Paying for Home Health Care: What Do Medicare and Medigap Cover?

Home health care, ordered by your physician to help you recuperate, is usually covered by your Medicare insurance plan and, if you have it, Medigap. Sorting through what is and isn’t covered can be tricky – use these guidelines to understand what your eligibility requirements and what you must pay out-of-pocket.

Prescribed only by a physician,Guest Posting home health care is skilled nursing care that aids in the recovery from illness, injury, or surgery in the patient’s home. And fortunately for many seniors who are now opting for care at home, Medicare insurance covers most costs related to home health care.

The government, however, has set some limitations on payouts – you are only eligible if you need intermittent care (usually defined as seven days a week or less than eight hours a day over 21 days or less) (1), physical/occupational therapy or speech language pathology; you are homebound; and the home health care agency providing care is approved by your Medicare insurance program.

In addition to medication administration, general supervision, and therapy services, the Medicare home health benefit covers a number of other necessities, including medical aids and supplies to aid in recuperation. On the occasion, though, you may be required to cover some of the costs associated with home health care. But what can you expect to pay out-of-pocket that’s not covered by Medicare dollars?

Medicare Insurance: Part A and Part B

Hospital Insurance (Medicare Part A) helps cover the costs of your inpatient care at hospitals, skilled nursing facilities, or religious non-medical health care establishments. Part A can also help cover hospice and home health care services. Individuals aged 65 and older are usually automatically enrolled in Medicare Part A and do not have to pay a monthly premium if Medicare taxes were paid while working. If you did not pay taxes, you are still eligible, but you will be required to pay a monthly premium.

Medical Insurance (Medicare Part B) helps cover services such as those offered by your physician and outpatient care. Many seniors maintain their enrollment in Part A, but elect not to use Part B, which requires a monthly premium that is dependent upon income, the requirements of which change yearly. Unfortunately, if you didn’t sign up for Part B when you were first eligible for insurance, your premium may be slightly higher (2).

For questions on your Medicare insurance benefits, you should contact 1-800-MEDICARE or read the handbook mailed to you each year entitled “Medicare and You.”

What’s Covered and What’s Not

Medicare insurance pays for physical and occupational therapy and speech language pathology services, counseling, some medical supplies, durable medical equipment (which must meet coverage criteria), as well as general assistance with daily activities which include dressing, bathing, eating, and toileting. For most other medical equipment, Medicare insurance will cover 80% of its cost (3).

However, Medicare will not cover twenty-four hour care at home, meals delivered to your home, and services unrelated to your care such as housekeeping. Of course, as mentioned above, you will be required to pay 20% for medical equipment not fully covered by Medicare insurance such as wheelchairs, walkers, and oxygen tanks (4).

In some cases, your home health care agency may present you with a Home Health Advance Beneficiary Notice (HHABN), which, simply put, means if your agency is ceasing your care services, you will be presented with a written statement outlining the supplies and services the agency believes your Medicare insurance benefits will not cover as well as a detailed explanation of why. Should this situation arise, you do have recourse – the HHABN lists directions on acquiring the final decision on payment issues or filing an appeal if Medicare refuses to cover costs for home health care. In the meantime, you should continue receiving home health care services, but keep in mind that you will be paying for these services out-of-pocket until Medicare accepts your claims and remits past expenses.

Medigap and Other Out-of-Pocket Expenses

Medigap, a supplemental insurance policy, is sold privately and covers the services and supplies not paid for by Medicare insurance. When used in conjunction, Medigap and Medicare can often cover a large majority of the costs of your home health care. Insurance companies offer a variety of different Medigap policies (A through L), but since each one comes with specific benefits, you’ll need to compare the highlights closely. Medigap policies vary by cost, and many insurance companies require you to have both Medicare Parts A and B in order to purchase a supplemental plan (5).

For seniors with both Part A and Part B Medicare, your home health care situation is usually covered, save for the 20% out-of-pocket expenses for medical equipment. Just remember to keep track of your Medicare insurance benefits (and Medigap if applicable) by verifying with your physician, home health care agency, and insurance representative. Paying for home health care does not have to cost you an arm and a leg, but do be prepared for the occasional (but necessary) out-of-pocket medical expenses.

