment is offered in the comfort and privacy of home. This enables the patient to live productive and rich life in a comfortable home setting.
By: Dave Morrow