There are many types of services available to help meet the long-term care needs of an older person living at home. Family members and friends may be able to help with some personal and household tasks. But you might want to hire professionals to assist with others.

Home health care services

Home health care services may help older people with many aspects of health care, such as medications, wound care, medical equipment, and physical therapy. The provider may come for a few hours each day or stay 24/7.

Home health care services may include in-home nursing care to help a person recover from surgery, an accident, or an illness. If the person just left the hospital and still needs nursing care at home for a short time, the hospital can help arrange for a home health aide. In-home health services can also help manage long-lasting (chronic) conditions such as diabetes, for example, by testing a person’s blood sugar or giving insulin through a pump.

What to know about costs:

• Home health services charge by the hour.
• Medicare has limited coverage of home health service costs. The services must be short-term and provided by agencies certified by Medicare.
• Medicaid also provides coverage for home health service costs, but these benefits vary by state.
• Most private health insurance plans do not cover these costs.
• You must pay all costs not covered by Medicare, Medicaid, or private insurance.

To find a home health care service, ask your doctor or other health care professional about good options in your area. You can also ask friends or neighbors for referrals.

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During the week of March 25, the Centers for Medicare & Medicaid Services (CMS) finalized a rule to make enrolling and staying in Medicaid easier, especially for older adults and people with disabilities. This rule is a companion to one finalized last fall that streamlined enrollment into Medicare Savings Programs (MSPs).

Medicaid is a joint federal and state program with many different categories of coverage, each with its own eligibility rules and processes. These pathways include coverage for pregnant people, children, low-income adults between 19 and 64 who are not Medicare eligible (expansion Medicaid), and older adults and people with disabilities.

That last category, usually called “Aged, Blind, and Disabled” (ABD) Medicaid, has onerous enrollment and redetermination processes that can impede access to care. Administrative hurdles can include state requirements that applicants schedule in-person interviews or complete multiple rounds of redetermination paperwork within 12 months. Such barriers can make applying for or keeping benefits more difficult and often undermine healthcare goals and outcomes.

CMS aims to alleviate some of these challenges in the newly finalized rule by clarifying federal minimum standards for ABD Medicaid application and redetermination processes. The rule bars in-person interviews for ABD Medicaid and requires states to provide a full year of eligibility before requiring redetermination paperwork. In addition, the rule simplifies other enrollment and verification processes, including requiring states to use prepopulated renewal forms and available data to make eligibility determinations, creating new timelines for applicants to submit needed documentation and for states to process applications, and establishing consumer protections around returned mail and address changes. The rule also clarifies existing policies to ensure state-to-state consistency and reduce non-compliance.

These regulations, coupled with the MSP streamlining rule, eliminate some of the barriers that impede access to important financial assistance programs and will protect the health, economic stability, and well-being of older adults and people with disabilities.

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Good news from Medicare! It now covers prescriptions for the oral antiviral COVID-19 treatment, Paxlovid, through the end of 2024. You can access it in a couple of different ways.

If your Part D plan participates in the Paxlovid patient assistance program, you can have your prescription filled free of cost at your pharmacy. Contact your plan to find out if it participates.

If your plan doesn’t participate, or you simply don’t have drug coverage, you can still get Paxlovid at no charge. You’ll just need to enroll in the U.S. Government Patient Assistance Program (USG PAP) operated by Pfizer. 

If you choose a Part D plan, you can search for Paxlovid and add it as a prescription drug when comparing drug plan costs on Medicare’s Plan Finder. This will allow you to choose a drug plan that automatically covers the medication.

If you decide on a drug plan that does not cover Paxlovid, you can still obtain the medication through the USG PAP mentioned above.

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The Affordable Care Act (ACA), passed 14 years ago during the week of March 21, strengthened Medicare and Medicaid and created important coverage guarantees and consumer protections for people of all ages.

From expanding access to affordable care to preventing discrimination based on health status, as well as improving Medicare’s financial status, the ACA made significant improvements to the nation’s healthcare infrastructure. These advances are especially important for older adults, who are more likely than younger adults to have health problems that cause them to rely on the ACA’s consumer protections.

Some of these benefits and protections are so important that it is hard to recall what the health insurance landscape and consumer rights were like before the ACA’s passage. As a reminder, we are highlighting some of the key components of the landmark legislation.

