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Medicare Hospice Benefit

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Medicare Hospice Benefit

Hospice and other end of life issues are not things we often want to talk about. However, being prepared and knowing all your options is a good idea.

We should start by describing hospice. Hospice is a program of care and support for people who are terminally ill. The focus is usually on providing comfort instead of treatment. It is a choice a patient needs to make with their doctor and family. Hospice programs also offer assistance and services to family members during the process of caring for the patient.

If you have Medicare it will cover hospice services. The Medicare hospice benefit covers your care and you shouldn’t have to go outside of hospice to get care (except in very rare situations).

Once you choose hospice care, your hospice benefit should cover everything you need. All Medicare-covered services you get while in hospice care are covered under Original Medicare, even if you were previously in a Medicare Advantage Plan (like an HMO or PPO) or other Medicare health plan.

Medicare Part A (Hospital Insurance) covers Hospice care if you meet these conditions:

Your hospice doctor and your regular doctor certify that you’re terminally ill (with a life expectancy of 6 months or less).

You accept palliative care (for comfort) instead of care to cure your illness.

You sign a statement choosing hospice care instead of other Medicare-covered treatments for your terminal illness and related conditions.

Palliative care means that the medical team will focus on relieving the patient’s pain and any other symptoms, including mental stress. Only your hospice doctor and your regular doctor can certify that you’re terminally ill and have 6 months or less to live.

To start the process you meet with your doctor to discuss all options. Medicare covers a one-time only hospice consultation with a hospice medical director or doctor to discuss your care options and management of your pain and symptoms. This one-time consultation is available to you, even if you decide not to get hospice care.

Medicare will cover the hospice care you get for your terminal illness and related conditions, but the care you get must be from a Medicare-approved hospice program.

Hospice care is can be given in your home. Although depending on your needs and wishes, there are also inpatient programs available. That is one of the things you will discuss with the hospice program (and your loved ones). Together you will create a plan of care that can include any or all of these services:

Doctor services

Nursing care

Medical equipment (like wheelchairs or walkers)

Medical supplies (like bandages and catheters)

Prescription drugs

Hospice aide and homemaker services

Physical and occupational therapy

Speech-language pathology services

Social worker services

Dietary counseling

Grief and loss counseling for you and your family

Short-term inpatient care (for pain and symptom management)

Short-term respite care

Any other Medicare-covered services needed to manage your terminal illness and related conditions, as recommended by your hospice team

You can find out more information at medicare.gov or by calling them at 1-800-Medicare. Hospice specific information and resources are available at https://www.medicare.gov/coverage/hospice-and-respite-care.html

You can also talk to your physician about your options and care available in your area.

This information is meant to inform you of coverage available to you should you need it. Don’t be afraid to talk openly with your family about end of life decisions.

Preventive Services

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Preventive Services

The Centers for Medicare and Medicaid Services (CMS) released a new report showing that more than 5 million Americans with traditional Medicare – or nearly one in six people with Medicare – took advantage of one or more of the recommended preventive benefits now available for free because of the Affordable Care Act.   Medicare wants to raise awareness about all of the important preventive benefits now covered at no charge to patients, including the new Annual Wellness Visit benefit created by the Affordable Care Act.  

 “I am committed to ensuring that the Medicare beneficiaries we serve are aware of and take advantage of their Medicare preventive benefits.” Assistant Secretary for Aging Kathy Greenlee.

According to the report, over 5.5 million beneficiaries in traditional Medicare used one or more of the preventive benefits now covered. The covered services do not have co pays and include mammograms, bone density screenings, and screenings for prostate cancer. 

In 2011, Medicare began covering an Annual Wellness Visit at no cost to Medicare beneficiaries.  As part of that visit, beneficiaries and their physicians can review the patient’s health and develop a personalized wellness plan.  Over 780,000 beneficiaries received an Annual Wellness Visit between January 1 and June 10. Additionally, more seniors have used the Welcome to Medicare Exam this year. The Welcome to Medicare is a one-time preventive health exam available to enrollees in the first 12 months they have Part B.  66,302 beneficiaries had taken advantage of the benefit by the end of May 2011, compared to 52,654 beneficiaries at the same point in 2010 – a 26 percent increase.

The new annual wellness visit can help spark the beginning of an ongoing conversation between patients and their doctors on how to prevent disease and disability.  Patients should take advantage of this time by reviewing their histories and making sure their primary care doctor knows about their other providers and prescriptions. They can also talk about the pros and cons of getting an influenza, pneumococcal or hepatitis B vaccination, or find out whether a diabetes test, a bone mass measurement, or any of several cancer screenings would be right for them.  Thanks to the Affordable Care Act, Medicare now covers many of these services without cost to patients.

  You can find additional information on prevention benefits on line at www.Medicare.gov, and at www.healthcare.gov

Affordable Care Act (ACA) Facts: Part 2 in a Series

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Affordable Care Act (ACA) Facts: Follow this Series

There is a lot of speculation and discussion about what affect health care reform legislation, the Affordable Care Act (ACA), will have on seniors and more specifically, Medicare. We decided to do a series of blog posts about the facts; this is our second post, so please see Fact # 1 in a post dated, Feb 8, 2011.

