Hospice is a program of end-of-life pain management and comfort care for those with a terminal illness. Medicare’s hospice benefit is primarily home-based and covers end-of-life palliative treatment, including support for one’s physical, emotional, and other needs. It is important to remember that the goal of hospice is to help an individual be as comfortable as possible, not to cure an illness.

To elect hospice, someone must:

• Be enrolled in Medicare Part A
• Have a hospice doctor certify that they have a terminal illness, meaning a life expectancy of six months or less if the illness takes its normal course
• Sign a statement electing to have Medicare pay for palliative care (pain management), rather than curative care
• And, receive care from a Medicare-certified hospice agency

Once an individual chooses hospice, all of their hospice-related services are covered under Original Medicare, even if they are enrolled in a Medicare Advantage Plan, unless their Medicare Advantage plan is part of a specific demonstration program, in which case the plan will pay for hospice care. Their Medicare Advantage Plan will continue to pay for any care that is unrelated to their terminal condition. Original Medicare payments to the hospice provider also cover any prescription drugs needed for pain and symptom management related to the terminal condition. The individual’s stand-alone Part D plan or Medicare Advantage drug coverage may cover medications that are unrelated to their terminal condition.

The hospice benefit includes two 90-day hospice benefit periods followed by an unlimited number of 60-day benefit periods The doctor must recertify the person’s terminal illness before each benefit period.

If someone you care for is interested in Medicare’s hospice benefit:

• Ask their doctor whether they meet the eligibility criteria for Medicare-covered hospice care.
• Ask their doctor to contact a Medicare-certified hospice on their behalf.
• Be persistent. There may be several Medicare-certified hospice agencies in your area. If the first one you or the doctor contact is unable to help, contact another.

Once you have found a Medicare-certified hospice:

The hospice medical director (and the individual’s regular doctor if they have one) will certify that they are eligible for hospice care. Afterward, the individual must sign a statement electing hospice care and waiving curative treatments for their terminal illness.

Their hospice team must consult with the individual (and their primary care provider, if they wish) to develop a care plan. Their team may include a hospice doctor, a registered nurse, a social worker, and a counselor.

The post How does Medicare cover hospice care? appeared first on C-Medisolutions.

Medicare Savings Programs help pay your Medicare costs if you have limited income and savings. Medicare Savings Programs are also called MSPs, Medicare Buy-In programs, or Medicare Premium Payment Programs. There are three main programs, with different benefits and eligibility requirements. *

• Qualifying Individual (QI) Program: Pays for Medicare Part B premium. Also reimburses for premiums paid up to three months before your MSP effective date, and within the same year of that effective date.
• Specified Low-income Medicare Beneficiary (SLMB): Pays for Medicare Part B premium. Also reimburses for premiums paid up to three months before your MSP effective day, but unlike QI, you may be reimbursed for premiums from the previous calendar year.
• Qualified Medicare Beneficiary (QMB): Pays for Medicare Parts A and B premiums. If you have QMB, typically you should not be billed for Medicare-covered services when seeing Medicare providers or providers in your Medicare Advantage Plan’s network. This means you should not owe Medicare deductibles, copayments, and coinsurances, as long as you see the right providers.

*There is a fourth MSP called the Qualified Disabled Working Individual (QDWI), which pays for the Medicare Part A premium for certain people who are eligible for Medicare due to disability. Contact your local Medicaid office to learn more.

There are even more benefits to enrolling in an MSP. MSP enrollment:

• Allows you to enroll in Part B outside of the regular enrollment periods
• Eliminates your Part B late enrollment penalty if you have one
• Automatically enrolls you in Extra Help, the federal program that helps pay your Medicare prescription drug (Part D) plan costs

To qualify for an MSP, you must have Medicare Part A and meet income and asset guidelines. 

If you do not have Part A but meet QMB eligibility guidelines, your state may have a process to allow you to enroll in Part A and QMB outside of the General Enrollment Period. 

