Marci's Medicare Answers
My doctor says I need home health care. Will Medicare cover this?
Medicare will help pay for your home care if all four of the following are true:
- You are homebound, meaning it takes a considerable and taxing effort to leave your home; and
- You need skilled nursing care on a part-time or intermittent basis and/or you need skilled therapy services; and
- Your doctor signs a home health certification stating that you qualify for Medicare home care because you are homebound and need intermittent skilled care. The certification must also say that a plan of care has been made for you, and that it is regularly reviewed by a doctor. Usually, the certification and plan of care are combined in one form that is signed by your doctor and submitted to Medicare.
- Starting April 1, 2011, as part of the certification, doctors must also confirm that they (or certain other providers, such as nurse practitioners) have had a face-to-face meeting with you that was related to the main reason you need home care. This meeting must occur within 90 days of starting to receive home health care or within 30 days after you have already started receiving home health care. Your doctor must specifically state that the face-to-face meeting confirmed that you are homebound and that you qualify for intermittent skilled care.
You receive your care from a Medicare-certified home health agency (CHHA).
Am I eligible for Medicare coverage of annual glaucoma screenings?
Medicare Part B covers annual glaucoma screenings at 80 percent for individuals who are at high risk. You or your supplemental insurer is responsible for the remaining 20 percent.
People are considered at high risk for glaucoma if they:
- Have a family history of glaucoma
- Have diabetes
- Are African American and aged 50 or older
- Are Hispanic and aged 65 or older.
If you are in a Medicare private health plan, you should contact your plan to see what rules and costs apply.
I have Extra Help, and I heard I can change drug plans at any time. Is that true?
Yes. If you receive Extra Help, the federal program that helps pay for Medicare prescription drug costs, you get aSpecial Enrollment Period (SEP) that allows you to join, disenroll from or switch Medicare drug plans on a monthly basis. The SEP begins the month that you become eligible for Extra Help, Medicaid or a Medicare Savings Program (MSP), and continues as long as you have Extra Help. (If you lose Medicaid or the MSP, or if you lose Extra Help during the calendar year, you get one two-month SEP. If you lose Extra Help for the next calendar year because you are no longer deemed eligible, you get one SEP that lasts from January to March.)
To switch plans, you should enroll in your new plan without disenrolling from your old plan. It is best to enroll into your new plan by calling 800-MEDICARE, rather than by calling the new plan. You will be automatically disenrolled from your previous Medicare private drug plan when your new coverage starts.
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Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To subscribe to “Dear Marci,” MRC’s free educational e-newsletter, click here.
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