Mobility and Medicare Coverage

Mobility, the ability to get around easily, often decreases with age. The U.S. Department of Health and Human Services estimates that as much as 37 percent of people 65 and older have limitations on their activities due to less mobility. Movements like reaching, bending, going up and down stairs, and getting in and out of the bathtub become difficult. Even walking can become harder as some older people have problems with their gait and balance.

Many of the physical changes that happen with aging are normal, but can affect mobility. Some of those changes include:

Arthritis in the jointsLess physical energySlower reflexesLoss of bone tissue (osteoporosis, especially in women)

Exercise and staying as active as possible will help an elderly person maintain more of their mobility and strength. But sometimes the lack of mobility becomes serious enough that it begins to affect all aspects of life. Those affected don’t socialize as much, give up enjoyable activities, and frequently become housebound.

This lack of mobility is often combined with a fear of falling. Older people often fear that they’ll break a hip or have another falling injury that would result in having to move out of their home. This can lead to a loss of their independence or an increased dependence on others for help. It can begin to feel like they are losing control over daily life decisions.

Mobility Aids
Fortunately, mobility aids like canes, walkers, electric wheelchairs, and electric scooters can help those with decreased mobility safely stay in their homes and maintain their independence. The correct type of mobility aid is determined by several factors—overall strength and balance are the most important. If you have good body strength and balance, using a cane will probably be the right mobility aid. If you aren’t as steady on your feet, you may need the extra support of a walker or rollator (wheeled walker). But if a cane or walker isn’t suitable for your needs, your doctor may suggest a power wheelchair or power scooter.

In order to get a mobility aid, you’ll need to be evaluated by your doctor first. Here are some of the specific things they will measure:

Your upper-body strength: You need upper-body strength to be able to balance yourself on a scooter, which has less support than a power wheelchair.Posture: Related to balance, you also must be able to maintain an upright posture to stay on a scooter. An electric wheelchair offers much more reinforcement for your weak upper body and posture.Arm, hand and leg strength: Scooters require that you are able to work hand controls and brakes. For instance, if you don’t have the arm and hand strength required, you may need a power chair with a joy-stick control.

After your evaluation, you will know which mobility aid is best for you. You can begin looking into different models of power chairs and scooters, electric wheel chair accessories, or scooter options.

Mobility Aids and Your Medicare Coverage
There are guidelines you must follow in order to have Medicare pay for most of your mobility aid.

You must have your evaluation with a doctor or other qualified health provider.The evaluation must say that you need a mobility aid for a medical condition.It must be documented and submitted to Medicare. This is called a “Certificate of Medical Necessity.”Like a prescription, you will need this information in order to get your new mobility aid.When you are shopping for your mobility aid, you will need to be sure that the wheelchair or scooter supplier is Medicare-approved or “assigned” by Medicare.”

Accepting “assignment” simply means that the supplier has agreed to accept what Medicare will pay. Your mobility aid is covered under Part B of Original Medicare. You may have to pay up to 20 percent of the cost after meeting your deductible.

NOTE: If you have a Medicare Advantage Plan or a Medi-Gap insurance plan to pay for additional, non-covered services, you will need to check your specific plan.

How Do I Find a Medicare-assigned Supplier?
To find a supplier that is Medicare-approved, look on the Medicare website, www.medicare.gov, under “Find Suppliers of Medical Equipment in Your Area” or call 1-800-MEDICARE (1-800-633-4227). The dealer must have a Medicare supplier number and must also meet strict standards.

Adapting to Increased Mobility
When you have your electric wheelchair or power scooter, you’ll need some time to learn to use your equipment safely. Allow time to adjust to this new device.

Some important things to do include:

Make sure your home is wheelchair “accessible,” not just via ramps or large doorways and entrances. You will need to have clear pathways inside your home for safe and easy maneuvering.Learn all you can about your chair or scooter by reading the owner’s manual. Pay special attention to battery information and suggested maintenance.You may want to look into vehicle transportation options for your wheelchair or scooter.
Accessorize your mobility aid with custom features like baskets for carrying items, mirrors for clear, safe vision, and cup holders, etc.

