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| Q: |
Can a beneficiary receive home health care and end stage renal disease services at the same time? |
| A: |
Yes, you may receive both services at the same time. |
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| Q: |
How Can I Get Care at Home? |
| A: |
To Get Medicare Home Health Care:
1. Your doctor must decide that you need medical care in your home, and make a plan for your care at home; and
2. You must need at least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech language pathology services; and
3. You must be homebound. This means that you are normally unable to leave home. Being homebound means that leaving home is a major effort. When you leave home, it must be infrequent, for a short time, or to get medical care; and
4. The home health agency caring for you must be approved by the Medicare program. |
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| Q: |
How do I know if I am eligible for both Part A and Part B? |
| A: |
You should contact your local Social Security office. The staff there can tell you if you are eligible for Part A and Part B. |
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| Q: |
How, when and where do I sign up for Medicare when I turn 65? |
| A: |
If you are already getting Social Security or Railroad Retirement checks when you turn 65, you will automatically be enrolled in Medicare. Your Medicare card (a red, white and blue card) will automatically be mailed to you about three months before your 65th birthday as part of your enrollment information package.
However, if you are not yet receiving Social Security or Railroad Retirement benefits, when you turn 65, you will need to contact your local Social Security Office. You will need to file your application during your 7-month enrollment period. That period starts three months before you turn 65 and ends three months after. |
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| Q: |
What do I have to pay for Home Health services? |
| A: |
Generally, you pay nothing for Home Health Care services and 20% of the Medicare approved amount for any durable medical equipment you need with Medicare Part B. Some examples of covered services include: part-time and intermittent skilled nursing care, home health aid services, medical supplies such as wound dressings, physical and occupational therapy. Medicare does not pay for the following services given in the home: 24 hour nursing care, meals, prescription drugs, and homemaker services such as shopping, cleaning and laundry. For more specific information, you should contact our customer service representatives at 1-888-896-4997. |
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| Q: |
What types of services are covered under Medicare Part A and Part B? |
| A: |
Medicare Part A helps to cover a variety of services including:
- Hospital stays
- Home Health Care
- Hospice Care
- Skilled Nursing Facility Care
Medicare Part B helps to cover a variety of services including:
- Doctor Services
- Laboratory Tests
- Outpatient Hospital Services
- Medical Equipment
- Blood
- Home Health Care |
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| Q: |
Will Medicare cover an overnight stay prior to an outpatient surgery? |
| A: |
Preadmission for an outpatient surgery would not be covered by Medicare as it is not medically necessary. |
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| Q: |
Will Medicare cover services relating to obesity? |
| A: |
Services for the treatment of obesity are covered when the services are a necessary part of the treatment for:
1. cardiac and respiratory diseases;
2. diabetes
3. hypertension
4. hypothyroidism
5. Cushion's disease, and
6. hypothalamic lesions.
Gastric bypass surgery for extreme obesity is covered if (1) it is medically appropriate for the individual to have the surgery; and (2) the surgery is to correct an illness which caused the obesity or was worsened by the obesity.
The use of the Gastric balloon is not covered, since its safety and effectiveness have not been established.
Intestinal bypass surgery is not covered because its safety has not been established. |
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| Q: |
Will the Medicare rates change in 2005? What are the new rates? |
| A: |
Effective January 1, 2005 there will be some changes in Medicare rates.
Inpatient Hospital Insurance (Part A):
DEDUCTIBLE - $912 (Per Benefit Period)
COINSURANCE - $228 a day for the 61st- 90th day in each Benefit Period
$458 a day for the 91 st-150th day for each lifetime reserve day (total of 60 lifetime reserve days – nonrenewable)
Skilled Nursing Facility Deductible - $114.00 per day for each Benefit Period (paid after first 20 days of care)
Supplemental Medical Insurance (SMI) – Part B deductible - $110 per year
Part B Monthly Premium - $72.20 per month
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| Q: |
Will the Medicare rates change in 2006? What are the new rates? |
| A: |
Effective January 1, 2006 there will be some changes in Medicare rates.
Inpatient Hospital Insurance (Part A):
DEDUCTIBLE - $952 (Per Benefit Period)
COINSURANCE - $238 a day for the 61st- 90th day in each Benefit Period
$478 a day for the 91 st-150th day for each lifetime reserve day (total of 60 lifetime reserve days – nonrenewable)
Skilled Nursing Facility Deductible - $119.00 per day for each Benefit Period (paid after first 20 days of care)
Supplemental Medical Insurance (SMI) – Part B deductible - $124 per year
Part B Monthly Premium - $88.50 per month |
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