Medicare workshop-presentation-2014

Peace HavenPeace Haven

Medicare WorkshopMedicare Workshop

Medicare has offered a Medicare has offered a Christian Science benefit since Christian Science benefit since

19661966

President Lyndon Johnson signed President Lyndon Johnson signed Medicare amendment to Social Medicare amendment to Social Security Act on July 30, 1965.Security Act on July 30, 1965.

MEDICARE PART AMEDICARE PART A

Part A – Hospital Insurance – Part A – Hospital Insurance – covers stay in a Religious covers stay in a Religious Nonmedical Health Care Nonmedical Health Care Institution or Hospital.Institution or Hospital.

Christian Science Nursing Christian Science Nursing Facilities are called RNHCIs.Facilities are called RNHCIs.


Most people receive premium-free Part A Most people receive premium-free Part A coverage. Part A is available for no cost at the coverage. Part A is available for no cost at the age of 65 if:age of 65 if:– You are eligible for benefits from Social You are eligible for benefits from Social

Security or the Railroad Retirement BoardSecurity or the Railroad Retirement Board– If you or your spouse worked at least 40 If you or your spouse worked at least 40

quarters, orquarters, or– You or your spouse had Medicare-covered You or your spouse had Medicare-covered

government employmentgovernment employment Those few who will want to purchase Part A, Those few who will want to purchase Part A,

will pay up to $426 each month.will pay up to $426 each month.


If you're under the age of 65, you may If you're under the age of 65, you may be eligible for Part A if you are disabled be eligible for Part A if you are disabled or have other specific healthcare needs.or have other specific healthcare needs.

The website The website www.medicare.gov explains explains the specific requirements.the specific requirements.

In most cases, if you choose to purchase In most cases, if you choose to purchase Part A, you must also have Medicare Part Part A, you must also have Medicare Part B and pay monthly premiums for both.B and pay monthly premiums for both.


Some individuals will Some individuals will automatically be enrolled in automatically be enrolled in Medicare Part A and B.Medicare Part A and B.– If you are automatically enrolled, If you are automatically enrolled,

you will receive your Medicare card you will receive your Medicare card in the mail 3 months before your in the mail 3 months before your 65th birthday.65th birthday.


Some individuals are not automatically Some individuals are not automatically enrolled in Medicare and will need to enrolled in Medicare and will need to sign up for Medicare Part A and B. sign up for Medicare Part A and B. – This includes those who aren’t receiving This includes those who aren’t receiving

social security benefits yet because they are social security benefits yet because they are working.working.

– If you need to sign up, contact the Social If you need to sign up, contact the Social Security Administration or a Social Security Security Administration or a Social Security Office 3 months before your 65Office 3 months before your 65thth birthday. birthday.


If you were still working at the age If you were still working at the age of 65 and were covered by your of 65 and were covered by your employer’s insurance plan, you employer’s insurance plan, you may want to contact the Medicare may want to contact the Medicare Coordinator of Benefits and let Coordinator of Benefits and let them know that you are no longer them know that you are no longer working so they can record working so they can record Medicare as your primary payer. Medicare as your primary payer.


How to Sign Up for Part A and BHow to Sign Up for Part A and B– Apply online at Social SecurityApply online at Social Security– Visit your local Social Security officeVisit your local Social Security office– Call Social Security at 1-800-772-1213Call Social Security at 1-800-772-1213– If you worked for a railroad, call 1-877-If you worked for a railroad, call 1-877-

772-5772772-5772 You don’t need to sign up for Medicare You don’t need to sign up for Medicare

annually. However, each year you can annually. However, each year you can review and change your benefits.review and change your benefits.

MEDICARE PART BMEDICARE PART B

Part B – Medical Insurance which includes medical Part B – Medical Insurance which includes medical procedures, doctors, equipment, ambulance procedures, doctors, equipment, ambulance services, etc…services, etc…

Most people pay a monthly premium currently Most people pay a monthly premium currently between $104.90 to $335.70 per month, based on between $104.90 to $335.70 per month, based on income.income.

Automatically enrolled in Part B, unless you Automatically enrolled in Part B, unless you specifically decline.specifically decline.

Part B cannot be used in a Christian Science Part B cannot be used in a Christian Science Nursing Facility.Nursing Facility.

Medigap or Medicare Supplement Insurance policy Medigap or Medicare Supplement Insurance policy may require that you have Part B coverage.may require that you have Part B coverage.