The Benefits

Medicaid Expansion: The ACA gave states the option to expand their Medicaid programs to include coverage for low-income, non-elderly adults (ages 19-64) without dependent children. To date, 41 states (including D.C.) have expanded Medicaid, which studies indicate has led to historic coverage gains, improvements in access and financial security, and economic benefits for states and providers.

Age-Based Discrimination: The ACA prevents insurers from charging older consumers more than three times what younger people pay. Prior to the ACA, there was no limit on this disparity; health insurance companies were typically free to set significantly higher and often cost-prohibitive premiums based on an individual’s age, among other factors.

Pre-Existing Conditions, Community Rating, and Guaranteed Issue: The ACA does not allow compliant insurance plans to deny, limit, or charge people more for coverage based on a pre-existing condition.

Elimination of Lifetime and Annual Limits: The ACA prevents private insurance plans from placing annual or lifetime limits on coverage. These important reforms help protect consumers from catastrophic health expenses and medical-bill-induced bankruptcy. Before the ACA, insurers could simply stop paying for an enrollee’s health care expenses after their costs reached a certain amount—often leaving the sickest patients responsible for extremely high costs.

Essential Health Benefits: To ensure that people with ACA-compliant plans have access to comprehensive coverage, the health law requires most insurers to cover, at a minimum, a set of 10 essential health benefits (EHB). Before the ACA, consumers were often unable to find affordable coverage for many of these services—nearly 1 in 5 Americans lacked coverage for mental health care, and almost 1 in 10 didn’t have any prescription drug coverage, despite 60% of the population needing at least one medication per year.

Access to Preventive Services: The ACA dramatically improved access to no-cost preventive services within Medicare and Medicaid and requires most private health insurance plans to cover a range of preventive health services without patient cost-sharing (co-payments, deductibles, or co-insurance). These changes, particularly when considered alongside the ACA’s coverage expansions, have increased access to clinical preventive services and improved public health.

The post After 14 Years, ACA Protections Remain Crucial for Older Adults appeared first on C-Medisolutions.

Medicare fraud and abuse can happen anywhere and usually results in higher healthcare costs and taxes for everyone. Some examples include:

• A provider that bills Medicare for services or supplies they never gave you, like charging you for a visit you never had, or a back brace you never got.
• A provider that charges Medicare twice for a service or item that you only got once.
• A person who steals your Medicare Number or card and uses it to submit fraudulent claims in your name.
• A company that offers you a Medicare drug plan that Medicare hasn’t approved.
• If you think you’ve spotted fraud, you may want to call your provider’s office to ask about it. They may be able to help you understand the charges, or figure out if they made a billing error.

If you suspect Medicare is being charged for an item or service you didn’t get, or your Medicare card or number is stolen, call 1-800-MEDICARE 1-800-633-4227 to report suspected fraud or abuse.

When you call, have this information ready:

• Your name and Medicare Number.
• The name of the provider you’re reporting, along with any identifying information you may have.
• The service or item you’re questioning and when you supposedly got it.
• The amount that Medicare approved and paid.
• The date on your Medicare Summary Notice, health or drug plan’s Explanation of Benefits, or claim.

• Protecting yourself from medical identity theft 

Medical identity theft is a serious crime that happens when someone uses your personal information without your consent to commit Medicare fraud or other crimes. Use the following tips to protect yourself from becoming a victim.

Do:

• Protect your Medicare Number and your Social Security Number.
• Guard your Medicare card like it’s a credit card.
• Become familiar with how Medicare uses your personal information. If you join a Medicare health or drug plan, the plan will let you know how it will use your personal information.

• Remember that Medicare will never call you to sell you anything or visit you at your home. Medicare, or someone representing Medicare, will only call and ask for personal information in limited situations:
• A Medicare health or drug plan may call you if you’re already a member. The agent who helped you join can also call you.
• A customer service representative from 1-800-MEDICARE can call you if you’ve called and left a message or a representative said that someone would call you back.
• If you filed a report of suspected fraud, you may get a call from someone representing Medicare to follow up on your investigation.
• Contact the Federal Trade Commission if you think you’ve been a victim of personal identity theft.

Don’t:

• Give your Medicare card, Medicare Number, Social Security card, or Social Security Number to anyone except your doctor or people you know who should have it (like insurers acting on your behalf or people who work with Medicare, like your State Health Insurance Assistance Program (SHIP). Get the contact information for your local SHIP.
• Accept offers of money or gifts for free medical care.
• Allow anyone, except your doctor or other Medicare providers, to review your medical records or recommend services.
• Join a Medicare health or drug plan over the phone unless you call us.

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