Tuesday, June 30, 2015

Costly difference for you between being admitted or under outpatient observation care

Warning:  There is a really BIG difference between being classified as an admitted patient vs observation care when you're in the hospital. ‘Observation status’ changes what Medicare pays for as well as qualifying you for rehab care.

Over the past few years, some hospitals have increasingly classified the status of Medicare beneficiaries as out-patient observation instead of admitted patients. This classification dramatically reduces Medicare’s contribution to your cost of a hospital stay and any follow-up care in a skilled nursing facility.

Medicare considers hospital observation an outpatient service. Current Medicare law requires a patient to be admitted to the hospital as an inpatient for a minimum of three days in order to receive coverage for follow-up care in a skilled nursing facility. After that, Medicare pays for the first 20 days of skilled care at 100%. Should a patient be under observation for all or part of his hospital stay, he will be responsible for the entire cost of rehab.

Observation patients may also be charged co-payments for their doctors’ fees and other hospital services including X-rays, drugs and lab tests.

How to Avoid “Observation” Status

The problem is that you may not know whether you are receiving observation care or have been admitted as a patient unless you ask so it’s up to you to take the following steps:

1.     Ask about your status when you are admitted and each day that you are in the hospital. Your status can be changed from inpatient to observation or back again.

2.    Ask your doctor if observation status is justified for your medical condition. If not, ask your doctor to contact the hospital to request that you be admitted as an inpatient.

3.     After discharge, if you find out Medicare won't cover your stay in a skilled nursing facility, ask your doctor whether you qualify for similar care at home through Medicare's home health care benefit.

4.    If you have to pay for services at a skilled nursing facility, but you believe those services should have been billed as inpatient, you can try formally appealing Medicare's decision.

If you have a Medicare Advantage Plan, costs and coverage may be different. Always check with your agent or plan provider.  My clients can always call me if they have questions at 440-255-5700 about these or other issues concerning their insurance coverage.

Tuesday, June 23, 2015

Traveling outside the U.S. this summer?

Make sure your insurance travels with you.

You may be surprised to learn that Original Medicare does not pay for health care services or supplies you get outside the U.S. except in very limited situations. Medicare considers the 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa to be a part of the U.S. 

On your cruise for example, Original Medicare may cover medically necessary health care services you receive on board the ship within the territorial waters adjoining the land areas of the U.S. However, Medicare will NOT pay for health care services you get when a ship is more than 6 hours away from a U.S. port when you receive the services, regardless of whether it’s an emergency. 

Original Medicare will provide coverage for out of country travelers only if their situations meet very specific exceptions as outlined in your Medicare & You Handbook. If your circumstances do not match the allowable exceptions, you will be responsible to pay the full cost to the health care provider. If your situation matches one of the allowable exceptions, you still pay the coinsurance or copayments and deductibles you would normally pay if you received these services or supplies in the U.S.

Medicare drug plans (Part D) cannot cover prescription drugs you buy outside the U.S. so be sure to bring a sufficient supply of your prescription medications with you.

If you have a Medicare Advantage Plan or Medicare Supplement, you may be entitled to additional coverage for health care services you receive outside the U.S. Advantage Plan coverage may vary so it’s best to give your insurance agent a call and ask them about your coverage before you begin your trip.

While I make every effort to provide you with up to date, accurate information, these are general guidelines. Your situation or circumstances may be different. For answers to your life, health or Medicare plan questions please contact me at Mutsko Insurance Services, LLC, 440-255-5700.

Wednesday, June 17, 2015

Medicare coverage for diabetes management

Original Medicare and Medicare Advantage Plans provide a broad spectrum of support and services to help you manage your diabetes. It is in the best interest of your health as well as your wallet to become familiar with your benefits.

For example, if your doctor determines you are at risk, Medicare Part B will cover the cost of up to 2 diabetes screenings each year.

Part B will also cover outpatient training for people at risk for complications from diabetes or recently diagnosed with diabetes. Training will include tips for eating healthy, being active, monitoring blood sugar and taking medication. Your doctor or other health care provider must provide a written order to a certified diabetes self-management education program for this to be covered. You will be responsible for 20% of the Medicare approved amount as well as any Part B deductible.

Medicare Part D (Prescription Drug coverage) is the part of your Medicare Plan that covers medications prescribed to manage diabetes. Part D also covers certain medical supplies for administration of insulin, including syringes, needles, alcohol swabs, gauze, and inhaled insulin devices. As with other medications, when you purchase prescriptions or other supplies, you will be responsible for your coinsurance, copays and any Part D deductible.

