News to Use for Agents in the Senior Market
A Publication of Senior Marketing Specialists
Week of January 30, 2017
Respite care—Temporary care provided in a nursing home, hospice inpatient facility, or hospital so that a family member or friend who is the patient’s caregiver can rest or take some time off.
Medicare will only pay for respite care if the Medicare beneficiary has a life-threatening illness and qualifies for the hospice benefit.
If an individual’s usual caregiver (like a family member) needs a rest, a patient can get inpatient respite care in a Medicare-approved facility (like a hospice inpatient facility, hospital, or nursing home). The hospice provider will arrange this for them. They can stay up to 5 days each time they get respite care. They can get respite care more than once, but it can only be provided on an occasional basis. They may need to pay 5% of the Medicare-approved amount for inpatient respite care.
Medicare publication on hospice and respite care: https://www.medicare.gov/Pubs/pdf/02154.pdf
Respite program locator map: https://archrespite.org/us-map
Why is this important? Helping your clients and their families through their most difficult times requires you to be aware of ways they can make the best of a bad situation.
This online medical encyclopedia on MedlinePlus offers thousands of articles about diseases, tests, symptoms, injuries, and surgeries. It also contains an extensive library of medical photographs and illustrations.
Find it here: https://medlineplus.gov/encyclopedia.html
MedlinePlus is the National Institutes of Health’s Web site for patients and their families and friends. MedlinePlus is produced by the National Library of Medicine.
Why is this important? A reliable source of information about healthcare helps you find bits and pieces of information to share with your clients in newsletters and on social media. This site is helpful because it brings you information about diseases, conditions, and wellness issues in language you and your clients can understand.
- The insurance that pays first (primary payer) pays up to the limits of its coverage.
- The one that pays second (secondary payer) only pays if there are costs the primary insurer didn’t cover.
- The secondary payer (which may be Medicare) may not pay all the uncovered costs.
- If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay.
Paying “first” means paying the whole bill up to the limits of the coverage. It doesn’t always mean the primary payer pays first in time.
- If you have retiree insurance (insurance from former employment)… Medicare pays first.
- If you’re 65 or older, have group health plan coverage based on your or your spouse’s current employment, and the employer has 20 or more employees… Your group health plan pays first.
- If you’re 65 or older, have group health plan coverage based on your or your spouse’s current employment, and the employer has less than 20 employees… Medicare pays first.
- If you’re under 65 and disabled, have group health plan coverage based on your or a family member’s current employment, and the employer has 100 or more employees… Your group health plan pays first.
- If you’re under 65 and disabled, have group health plan coverage based on your or a family member’s current employment, and the employer has less than 100 employees… Medicare pays first.
Medicare Publication: Coordination of Benefits https://www.medicare.gov/Pubs/pdf/11546.pdf
Medicare Publication: Your Guide to Who Pays First https://www.medicare.gov/Pubs/pdf/02179-Medicare-Coordination-Benefits-Payer.pdf
Why is this important? It is very common for your clients to have other coverage involved when they are on Medicare. To understand how to help your clients with their claims you have to start with who has primary responsibility for the bill.
For an on-the-go and printable version, try the talkingMEDICARE Downloadable Edition!