Posts Tagged ‘skilled care’

Medicare Part B (2010)

Wednesday, May 26th, 2010

Part B is Medical Insurance and covers physicians services, outpatient care, test, and supplies.

On Expenses
incurred for:
Medicare Covers You Pay $155 Annual Part B Deductible PLUS

Physicians services, inpatient, outpatient medical/surgical services, physical/speech therapy, diagnostic test.

80% of approved amount 20% of approved amount
Clinical Laboratory Services
Blood Test, Urinalysis
Generally 100% of approved amount Nothing for Services
Home Health Care
Part-time or intermittent skilled care, home health aide services, durable medical supplies and other services.
100% of approved amount; 80% of approved amount for durable medical equipment Nothing for Services; 20% of approved amount for durable medical equipment
Outpatient Hospital Treatment
Services for the diagnosis or treatment of an illness or injury
Medicare payment to hospital based on hospital cost 20% of Billed Amount

After first 3 pints of blood, 80% of approved amount

First 3 pints plus 20% of approved amount for additional pints

On all Medicare-covered expenses, a doctor or other health care provider may agree to accept Medicare “assignment.” This means the patient will not be required to pay any expense in excess of Medicare’s “approved” charge. The patient pays only 20% of the “approved” charge not paid by Medicare.

Physicians who do not accept assignment of a Medicare claim are limited as to the amount they can charge for covered services.

Introduction to Long-Term Care

Friday, May 21st, 2010

What is Long Term Care

Long Term Care is the assistance persons need when they are unable to care for themselves and need assistance with activities of daily living or have severe cognitive impairment such as Alzheimer’s disease.  The need for long-term care can be the result of an accident or illness or advanced age.  Long-term care provides a broad range services including skilled care in your home, an assisted living facility, or a nursing facility.

Senior couple meeting with agent

Who Needs Long-Term Care?

  • 19% of Americans aged 65 and older experience some degree of chronic physical impairment
  • Approximately 55%  of those age 85 and older are impaired and require Long-Term Care
  • By 2020, 12 million older Americans will require long-term care.
  • Family and friends are the care-givers for 70% of elderly people.
  • People aged 65 and older face a 40% risk of entering a nursing home.
  • 22% of people over 85 are in a nursing home.
  • Women face a 50% higher likelihood of entering a nursing home after age 65.

Some Misconceptions about Medicare and Medicaid

 Medicaid pays for the health services for the very poor of any age.  Being eligible for Medicaid does not insure placement in a nursing home.  Under Medicaid, nursing home care is the only option.  Home care, assisted living centers, adult day care, outpatient services, and alternative caregiver services are not usually paid under Medicaid.

 Medicare pays for health care for people 65 and older and for those who are disabled.  Medicare does not pay for long term medical service such as assisted living or adult day care.  Medicare pays only the first 100 days of skilled care only if you have been in the hospital for at least three days immediately prior to entering skilled care.

 Exceptions, Limitations and Exclusions

 Most long-term care insurance policies will not pay benefits if the care is a result of:

  • Attempted suicide or intentionally inflicted injury
  • Voluntary participation in a crime
  • Care provided outside of the U.S. or Canada
  • Care provided in a government facility
  • Alcoholism or drug addiction
  • Care for nervous or mental disorders other than dementia or Alzheimer’s disease

 Pre-existing Conditions

 Coverage may be declined if you already have the following conditions:

  • Alzheimer’s Disease
  • Severe Arthritis
  • Diabetes which is not controlled
  • Cancer within the last 6 months
  • Stroke within the last 6 months
  • Functional limitations as a result of a stroke
  • Congestive heart failure in the last 6 months
  • Parkinson’s Disease
  • Severe Emphysema
  • Chronic Obstructive Pulmonary Disease

Senior man speaking to a nurse while at the hospital

 Contact Hatcher Kimrey Insurance to help you select the long-term care coverage best suited for you.  Remember… We are always there for you!