Medicare Educational Seminars

 

Freedom Financial Services is built on the belief that everyone is entitled to the same education and understanding about their insurance. To this end, we hold a number of educational seminars about your Medicare options, rights, and entitlements. 

 

Our Medicare Made Clear seminars break down, simply, the pieces of Medicare and how they work. We also cover the difference between your health plan options, as well as the things that Medicare does not cover. Many people are unaware of their exposure under Medicare. We'll make sure you are! 

 

Contact us for more information about our next event.

 

Medicare Savings Programs

 

Did you know that there are a number of programs available to help you save on your medical and prescription costs, without the need for more insurance? We can direct you to the right place, help you with applications, and provide assistance to get you the information you need.

 

Medicare

 

In general, individuals are eligible for Medicare if they (or their spouse) worked for at least 10 years in Medicare-covered employment and are at least 65 years old and are a citizen or permanent resident of the United States of America.

 

Individuals who are under 65 years old can also be eligible if they are disabled or have end stage renal disease.  People under 65 and disabled must be receiving disability benefits from either Social Security or the Railroad Retirement Board for at least 24 months before Medicare automatic enrollment occurs.

 

Many beneficiaries are dual-eligible. This means they qualify for both Medicare and Medicaid. In some states those with certain income, Medicaid will pay the beneficiaries Part B premium for them (most beneficiaries have worked long enough and have no Part A premium), and also pay any drugs that are not covered by Part D.

 

Part A: Hospital Insurance

 

Part A covers hospital stays (including stays in a skilled nursing facility) if certain criteria are met:

 

• The hospital stay must be at least three days, three midnights, not counting the discharge date.

• The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay.  For instance, hospital stay for broken hip and then nursing home stay for physical therapy would be covered.

• If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered.

• The care being rendered by the nursing home must be skilled.  Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADLs) such as personal hygiene, cooking, cleaning, etc.

• The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2008, $128.00 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell.

• If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period.

 

Part B: Medical Insurance

 

Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not taking Part B if not actively working.

 

Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, Immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit.

 

Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered.

 

As with all Medicare benefits, Part B coverage is subject to medical necessity. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria. On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD). Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003. Other usual and customary charges are determined by Diagnostic Related Groups (DRGs).

 

Part D: Prescription Plans

 

Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies.

 

Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are able to choose not to cover some drugs at all. he exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates. Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases.

 

It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid will pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.