Looking into some Medicare benefits

News and Views from Rita

Comparing services using the Medicare website

This month, I am going to use the Medicare website (which you too can easily use at http://www.Medicare.gov/home health care). The three homes I picked out to compare are the Fairbanks Memorial Hospital, the Hospice & Homecare of Juneau and the Mat-Su Regional Home Care. The first two are privately owned and the third is proprietary.

All three of these institutions compare favorably as to Nursing Care, Physical, Occupational and Speech therapy, Medical social services and having home health aides.

As to the quality of patient care, the Fairbanks Memorial Hospital came out the best of the three facilities and at times, beating the average Alaskan or even National averages. I believe that we can dismiss the patient surveys because as little as fewer than 100 patients completed the survey. We Alaskans obviously do not believe in surveys.

As far as costs go, you can bet that Alaska wins that category, hands down.

Medicare coverage for home health services

Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance) cover eligible home health services like intermittent skilled nursing care, physical therapy, speech-language pathology services, continued occupational services, and more. Usually, a home health care agency coordinates the services your doctor orders for you.

All people with Part A and/or Part B who meet all of these conditions are covered:

• You must be under the care of a doctor, and you must be getting services under a plan of care established and reviewed regularly by a doctor.

• You must need, and a doctor must certify that you need, one or more of these: Intermittent skilled nursing care (other than just drawing blood); physical therapy, speech-language pathology, or continued occupational therapy services. These services are covered only when the services are specific, safe and an effective treatment for your condition. The amount, frequency and time period of the services needs to be reasonable, and they need to be complex or only qualified therapists can do them safely and effectively.

To be eligible, either, 1) your condition must be expected to improve in a reasonable and generally-predictable period of time, or 2) you need a skilled therapist to safely and effectively make a maintenance program for your condition, or 3) you need a skilled therapist to safely and effectively do maintenance therapy for your condition.

• The home health agency caring for you must be Medicare-certified

• You must be homebound, and a doctor must certify that you’re homebound.

You’re not eligible for the home health benefit if you need more than part-time or “intermittent” skilled  nursing care. You may leave home for medical treatment or short, infrequent absences for non-medical reasons, like attending religious services. You can still get home health care if you attend adult day care.

Note: Home health services may also include medical social services, part-time or intermittent home health aide services, medical supplies for use at home, durable medical equipment, or injectable osteoporosis drugs.

Get help buying-in to Medicare

If you are having a problem paying for your Medicare, there is also a program that will help you get your Medicare premium paid for and that is the Medicare Savings program, also known as the Medicare Buy-In. You can get applications for any of these programs at your nearest Adult Public Assistance office.

An admonition

Do not be afraid to apply for any program. All they can do is deny you, and you might be surprised by getting help you never realized you were eligible for. And about that denial, there is always the “appeal process.”

Volunteer wanted

I am still looking for someone to assist me. I can assure you that you will get to know all of the answers and will bask in the knowledge that you have helped someone who really needed the help.

Rita Hatch is an Older Persons Action Group board member and volunteers for OPAG’s Medicare assistance program.