How to Drop Part BHow to Drop Part B– If your Medicare coverage hasn’t started If your Medicare coverage hasn’t started

yet:yet: And you were automatically enrolled in both And you were automatically enrolled in both

Part A and Part B and sent a Medicare card, Part A and Part B and sent a Medicare card, follow the instructions that come with the card, follow the instructions that come with the card, and send the card back. If you keep the card, and send the card back. If you keep the card, you keep Part B and will pay Part B premiums.you keep Part B and will pay Part B premiums.

Or if you signed up for Medicare versus being Or if you signed up for Medicare versus being automatically enrolled, contact Social Security automatically enrolled, contact Social Security to drop Part B. to drop Part B.


– If your Medicare coverage has already If your Medicare coverage has already started:started: Contact Social Security for instructions on how Contact Social Security for instructions on how

to submit a signed request to drop Part B. Your to submit a signed request to drop Part B. Your coverage will end the first of the month after coverage will end the first of the month after Social Security gets your request.Social Security gets your request.

– You generally won’t be able to re-enroll in You generally won’t be able to re-enroll in Part B until the next enrollment period Part B until the next enrollment period (January 1 – March 31st) and you will have (January 1 – March 31st) and you will have to pay a late enrollment penalty, which to pay a late enrollment penalty, which can be substantial. can be substantial.

MEDICARE PART CMEDICARE PART C

Part C – includes Managed Care Part C – includes Managed Care Organizations, also known as HMOs Organizations, also known as HMOs (health maintenance organizations) (health maintenance organizations) and PPOs (preferred provider and PPOs (preferred provider organizations) organizations) – Require prior written authorization for Require prior written authorization for

coverage in a Christian Science Nursing coverage in a Christian Science Nursing Facility which can be difficult to obtain.Facility which can be difficult to obtain.

– Authorization must happen before Authorization must happen before admission or immediately upon arrival.admission or immediately upon arrival.

MEDICARE PART DMEDICARE PART D

Part D – Prescription Drug Service Part D – Prescription Drug Service – most people pay a monthly – most people pay a monthly premium. Insurance provided by premium. Insurance provided by private companies. private companies.

Part D cannot be used in a Part D cannot be used in a Christian Science Nursing Facility.Christian Science Nursing Facility.

REQUIREMENTS FOR REQUIREMENTS FOR MEDICARE COVERAGEMEDICARE COVERAGE

For Medicare to cover Christian For Medicare to cover Christian Science Nursing Care at a Science Nursing Care at a Christian Science Nursing Facility, Christian Science Nursing Facility, the beneficiary (patient) must:the beneficiary (patient) must:– sign an election formsign an election form– have a condition that would qualify have a condition that would qualify

him or her forhim or her for inpatient care in a inpatient care in a hospital or a skilled nursing facilityhospital or a skilled nursing facility A skilled nursing facility is not the same A skilled nursing facility is not the same

as a nursing homeas a nursing home

MEDICARE ELECTIONSMEDICARE ELECTIONS

When a patient is admitted, the patient will When a patient is admitted, the patient will sign an election upon admission so it is sign an election upon admission so it is available for Medicare.available for Medicare.

The election form is only sent to Medicare The election form is only sent to Medicare if the patient’s care level qualifies for if the patient’s care level qualifies for Medicare.Medicare.

Once an election is sent to Medicare it is in Once an election is sent to Medicare it is in effect until it is revoked by the patient.effect until it is revoked by the patient.


Prior to the filing of an election form, Prior to the filing of an election form, a Christian Scientist can use Medicare a Christian Scientist can use Medicare for medical services or supplies and it for medical services or supplies and it won’t impact the use of Medicare in a won’t impact the use of Medicare in a Christian Science Nursing Facility.Christian Science Nursing Facility.

After an election is filed, there are After an election is filed, there are consequences associated with using consequences associated with using Medicare for medical services and Medicare for medical services and supplies.supplies.


Receiving medical care after an Receiving medical care after an election is establishedelection is established– Once – no waiting period.Once – no waiting period.– Twice – 1 year waiting period.Twice – 1 year waiting period.– Three Times – 5 year waiting period.Three Times – 5 year waiting period.

A revocation doesn’t occur again A revocation doesn’t occur again until a new election is filed.until a new election is filed.


