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Maybe interesting information to you.
Dana (C4-5, 31 years post, 51, KC) |
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www.medicarerights.org | e-newsletters ![]()
Volume 4, Issue 34: Week of August 22, 2005
Welcome to Dear Marci, a free, weekly newsletter designed to keep you in the loop about health care benefits, rights and options for older Americans and people with disabilities.
Dear Marci is a service of the Medicare Rights Center (MRC) (www.medicarerights.org), the nation's largest independent source of health care information for people with Medicare. A national nonprofit founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.
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Topic of the Month: Long-Term Care
Long-term care, commonly abbreviated as LTC, refers to a range of medical, personal and social services designed to meet the needs of people with disabilities, chronic illnesses or ongoing limitations in their ability to function as independently as possible. LTC may be delivered at home, in a nursing home, in an adult day care facility or other facility. While Medicare does not pay for most long-term care needs, in this month's issues we will examine the coverage Medicare does provide through the Home Health, Skilled Nursing Facility and Hospice benefits.
Marci's Mailbox
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Dear Marci,
I’m currently living in a nursing home and as a resident I have to buy my medications from the pharmacy my facility contracts with. Will I be able to use the new Medicare prescription drug benefit?
–Jim (Henderson, NV)
Dear Jim,Yes, Medicare private drug plans are required to provide convenient access to long-term care facility pharmacies in their plan networks. But you need to make sure you enroll in a Medicare prescription drug plan that works at the specific pharmacy that your nursing home uses and covers the drugs that you need.
If you are a nursing home resident and have both Medicare and Medicaid, your Medicaid drug coverage will end December 31, 2005 (your other Medicaid coverage will remain the same). Starting January 1, 2006, Medicare will begin covering your drugs. You will be automatically enrolled in extra help paying for Medicare prescription drug coverage and you will not have to pay anything for your medications. But you should choose and enroll in the Medicare private drug plan that is right for you. If you do not make a plan selection by December 31, 2005, you will be automatically enrolled in a randomly selected plan that may not cover the drugs you need or work with your pharmacy.
In order to ensure that you have access to the prescription drugs you need as a long-term care facility resident, you will be able to change your Medicare private drug plan when you enter a nursing home and once a month while you are living there. In addition, when you leave the facility, you will have two months to change your Medicare private drug plan, should your current plan not fit your needs outside the facility.
To guarantee access to the appropriate drugs, there will be a mandatory transition period for nursing home residents during which plans must honor a 60-180 day prescription if a resident's current medication is not included in their formulary.
Note: If you do not have Medicaid, you may qualify for extra help paying your Medicare prescription drug costs (including the monthly premium, deductible and coinsurance) if your monthly income is below $1,197 for singles ($1,604 for couples) and your assets are below $11,500 for singles ($23,000 for couples). But you have to apply for this help – apply online at Social Security.
Stay tuned next week to learn more about home care provided through the Medicare hospice benefit!
–Marci
Have a question for Marci? Click here to e-mail your questions. Please include your city, county and state of residence.
Spotlight on Resources
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For more information about how the new Medicare drug benefit and extra help will work, visit the Medicare Rights Center web site.
Want an expert’s help in choosing a long-term care facility? Visit the National Long-term Care Ombudsman Resource Center online to read about how an ombudsman can assist you and then search by state to find a local representative.
Long-term care can be a difficult issue to discuss with your loved ones. Find conversation guidelines for families online at the Families 4 Care web site. The site also outlines the various financial options you can explore to pay for long-term care.
Find your local nursing home association online at the American Health Care Association. Many of these statewide professionals’ organizations can help you find a local facility and provide other valuable local consumer resources.
Call your State Health Insurance Assistance Program for more information on Medicare benefits, rights and options. Call Social Security (800-772-1213) for questions about enrolling in Medicare.
Health Tip of the Week
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Smart Travel: Part 2 — Travel Health Insurance
There is no faster way to ruin a trip than to get sick or injured – except being unable to access care once an emergency arises. Quality health care can be extremely expensive in foreign countries and, according to the State Department’s Bureau of Consular Affairs, while a U. S. consular officer can help travelers locate appropriate medical services and inform family and friends, the responsibility of payment is the traveler’s.
When planning to travel abroad, an important part of the process should include review of your health insurance policy. If your regular health insurance does not cover you abroad, consider purchasing travel health insurance (this is different from trip insurance, which guarantees a refund if you should have to cancel your trip). These are short-term health insurance policies designed specifically to cover travel. You may prefer a policy which pays doctors or hospitals direct rather than you having to pay on the spot and ask for reimbursement later. Check if the policy covers ambulances or an emergency flight home.
Medicare does not provide for payment of hospital or medical services obtained outside the United States. However, some Medicare supplement plans (plans C through J) offer foreign emergency care coverage at no extra cost for treatments considered eligible under Medicare. These plans require users to pay the bills first and obtain receipts which they can submit later on for reimbursement. Many of these plans have a maximum amount they will cover per trip.
If your regular health insurance already covers you for medical expenses abroad, you can buy a medical assistance program that offers consultative and evacuation services without the health insurance portion. These plans are fairly inexpensive and typically offer emergency consultation or translation services by telephone.
To compare travel insurance quotes online, log on to insuremytrip.com, quotetravelinsurance.com or tripinsurancestore.com.
And don’t forget! As we suggested last week, bring your medications, insurance policy identity cards and claim forms with you in your carry-on when you travel. For more tips on travel abroad, visit the State Department's Bureau of Consular Affairs.
Survey Says
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According to a Spring 2005 health poll conducted by the Kaiser Family Foundation, less than one in seven Americans say they believe government programs such as Medicare or Medicaid (13%) would be the main source of funds if they or a family member needed nursing home care, while three in ten (30%) adults say they believe their long-term care insurance would fund their care. (Currently the national average for a private room is approximately $70,000 per year.)
In reality, private insurance is estimated to pay for a small share of nursing home expenses (8%), while Medicaid (46%) is the major source of financing for nursing home care.
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