After you have adapted to using your aid and you feel more comfortable, you will notice how much independence you have regained. Having increased mobility allows you to be more involved with family, friends, and the life activities that you thought you had lost.

View the original article here

Kidney Dialysis Facts and Medicare Coverage

Kidney dialysis is a treatment that helps the kidneys perform functions that they are no longer able to do. Dialysis will not cure kidney disease and usually can’t reverse permanent kidney failure, but it means that people can live longer, more normal lives.

Just as healthy kidneys do, dialysis keeps your body’s fluids and chemicals in balance.
Dialysis does the following:

It removes extra salts, water, and fluids to keep them from building up in the bodyIt maintains a safe level of certain chemicals in your blood, like potassium, sodium and bicarbonateIt helps control your blood pressure

When Do You Need Dialysis?
Dialysis is needed when you develop end stage kidney failure, sometimes called end-stage renal disease or ERSD. That usually happens when you’ve lost about 85 to 90 percent of your kidney function. There are some types of kidney failure that improve with treatment. This is usually true for “acute” kidney failure, when dialysis is only needed for a shorter time.

But in end stage kidney failure (ERSD), your kidneys don’t recover and you will need to have dialysis treatments for the rest of your life. At this stage, some people are candidates for a kidney transplant, in which case they are put on a waiting list for a new kidney.

Different Types of Dialysis
There are two kinds of dialysis treatments. Your doctor and healthcare providers will decide which type is best for you.

Hemodialysis: A special filter is used to clean your blood (a dialyzer) and the filter connects to a machine. Your blood then flows through the tubes, into the filter, and wastes and extra fluids are removed. The cleaned blood returns to your body through another set of tubes.Peritoneal dialysis (PD): A solution called dialysate flows through a tube in your abdomen. After several hours, the dialysate has removed the wastes from your blood and can be drained from the abdomen. After that, your abdomen is filled again with new dialysate and the wastes are cleaned out again.

There are two forms of PD:

Continuous ambulatory peritoneal dialysis (CAPD): This form doesn’t require a machine as it is ambulatory, meaning you can walk around with the dialysis solution in your abdomen.Continuous cycler-assisted peritoneal dialysis (CCPD): This method uses a machine called a cycler to fill and drain your abdomen. Often this is done while you sleep. This form is also called Automated peritoneal dialysis (APD).

How Long Do the Dialysis Treatments Take?

The time required for your dialysis will depend on several things:How well your kidneys functionYour sizeHow much fluid weight you have gained since your last treatmentHow much waste you have in your body

Hemodialysis usually lasts about four hours and is done three times a week.

Peritoneal dialysis is on a different schedule and varies by the type of PD you have. The process of filling and draining solution from your abdomen is called an “exchange.” The time the solution is in your abdomen is called the “dwell time.” Usually you have four exchanges daily, each with a dwell time of four to six hours.

Where Do You Get Your Dialysis?
Dialysis can be done in a hospital, dialysis facility or at home. In a hospital or dialysis facility, a nurse or trained technician gives you your treatment. At home, you can do it yourself or have a family member help you. If you are going to do dialysis at home, you will need to have the required training.

Does Medicare Cover Dialysis?

Medicare does cover dialysis treatments if you meet the requirements.You qualify if you are diagnosed with end-stage kidney failure or ERSDYour doctor has written a prescription (an order) for dialysis treatmentThe facility where you get your treatments must be Medicare-approved

If you receive your dialysis inpatient in a hospital, your treatment is covered by Medicare Part A. Both outpatient dialysis facilities and home dialysis are covered by Medicare Part B. It’s important to know that there are specific things that must be done for home dialysis to be approved.