Fact # 2 The ACA will reduce Medicare spending growth, extend Medicare solvency and is projected to reduce the budget deficit.

While Medicare spending will continue to grow, over the next 10 years the healthcare law will slow the overall rate of growth. Average spending per person will grow at about 2% per year, according to the Congressional Budget Office (CBO) this is compared to the current rate of 4% per person per year. This slight decrease will be a result of reductions in waste, fraud and abuse.  The CBO also projects that the ACA will save Medicare about $400 billion over 10 years and will extend the solvency of the Medicare Trust Fund until 2026.

What you need to know:

In 2011, the ACA will slow payment increases that are made to Medicare providers such as, hospitals, nursing homes and home health agencies. Please note that doctors are not included in that group. The ACA does not reduce payments to your primary care doctor.

Also in 2011, payments to Medicare Advantage (MA) will be reduced. Approximately 25% of seniors are enrolled in MA plans, HMOs or PPOs offered by private insurance companies, the other 75% have traditional Medicare. The ACA will gradually lower payments made to MA plans, which on average cost 13% more than original Medicare. Another change that ACA makes to Medicare Advantage (MA) plans is that those plans will not be able to charge you more than what you would pay if you were on original Medicare for services such as kidney dialysis, chemotherapy, or skilled nursing home care.

Because of these laid out in the Law, MA plans may cut some of the extra benefits they offer that are not covered by traditional Medicare and some may increase their premiums. Please note that MA plans cannot cut any basic benefits under Medicare, such as doctor visits and hospital care. You will also have the same right to switch out of your MA plan to original Medicare, the new law will not affect your right to Medicare benefits.

Another way that Medicare savings will occur according to statements in the Affordable Care Act, is for higher income individuals to pay higher prescription drug premiums. This will affect about 5% of Medicare recipients in 2011, single people with incomes above $85,000 and couples with adjusted gross incomes above $170,000.

The ACA states that in 2014 a Payment Advisory Board will be created. This board of experts will recommend specific ways to reduce Medicare costs without cutting benefits or increasing out-of-pocket costs.

Information in this blog was gathered from the Affordable Care Act,  Congressional Budget Office, Centers for Medicaid and Medicare and the National Council on Aging.

For more information check out the following links:

A brochure from Medicare:

http://www.medicare.gov/Publications/Pubs/pdf/11467.pdf

Webpage from the National Association of States United for Aging and Disabilities (NASUAD):

http://www.nasuad.org/affordable_care_act/nasuad_materials.html

Answers from the National Association of Area Agencies on Aging (n4a):

http://www.n4a.org/advocacy/health-care-reform/

Straight Talk for Seniors from the National Council on Aging:

http://www.ncoa.org/public-policy/health-care-reform/straight-talk/

Are you prepared? What is an Advanced Directive?

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Are you prepared?

What is an Advance Directive? Why would you need one? Where do you get a form? These are all important questions for anyone, but especially for older adults. You know your rights as a patient and that you can make your own decision about medical treatments, you discuss them with your physician. But what if you were not able to discuss them with your doctor? What if you became incapacitated and were incapable of conversation or comprehension?

That’s where an Advance Directive can help you. They have many other names and come in various types. Some people refer to them as Living Wills, or Instruction Directive, this type of Advance Directive allows for you to make a statement about your treatment preferences. Another type, Proxy Directive or Durable Power of Attorney for Healthcare, allows you to name a proxy, someone you trust to make decisions for you if you are not able. There is also a Combined Directive, in which you may give instructions as to your care if you are incapacitated but also name a proxy to care out those wishes and make decisions based on your treatment preferences.

An Advance Directive can be as simple or specific as you wish. In New Jersey there is no specific form that must be followed for an Advanced Directive and you do not need a lawyer to prepare one. It is suggested that if you have questions you could consult a lawyer or medical professional. There are many models available for Advance Directives and there will be links at the end of this blog. An Advance Directive can simply be a letter stating your health care wishes or it can be a detailed list of treatments that you would or would not want. It is important to remember that an Advance Directive can be used to request treatment not just withhold or withdraw treatment. It is a legally recognized document that can make your wishes know to your family in the event that you are unable to speak for yourself. It only requires your signature and two adults to witness your signature. You can have it notarized or signed by a legal authority but this is not necessary to make it a legal document.

You should share copies of your Advance Directive with your doctor, with family members and if you name a proxy or healthcare representative, you should share a copy with that person as well. Under New Jersey Law, medical staff must honor any written Advance Directive, they are only in effect when you are not capable of making your own decision. It is recommended that you review your Advance Directive every 5 years, you should initial it and have a witness if you make any changes.

The time to think about an Advance Directive is when you are healthy and able to make clear decisions. This way you can make your own decisions and/or appoint someone you trust to make those decisions.

Some resources:

Advance Directive Forms from Legal Services NJ

 

Brochure from New Jersey Ombudsman for the Institutionalized Elderly for more information call 1-877-582-6995 or 609-943-4023

New Jersey Hospital Association

Medical Society of NJ