Even if you don’t use insulin, Medicare Part B covers blood sugar self-testing equipment and supplies with a prescription from your doctor. Self-testing supplies include monitors, test strips, lancet devices, lancets and glucose control solutions. Check with your Medicare provider before ordering any supplies or durable medical equipment for the name of their recommended provider. Physicians and suppliers have to meet strict standards to be enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them. If suppliers don't accept assignment, there’s no limit on the amount they can charge you.

If you have a Medicare Advantage Plan, it will provide you with the same coverage as Original Medicare, and often additional benefits.

The management of diabetes can be complicated, but help is available. The tips  presented here are general guidelines and you should always verify that your  providers accept Medicare assignments. For more specific benefit information, contact your insurance agent or consult your Medicare plan materials.

Got questions on health, life or Medicare Insurance? Contact me at 440-255-5700 or email me. I’ll answer your questions and help you find the right insurance plan for you.

Monday, June 8, 2015

Mind your Meds

7 safety tips for prescription medications

Do you take a long list of drugs to manage serious health problems? Or do you simply reach for an over-the-counter medication from time to time? Either way, there's a lot you can do to make sure you get the most benefit from the medication -- and stay safe in the process. These tips are a good place to start.

1.  Get organized. Create a chart that outlines your medications, including when and how much to take. You can hand write your chart or you can pick up a complimentary wallet-size medication record/ID card at our office.

2.  Check into using e-tools and apps from your iPad or smart phone to help you track your medication usage. Two free apps that have good reviews are:

Med Helper  –  Pill Reminder and Medication Tracker
Pill Alert  –  Medication, Prescription Reminder and Tracker, and Tracker.
Keep your list of medications in your wallet, purse or on your cellphone. Include dosage information and what the medication is used for. Eye drops, skin medications and herbal remedies are considered medications and should be included on your list. This list will provide emergency personnel or a new doctor with much needed information.

3.   Do not stop taking medication unless you talk to your doctor first or you are experiencing a serious side effect. Call your doctor as soon as possible if you feel you need to stop a medication.

 4.   Take extra medication with you when you travel in case your flight is delayed or you need to stay away longer than planned. Always carry your medication in your carry-on luggage.

 5.    Ask your doctor about the effects of food on your prescribed medication. Some foods interfere with the body's ability to absorb medications into the blood stream. On the other hand, some prescription medications should be taken with food to prevent stomach irritation.

6.     Don’t share your medication under any circumstances. You may feel you are doing someone a favor, but this is one good deed that can turn deadly.

7.    Prescription drug abuse is the fastest growing segment of drug abuse in our country. Store your prescriptions in a safe place, out of view of anyone you don’t know or trust completely. Instead of keeping your medications lying around on a counter or a bathroom medicine cabinet that’s out of your sight, consider keeping them in a lock-box, a kitchen cabinet or other place that’s easy for you to keep an eye on. Law enforcement officials have warned people that those stealing their medication can be a friend, a caregiver, a contractor or even a family member.

Monday, June 1, 2015

When was the last time you saw your dentist?

Taking care of your teeth isn't just about having a nice smile. Recent research has found that the condition of your mouth is closely linked to your overall physical health. Whether the disease or condition is the cause or the effect is not always clear, but the links are apparent between diabetes, heart disease, Alzheimer’s disease and osteoporosis with poor oral health.  

Regular visits to your dentist should be part of your overall health care plan. But, unfortunately, dental options are very limited for anyone without dental insurance or who has Original Medicare. Original Medicare does not pay for routine dental care including the costs of exams, teeth cleaning, tooth extractions, x-rays and dentures. This means that you can expect to pay 100% of the costs for all these services if you want to keep your healthy smile and you don’t have supplemental dental insurance.  (Original Medicare will only cover the cost of dental procedures related to covered medical procedures that are necessary to treat a non-dental condition and must be treated at the same time and by the same doctor as the covered condition.)

There are affordable options to help you with the cost of routine dental care. These include private insurance plans and Medicare Advantage Plans with dental coverage. Some plans cover a percentage of your costs for cleanings, x-rays and exams while other are more comprehensive and will cover major dental services like crowns, bridges, root canals and denture, in addition to your routine care. It all depends on what type of coverage you are looking for.

Another option is to check with dental colleges and dental hygiene schools. Many, including Lakeland Community College, offer dental clinics for adults and children for preventive services. Students gain valuable experience and provide services at a reduced cost, all under the supervision of licensed professionals. For more information on the clinic at Lakeland, visit their website at http://www.lakelandcc.edu/web/about/clinic-dental.

Whatever you do, it’s time to stop neglecting your dental care. Stop skimping on this and realize that your dental health as an investment in your overall health. Call me today at 440-255-5700 or email me at Lmutsko@mutskoinsurance.com and let’s look at the affordable dental insurance options for you and your family. For more information, visit our website at www.mutskoinsurance.com.