How is Home Dialysis Covered by Medicare?
Medicare home dialysis is a bit more complicated than treatments received in the hospital or dialysis facility. Medicare pays for the following:

Outpatient doctor’s servicesSelf-dialysis training (this includes instruction for you and the person helping you with home dialysis treatments)Home equipment and dialysis supplies like the machine, water treatment system, alcohol and sterile drapes, etc.Certain home support services, which might include visits by a trained dialysis facility worker to check on your home treatment or to help in emergencies.Other services like laboratory tests relating to your dialysis

Some services that are NOT covered are:

Paid dialysis aides to help you at homeLost pay when you get your self-dialysis trainingA place to stay while being treated

NOTE: In January 1, 2011, a new payment system for both facility and home dialysis treatments went into effect. To find out how it works, please refer to your Medicare coverage booklet or go to www.medicare.gov and look under Kidney Dialysis.

How Do I Find a Dialysis Facility?
Your kidney doctor will know where you can get your dialysis treatments since they frequently work with the facilities and their patients. But you can choose any facility that you want, as long as it is Medicare-approved so your treatment will be mostly paid for.

How Will I Feel With Dialysis Treatments?
People usually wonder if dialysis is painful. There might be some discomfort when needles are inserted, but most patients say they have no other problems. Sometimes, your blood pressure will drop slightly, but that usually goes away with regular treatments.

Dialysis patients also want to know if they will feel better. Most people report that they do feel better and less tired, have a better appetite. But even if you feel fine, you will need to continue with your dialysis treatments.

How Will Dialysis Affect My Life?
Dialysis patients often say they feel more normal, except for when they receive their treatment. Many dialysis patients are able to go back to work after they’ve become accustomed to their treatments. But that depends on your job – work that requires physical labor may not be advised. You can also travel if you make arrangements to receive your dialysis at other facilities while you are away.

View the original article here

Different Types of Nursing and Your Medicare Coverage

Whether you’re in a doctor’s office, the hospital, or a rehabilitation facility, you will likely receive nursing care. Nurses provide many different types of care and work in a variety of medical settings. It’s helpful to know what patient care nurses provide. A patient can receive different levels of care depending on the nurse’s license and training. If you have Medicare coverage, most of your care will mainly be what is called Medicare skilled nursing.

What are the Different Types of Nursing Care?
Just like most professions, nurses have special training that teaches them how to care for patients. There are levels of training, college degrees, and licenses that nurses must receive in order to practice. And like different kinds of doctors, nurses sometimes have a specialized field. Below is an overview of the levels of training, licenses, and care they provide.

Licensed Practical Nurse (LPN): An LPN is a nurse who works under the supervision of registered nurses and doctors. LPNs often assist the registered nurses. They must complete a one year training program, which is often through vocational schools and community colleges. The nurses then have to take a test to be licensed by the state.

LPN’s take your blood pressure and other vital signs, give shots, collect samples like blood for testing, and provide general bedside care. LPNs spend time with patients and assist with daily care, including bathing and dressing. They work closely with registered nurses and other care providers. LPNs also work in many different settings, including doctor’s offices, skilled nursing facilities, and home health care.

Registered Nurse (RN): An RN must complete training either in a four-year bachelor’s degree college program, a two-year associate’s degree program, or graduate from a nursing program. They must pass a state licensing exam before they can treat patients.

RNs work in many settings. Because they have a higher level of training than an LPN, they are able to care for patients without direct supervision in more situations than LPNs. They will monitor your medications, start and check IVs, and perform many other medical procedures, but a doctor must “sign off” to show that he is overseeing the patient’s care. Many RNs will specialize in one area, like helping doctors deliver babies.

Nursing and Medicare Coverage
When you look at what your Medicare insurance covers, you’ll often see the words, “skilled nursing.” This is a term that is used to describe the level of nursing care that your Medicare insurance will pay for. Most often, you’ll see it when they talk about “skilled nursing facilities.” This is where patients receive skilled nursing services under the different parts of Medicare. Only registered nurses are considered “skilled nursing.”

Medicare Part A

Inpatient. As you may know, Part A of your Medicare coverage (if you have Original Medicare) pays for most of your care when you are hospitalized. Coverage includes care that you receive from hospital nursing staff, as long as they are registered nurses.Rehabilitation. Part A also pays for most of your care while in a “skilled nursing facility.” This is a rehabilitation facility that you attend if you need additional recovery care after your hospital stay. The nurses will ensure that you receive your medications, care for your wound if you’ve had surgery or an injury, and communicate with other medical staff, especially your doctor.