Example: a patient receives Example: a patient receives Christian Science Nursing Care and Christian Science Nursing Care and signs an election form. The patient signs an election form. The patient then receives medical care. then receives medical care. – This creates one revocation.This creates one revocation.– After the revocation occurs the After the revocation occurs the

patient can receive as much medical patient can receive as much medical care as they need or want. care as they need or want.


– Then the patient returns to a Then the patient returns to a Christian Science Nursing Facility. Christian Science Nursing Facility. After discharging the facility the After discharging the facility the patient purchases a wheelchair and patient purchases a wheelchair and uses Medicare to pay for the uses Medicare to pay for the purchase. The patient has just purchase. The patient has just created a second revocation. Now the created a second revocation. Now the patient must wait one year to re-enter patient must wait one year to re-enter a Christian Science Nursing Facility a Christian Science Nursing Facility under Medicare.under Medicare.

DETERMINING DETERMINING COVERAGECOVERAGE Medicare does not require a Medicare does not require a

medical diagnosis for Christian medical diagnosis for Christian Scientists receiving care in a Scientists receiving care in a Christian Science Nursing Facility.Christian Science Nursing Facility.

Using guidelines from Medicare, a Using guidelines from Medicare, a Christian Science Facility Nurse Christian Science Facility Nurse will determine if a patient’s care will determine if a patient’s care needs qualify for Medicare.needs qualify for Medicare.

MEDICARE COVERSMEDICARE COVERS

Part A Includes: Christian Part A Includes: Christian Science Nursing Services Science Nursing Services

Room and mealsRoom and meals

Most nursing suppliesMost nursing supplies

MEDICARE DOES NOT MEDICARE DOES NOT COVERCOVER Christian Science Nursing Care Christian Science Nursing Care

that does not require a that does not require a JournalJournal--listed Christian Science Nurselisted Christian Science Nurse

Christian Science PractitionersChristian Science Practitioners Personal items such as telephone Personal items such as telephone

and hairdresser chargesand hairdresser charges Rest and studyRest and study Private duty or home nursingPrivate duty or home nursing

PART A: WHAT YOU PART A: WHAT YOU PAY (2014 Rates)PAY (2014 Rates)

Initial Period60 days

Lifetime Reserve60 days

Co-insurancePeriod 30 days

$1,216 Deductible

$304 per day

$608 per day

PART A PART A COVERAGECOVERAGE

Medicare is designed for short term Medicare is designed for short term stays and ends when the patient no stays and ends when the patient no longer has a condition that would longer has a condition that would qualify for Medicare coverage in a qualify for Medicare coverage in a hospital or a skilled nursing facility.hospital or a skilled nursing facility.

Christian Science nurses expect quick Christian Science nurses expect quick healing. This progress may result in healing. This progress may result in nursing determining that the patient’s nursing determining that the patient’s condition no longer warrants condition no longer warrants Medicare coverage. Medicare coverage.

EXAMPLE OF EXAMPLE OF COVERAGECOVERAGE Days 1 to 60 - all inclusive flat rate - Days 1 to 60 - all inclusive flat rate -

$420/day$420/day

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Month 1 (30 days) x $420 = $12,600Month 1 (30 days) x $420 = $12,600

Month 2 (30 days) x $420 Month 2 (30 days) x $420 = $12,600= $12,600

Total ChargesTotal Charges = = $25,200$25,200

You Pay $1,216You Pay $1,216

Medicare pays $23,984Medicare pays $23,984

USING MEDICARE USING MEDICARE AGAINAGAIN Although Medicare is a short-term program, it Although Medicare is a short-term program, it

may be used more than once.may be used more than once. If 60 days has passed between stays in a If 60 days has passed between stays in a

Christian Science Nursing Facility, another Christian Science Nursing Facility, another deductible must be paid by the patient.deductible must be paid by the patient.

If less than 60 days has passed between stays If less than 60 days has passed between stays in a Christian Science Nursing Facility and the in a Christian Science Nursing Facility and the patient has Medicare days remaining, then patient has Medicare days remaining, then Medicare picks up where it left off when the Medicare picks up where it left off when the patient discharged. patient discharged.

USING MEDICARE USING MEDICARE AGAINAGAIN

Medicare may be used again at a Medicare may be used again at a Christian Science Nursing Facility Christian Science Nursing Facility if:if:– The patient is out of the facility for The patient is out of the facility for

60 days and does not use Medicare 60 days and does not use Medicare anywhere.anywhere.

