Home health coverage, shingles vaccines and more

News and Views from Rita

I just thought you might want to know that on Wednesday, August 14, Social Security celebrated 78 years of providing retirement security to older Americans. In this time of financial uncertainty, when other sources of retirement income such as pensions and savings are increasingly out of reach for many Americans, Social Security is more important than ever, especially for those who do not have any other retirement income.

July 30 marked the 48th anniversary of the establishment of Medicare and Medicaid. In 1964, the year before these programs were signed into law, almost one half of older Americans did not have health insurance and only one quarter were estimated to have adequate hospital insurance coverage. Today Medicare provides guaranteed health care benefits to over 50 million older adults and people with disabilities.

With the Affordable Care Act (ACA) Medicare is stronger than ever and access to Medicaid will be expanded to millions of low-income families. Nearly half of all the people with Medicare have incomes of $22,500 or less per year, and four in 10 live with three or more chronic health conditions.

If you would like proof that the new health care law is already helping ordinary people, talk to some of the 8.5 million Americans who received rebates from their insurance companies this summer. These folks got checks in the mail because of the Affordable Care Act, which required insurers to spend at least 80 percent of their premium dollars on medical care, instead of overhead like salaries or advertising. If any insurance company doesn’t meet that standard, it has to provide a rebate to its customers. 

Some of the other benefits that are now in place are that children under the age of 26 are able to remain on their parents’ health insurance; prescription drugs are now more affordable; preventive services are now available with no deductible or co-pay; the law has now removed lifetime limits on health benefits; increased support for community health centers; individuals can no longer be locked out of insurance due to pre-existing conditions.

Perusing the ‘marketplace’

A date to remember: October 1, 2013, is the first day that you can navigate to the Health Care website http://www.healthcare.gov. There you will be comparing different “Marketplace” plans to see which is the best one for you.

If you are covered by Medicare, Medicaid, Tri-Care, Indian Health Service or any employer health care plan that you are satisfied with, you do not have to get any Marketplace health insurance. You can however check in the Marketplace to see if there is any plan that may be cheaper than the one you have.

If you change your plan to a Marketplace plan, be advised that the new plan will not start until January 1, 2014 .

Shingles vaccine for the low-income

For anyone who has not gotten the Zoster vaccine for shingles because of the high cost, be advised that it is available for eligible or underinsured adults aged 60 or older at any local public health center. Many people have resisted getting the vaccine because although Medicare will pay for it, AlaskaCare will not.

Other vaccines available: Influenza, Pneumococcal, Tetanus/Diptheria/Pertussis.

For more information, call the Alaska Immunization Helpline at 269-8088 in Anchorage or toll-free in the rest of the state at 888-430-4321.

AlaskaCare retiree members are considered underinsured because their health plan does not cover these vaccinations, and are therefore eligible to receive them under this program. When you go for an appointment to get the vaccine, you must also take your AlaskaCare insurance card for identification.

If you are enrolled in Medicare Part B or D, be aware that Medicare Part B covers the influenza and pneumonia vaccines. You will therefore only be eligible to receive the Zoster and DTaP vaccinations under the state’s Underinsured Program.

Medicare Part D, however, covers all four of these vaccinations.

I do have a list of public health centers across the state, so call me if you need to find out where yours is.

Medicare and home health care

For those who have asked if Medicare covers home health care, one must meet all of the following criteria:

• Be homebound, meaning that it is extremely difficult for one to leave the home and one needs help in doing so.

• Needs either skilled nursing care on a part-time basis or skilled therapy services. Skilled care is care that only can be given by a licensed nurse or therapist.

• Have an office visit with your doctor within 60 days before you begin receiving home care or 30 days after you start receiving home care.

• Get your doctor to sign a home health certification, confirming that you qualify for home care because you are homebound and need skilled care. The certification must also state that your doctor has approved a plan of care for you and that you have had the required office visit.

• Receive care from a Medicare-certified home health agency.

If you meet all the requirements, Medicare should pay for skilled care you receive in your home, as well as services you receive from a home health aide. Know that Medicare will not pay for home health aide services (such as help with bathing or dressing or using the bathroom) if you do not have a need for skilled care.

Although you may hear otherwise, Medicare will pay for skilled care that helps you maintain your ability to function or prevents your health from getting worse.

Rita Hatch volunteers for Older Persons Action Group’s Medicare Counseling and Assistance program. Call her at 276-1059 in Anchorage, or toll-free statewide outside of Anchorage at 1-800-478-1059. Her e-mail address is ritaopag@gci.net.

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