Note: A skilled nursing or rehab facility is sometimes also called a “nursing home.” The care you receive in a nursing home or skilled nursing facility that isn’t solely to continue recovering after a hospital stay is not usually covered by Medicare.

Home Health Care Services. When you return home either from your hospital stay or rehab, you can receive home health services. Under a doctor’s care, you will receive skilled nursing care by nurses who come to your home to monitor your recovery. These nurses work through a Medicare-certified home health agency. They will make sure that you take your medications and are healing properly.Hospice Care. If you are terminally ill and you, your family, and your doctor have decided to stop treatment and need palliative (comfort) care, you will receive most of these services through Medicare coverage. Typically, you will receive your care at home. Nurses will make home visits to administer pain medications and monitor your condition.

The Role of Skilled Nursing in Your Care
Nurses are key players to help you recover from illness, surgery, injury, or make your end-of-life more comfortable when you choose hospice care. Of all the members of your health care provider “team,” you will probably have the most contact with nurses. And since they communicate information about your recovery to doctors and other necessary people, it’s important to talk to them about any problems you might be having. Don’t be afraid to ask questions if you don’t understand something about a medicine or your care. If the nurse doesn’t know the answer, she will find out or ask the doctor.

Note: The information here is for Original Medicare coverage; if you have a Medicare Advantage plan and/or a Medigap plan, different care may be covered. Please refer to your printed plan information or look online at www.medicare.gov.

View the original article here

Hospice Care and Medicare Coverage

Like many people, you’ve probably heard of “hospice,” but may not know exactly what it is or what’s involved. It is a type of care given to terminally ill people when they no longer respond to medical treatments that were meant to cure them. Hospice is a “concept of care” or a unique way of caring for dying patients and their families. The idea is to improve the quality of the dying person’s last days and allow them to die with dignity.

What is Hospice Care?
Hospice is not a place to receive care, like a hospital. In fact, most hospice care takes place in your home. It’s a program that believes dying people should have as much comfort and support as possible at the end of their lives. Although there are hospice facilities, most people choose to stay at home where they are most comfortable. Hospice care can also be provided in a family member’s home or in a nursing home.

It’s important to know that hospice care does not prolong a terminally-ill person’s life or in any way make them die faster. A team of specially trained hospice staff and volunteers provide all the services that the person and their family will need.

All of the person’s needs are addressed—medical, physical, emotional, social, and spiritual. Hospice also provides support to the person’s family or caregiver. One of the most important parts of the care hospice provides the patient is pain management with medications. But hospice workers also help with daily living needs like bathing.

How Do you Get Hospice Care?
If you are terminally ill, you may be referred by your doctor into hospice when your life expectancy is less than six months. You, as the patient, have the right by law to make the decision. When you and your family are considering hospice, but are uncertain, a hospice worker can conduct an evaluation at your home and tell you if it’s the right time, or if a later date would be appropriate.

You can choose a hospice program in your community. Get recommendations for programs in your area from your doctor, a hospital, nurse, social worker, or family and friends. It’s important that you choose a program that has been Medicare-certified because Medicare will pay for most hospice care.

What Happens When you Enter Hospice?
Here’s what will happen when you enter a hospice program:

When you are admitted to a hospice program, the hospice staff will contact your doctor to make sure that he or she agrees that hospice is the right choice for you.You’ll be asked to sign consent and insurance forms.Your hospice provider will determine what will be necessary for your care—make arrangements to get any equipment, etc.This is the best time to ask any questions you might have about how the program will work.The hospice team will make an individualized care plan that will also determine how much caregiving you will need from your family or caregivers.The hospice staff will visit often and will always be available to answer medical questions.

Who is on the Team and What do they Provide?
Your care will be provided by a doctor, a nurse, social workers, counselors, home health aides, clergy, therapists, and volunteers. Each provider has a different role in your care and has special expertise in both their area and in hospice care. Hospice programs provide medications, medical equipment, and other services that are involved in working with a terminal illness.