How to build a health care system that works

A Lewin Group report for the Advanced Medical Technology Association shows that hot new devices are not getting to older Americans. In the middle of the most rapid technological development period ever, …

A Lewin Group report for the Advanced Medical Technology Association shows that hot new devices are not getting to older Americans. In the middle of the most rapid technological development period ever,Guest Posting the Health Care Financing Administration (HCFA), which oversees Medicare, insists on approving each medical device, one at a time. Often it demands separate approvals for each region of the country. This process can take from 15 months to five years. Once the device is approved, HCFA pays no more for the use of the new technology than it did for what it replaced, even if the new technology saves costs further down the line. The question here is: Why is this necessary at all? These devices have already jumped through the hoops of both peer-reviewed medical journals and FDA approval, and HCFA already sets the amount it will pay for each case, no matter what device is used on the patient. The question here is: Where is the single vision for the care of older Americans? Who is really thinking about this? The rise in drug costs is not just about the greed of the “Big Pharm” companies. It’s about powerful new drugs, far more capable than any we have had before, extending people’s lives and functioning. It’s the age of the “miracle drug.” And the trend is not slowing. Any look in the health care crystal ball shows pharmaceuticals taking over more and more of health care. In fact, drugs will eventually replace much of the surgery and other therapies that we do today. But we’re still arguing about whether to pay for it for older Americans, as if drugs were somehow not part of what we call “health care,” but some weird Golden-Ager self-indulgence. The question once again is: Where’s the vision? These three articles, picked from a random recent week, carry a huge theme: U.S. health care is drifting in the dark. The theme echoes down the pages of health care news, week after week, year after year. Health care is the weakest link in the world’s strongest economy, the sad and disheveled sector in the midst of bright wealth and revolutionary vigor. No mind directs health care, and no debate invigorates it. We are having trouble building the health system of the future because we have no health system of the present. We pretend horror at the thought of “nationalizing” health care. The reality is that through financing, rule-setting, and legislation, the federal government is already in charge of health care in the United States. Could we admit that? Apparently not. In Canada – in fact, in most countries – “how to run health care” is an open social and political discussion. In the U.S., we have separate discussions called “who should pay for health care,” “ain’t those HMOs nasty,” and “look at those greed-heads running the hospital,” mixed up with red-flag, over-simplified issues such as abortion and cloning. We have no discussion about “how to run health care,” let alone “how to build a health care system that works” or even the deeper question: “What is health care?” To build a system that works, we have to think about – and talk about – a whole system. As long as we focus on one piece at a time, we are doomed. The discussion would have to start with the question: What are we after here? Is it just the lowest cost health care that doesn’t actively kill people? Is it a tiered and “nuanced” system that matches our class-and-status society, with the best for the rich, nothing for the homeless? Is it optimal health for all – as a way of cutting costs? What about simplicity, ease of use? Right now everyone in the United States has two jobs, their day job and the other one, called “figuring out the health care system.” What about a sense of connection, caring, and meaning in what are, after all, our greatest trials and final moments?

Scope of Digital Marketing and Its Career Opportunities in India

Organizations in India are changing their marketing strategies. From the time of traditional ways of marketing, today, every organization’s key marketing strategy is digital marketing. The scope of digital marketing is so vast in India, it has created an array of career opportunities.With almost a fourth of the country’s population holding a smart phone in their hands with unlimited internet access, marketing agencies are finally realizing how important it is to concentrate their budget and resources on digital marketing in India, especially its mobile marketing aspect. Long gone are the days when companies with their sky high marketing budgets used to think about just billboards and hoardings, print media ads, TV and radio ads, etc. To stay ahead of the competition and survive such competitive times, a lot of startups are not even thinking about traditional marketing.Companies, whose sole purpose is to promote their brand name, are trying to push their product or service, especially through advertising on social media platforms. On the other hand, companies who’re trying to sell their product or service are doing it through, “Pull marketing”, i.e., advertising on search engines, where the users or the consumers know their requirements. This example may not always be true.Now, talking about the career opportunities in digital marketing in India, there are a lot of fields in online marketing you can choose from. Some of them are, search engine optimization (SEO), pay per click (PPC), social media marketing and optimization (SMM & SMO), email marketing, content marketing, digital analytics and many more. The scope of internet marketing in India is so vast, it has spread from metropolitan cities to tier 2 cities in India. You don’t really need a degree to start your career in internet marketing, but to expertise in any aspect of digital marketing, from your journey as a digital marketing intern to digital marketing manager, you need professional guidance.Let’s discuss job roles once you have decided on your specialization.Search Engine Optimization Manager: As an SEO manager, you’re responsible for optimizing the website for ranking higher in the search engine results through on page as well as off page techniques.Pay Per Click Manager: A PPC manager manages the marketing of the desired website pages on a search engine or even social media, trying to get a lower cost per click (CPC).Digital Analytics Manager: As a digital analytics manager, you’ll be expected to analyze data from all possible relevant sources and bring necessary changes to the digital campaigns.Read more about the scope of digital marketing in India.