– Or, the patient remains in a Or, the patient remains in a Christian Science Nursing Facility Christian Science Nursing Facility but at a lower level of care for 60 but at a lower level of care for 60 consecutive days.consecutive days.

MEDICAID VS MEDICAID VS MEDICAREMEDICARE MedicareMedicare

– Age 65 or older or disabledAge 65 or older or disabled– Short termShort term– Skilled careSkilled care– No financial requirementsNo financial requirements

MedicaidMedicaid– Age 65 or older or disabledAge 65 or older or disabled– Short or long termShort or long term– Includes skilled and non-skilled careIncludes skilled and non-skilled care– Less than $1,500 in financial assets (Ohio)Less than $1,500 in financial assets (Ohio)

MEDICAIDMEDICAID

Two states with Christian Science Two states with Christian Science Nursing Facilities ther offer Nursing Facilities ther offer Medicaid coverage to Christian Medicaid coverage to Christian ScientistsScientists– OhioOhio– California (MediCal)California (MediCal)

PHONE NUMBERS & PHONE NUMBERS & WEBSITESWEBSITES

MedicareMedicare1-800-633-4227 1-800-633-4227

www.medicare.govwww.medicare.gov

Social Security AdministrationSocial Security Administration1-800-772-12131-800-772-1213

www.socialsecurity.govwww.socialsecurity.gov

Peace HavenPeace Haven1-314-965-3833 1-314-965-3833

www.peacehavenassociation.orgwww.peacehavenassociation.org

FACILITY PAYMENTSFACILITY PAYMENTS

It is important to understand that It is important to understand that neither Medicare or Medicaid neither Medicare or Medicaid cover 100% of the facility’s costs cover 100% of the facility’s costs to operate and provide care.to operate and provide care.

An inherent amount of An inherent amount of benevolence is given to all those benevolence is given to all those who have Medicare or Medicaid who have Medicare or Medicaid as their payer.as their payer.

INSURANCE FOR CSINSURANCE FOR CS

Three major types of insurance:Three major types of insurance:

Medigap (Medicare Supplement)Medigap (Medicare Supplement)

General Health Insurance PoliciesGeneral Health Insurance Policies

Long Term Care (LTC)Long Term Care (LTC)

MEDIGAPMEDIGAP

Medicare Supplement InsuranceMedicare Supplement Insurance

This covers the Medicare This covers the Medicare deductible and coinsurance. It deductible and coinsurance. It may also cover care after may also cover care after exhaustion of Medicare benefits.exhaustion of Medicare benefits.

HEALTH INSURANCE HEALTH INSURANCE POLICIESPOLICIES

Can be challenging to bill for coverage.Can be challenging to bill for coverage.

Make sure Christian Science care is Make sure Christian Science care is specificallyspecifically mentioned in the policy. mentioned in the policy.

Don’t just accept that the policy will pay Don’t just accept that the policy will pay because the insurance agent says so.because the insurance agent says so.

LONG TERM CARE LONG TERM CARE (LTC) (LTC)

Long Term Care InsuranceLong Term Care Insurance– No diagnosis is usually requiredNo diagnosis is usually required– Patient must need assistance with at least 2 Patient must need assistance with at least 2

Activities of Daily Living (ADLs)Activities of Daily Living (ADLs) Examples of ADLs are mobility, eating, Examples of ADLs are mobility, eating,

dressing, etc…dressing, etc…– Insurance companies generally only ask for Insurance companies generally only ask for

proof that care is being provided proof that care is being provided – Benefits are usually significantly less than Benefits are usually significantly less than

other Health Insurance coverage ($100 - $200 other Health Insurance coverage ($100 - $200 a day)a day)

INSURANCE INSURANCE COMPANIESCOMPANIES

Peace Haven does not recommend Peace Haven does not recommend insurance, but the following insurance, but the following companies have paid in the past: companies have paid in the past: – United Health Care (Medicare United Health Care (Medicare

Supplement)Supplement)– AARP (Medicare Supplement)AARP (Medicare Supplement)– UNUM (LTC)UNUM (LTC)– SCS/Monumental (LTC)SCS/Monumental (LTC)

CONCLUSIONCONCLUSION

Questions & AnswersQuestions & Answers

Followed by a quick Followed by a quick Affordable Care Act UpdateAffordable Care Act Update

Medicare workshop-presentation-2014

Health & Medicine

Transcript of Medicare workshop-presentation-2014