How Can I Make Sure My Hospice Care is Covered by Medicare?
As with all medical services covered by your Medicare insurance, there are certain things you will need to do so that your hospice care is paid for. Hospice care is paid for under Medicare Part A, which is Hospital Insurance. Below are the Medicare coverage guidelines:

The terminally-ill person is eligible for Medicare Part AThe person entering hospice care has less than six months to live due to a terminal illness and which is determined by their doctor.The terminally-ill person must sign a statement that hospice care has been chosen over other Medicare benefits such as assisted living or hospital care.Medicare will still pay for covered benefits for any health problems that aren’t related to the terminal illness.

What Does Medicare NOT Cover?
Medicare will not pay for the following:

Any treatment that is meant to cure your illnessPrescription drugs to cure your illness instead of controlling your symptoms and pain reliefCare from any provider that wasn’t provided by the hospice medical teamCare in an emergency room, inpatient facility, or ambulance transportation, unless it’s arranged by your hospice team or is not related to your terminal illness

Other Things to Consider
Hospice care is not just for the terminally-ill person. Losing a family member that you love or someone for whom you’ve cared for is very difficult and painful. Hospice recognizes how important it is for you to have the support that you need. That’s why they provide respite care and counseling. Take advantage of all the services and support that the hospice team gives you. They understand what you are going through because they are experts.

For additional information about all services provided by hospice under Medicare, please refer to www.medicare.gov

View the original article here

When To Enroll For Part D Coverage

What is the Annual Election Period for Part D drug coverage?

The Annual Election Period is the time of year in which you can join, drop, or switch Part D plans. The 2010 Annual Election Period begins on November 15 and ends on December 31, 2010. If you do not enroll/switch by December 31, 2010, you may not be eligible until the next Annual Election Period in 2011, which will be October 15 through December 7, 2011.

From January 1 to February 14, 2011, beneficiaries enrolled in Medicare Advantage plans will be allowed to sign up for a stand-alone Part D plan if they drop out of their Advantage plan and return to Original Medicare during this time period.

Note regarding “Open Enrollment”: In past years, Medicare Advantage (MA) enrollees had an opportunity to make changes to their coverage from January 1 – March 31. That Open Enrollment Period will be eliminated in 2011. Individuals with a Medicare Advantage plan may elect to disenroll from their MA plan during the Medicare Advantage Disenrollment Period from January 1 through February 14 in order to return to Original Medicare. These individuals may enroll in a Part D plan during this time frame only.

If I enroll during this time, when does my Part D coverage begin?

If you enroll during the Annual Election Period your Medicare Part D coverage will begin on the following January 1 and will continue for the entire year.

Is there any other enrollment time?

You may enroll in a Part D plan during your Initial Enrollment Period, during the Medicare Advantage Disenrollment Period (if you meet those qualifications), or during a Special Enrollment Period due to special circumstances.

Do I need to enroll in a Medicare Part D plan?

Yes, it is important to enroll in a Part D plan when you are first eligible. If you don’t join a Medicare drug plan when you were first eligible for Medicare, and you didn’t have other creditable prescription
drug coverage, or you didn’t have Medicare prescription drug coverage or other creditable prescription drug coverage for 63 days or more in a row, you will receive a late enrollment penalty.

If you do not enroll in a Medicare Part D plan during your initial enrollment period, and then decide to enroll later, the Medicare Part D program may add a 1% per month increase in your Part D premium. For example, it you decide to enroll 7 months after your initial enrollment period, then your premium could increase by 7 percent.

Do I still need to enroll if I do not take any medications?

Yes, even if you do not take any medications currently, you should still enroll in a Medicare Part D plan as soon as you are eligible. You can enroll in the Medicare Part D plan with the lowest premium. You will be covered if/when your needs change, and by joining a Part D plan when you are initially eligible, you will avoid the extra premium cost that will be added if you decide to enroll later.

How do I enroll in a Medicare Part D Plan?

Use our Medicare Comparison Tool or Call 1-800-650-2857.

View the original article here