It also may be helpful to note that income and asset guidelines vary by state. Certain income and assets may not count and some states do not count assets at all when assessing MSP eligibility. You can contact your State Health Insurance Assistance Program (SHIP) to learn more about MSPs in your state and to receive assistance with the application process.

This really is a great program that helps so many beneficiaries with their Medicare costs! Again, contact your local SHIP to see if you’re eligible for an MSP in your state.

Health Tip

May is Mental Health Awareness month, a national movement to raise awareness, fight stigma, and advocate for policies that support those with mental illness. Find your local National Alliance on Mental Illness (NAMI) to learn what kinds of programs and support are offered in your area. You can also learn about what behavioral health care is covered by Medicare.

The post What is the Medicare Savings Program? appeared first on C-Medisolutions.

If you have a concern about the quality of care received from a Medicare provider, your concern can be directed to the Beneficiary and Family-Centered Care-Quality Improvement Organization (BFCC-QIO) for your area. The BFCC-QIOs are made up of practicing doctors and other health care experts. Their role is to monitor and improve the care given to Medicare enrollees. BFCC-QIOs review complaints about the quality of care provided by physicians, hospitals, skilled nursing facilities, home health agencies, and ambulatory surgery centers. 

Examples of situations about which you might wish to file a quality-of-care complaint include:

• A medication mistake 
• Developing an infection during a stay in a facility
• Receiving the wrong care or treatment 
• Running into barriers to receiving care 

 You can file a quality-of-care complaint by calling your QIO or submitting a written complaint. When the BFCC-QIO gets your complaint:

• They should call you to ask clarifying questions about your complaint and to get the contact information for your provider.
• A physician of matching specialty will review the medical record to determine whether the care provided met the medical standard of care, or whether the standard of care was not met.
• You and your doctor will be notified by phone and in writing when the review is over (the review process can take up to a few months).

Livanta and KEPRO are currently the two BFCC-QIOs that serve the entire country. To find out which BFCC-QIO serves your state or territory and how to contact them, visit www.qioprogram.org/locate-your-bfcc-qio or call 1-800-MEDICARE.

If you have a Medicare Advantage Plan, you can choose to make complaints about the quality of care you receive through your plan’s grievance process, through the BFCC-QIO, or both.

Your state may have other ways for you to file a complaint about a provider or facility You may be able to file a complaint through the consumer or patient protection sections within your state’s office of the Attorney General. You can also consider filing a complaint through the state licensing boards that oversee providers, for example, the Board of Medicine or the Nursing Board.

The post How do I file a quality-of-care complaint? appeared first on C-Medisolutions.

The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical. Also, this service is similar to but separate from the one-time Welcome to Medicare preventive visit.

During your first Annual Wellness Visit, your PCP will develop your personalized prevention plan. Your PCP may also:

• Check your height, weight, blood pressure, and other routine measurements
• Give you a health risk assessment
• Review your functional ability and level of safety
• Learn about your medical and family history
• Make a list of your current providers, durable medical equipment (DME) suppliers, and medications
• Create a written 5-10 year screening schedule or check-list
• Screen for cognitive impairment, including diseases such as Alzheimer’s and other forms of dementia
• Screen for depression
• Provide health advice and referrals to health education and/or preventive counseling services aimed at reducing identified risk factors and promoting wellness
•  AWVs after your first visit may be different. At subsequent AWVs, your doctor should:
• Check your weight and blood pressure
• Update the health risk assessment you completed
• Update your medical and family history
• Update your list of current medical providers and suppliers
• Update your written screening schedule
• Screen for cognitive issues
• Provide health advice and referrals to health education and/or preventive counseling services

Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover AWVs without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s requirements for the service.

 Contact your healthcare provider if you want to schedule your Annual Wellness Visit!

The post What is an Annual Wellness Visit? appeared first on C-Medisolutions.