Questions About Public Health Programs

1. Can Medicare prevent me from hiring a companion for a resident in a nursing home?

   Question - Medicare is not likely to know or care if you hire a private companion to sit with your relative while he or she is in a skilled nursing facility. However, the nursing facility itself might not permit it. Medicare nursing home coverage is provided only in a skilled nursing facility and only for a patient...
   1 Expert Answer, 1 Community Answer

2. If our private insurance doesn't cover a claim, can we send it to Medicare?

   Question - You've asked several different questions about Medicare, so let's take them one at a time. First, you can submit your husband's medical bills to Medicare even if you've also submitted them to your work-related insurance. Which coverage pays first depends on the size of your employer...
   1 Expert Answer

3. Does Medicare pay for patient ceiling lifts?

   Question - Medicare Part B covers medical equipment that includes "patient lifts" -- mechanical or hydraulic devices that help to safely lift a person out of or into a bed or chair. These lifts are intended to avoid injuries to patients and caregivers alike...
   1 Expert Answer

4. Does Medicare pay for electric wheelchair replacement batteries?

   Question - Today's Option is a private Medicare Part C Medicare Advantage plan that you have enrolled in and that provides all your Medicare coverage, including coverage for your wheelchair. In order to find out the specifics of how the plan will cover replacement batteries for your wheelchair, you need to carefully...
   1 Expert Answer

5. Will Medicare accept property as payment or collateral?

   Question - You are in a situation a lot of people find themselves in – trying to help someone stay at home rather than have to enter a nursing facility or other long-term residence, but unable to provide enough round-the-clock care. Unfortunately, Medicare’s home care coverage is extremely l...
   1 Expert Answer

6. Will Medicare pay for an ostomy nurse?

   Question - Medicare Part B home care coverage is extremely limited and probably will not cover regular visits from a nurse for any length of time. But it may cover a few short-term visits from a nurse from a home care agency who can show your mother how to properly and comfortably use her ostomy equipment and supplies...
   1 Expert Answer, 1 Community Answer

7. If a Medicare patient is readmitted to the hospital, does she have to be discharged from PT/OT?

   Question - If a patient is receiving outpatient PT and gets admitted to the hospital then the PT must write a D/C note and discharge that patient from therapy because the patient's status has changed. Once the patient is discharged from the hospital and if they require continued outpatient therapy--they must get...
   2 Expert Answers, 1 Community Answer

8. If I have Medicare Parts A and B plus Tricare, do I need more insurance?

   Question - If you are enrolled in Medicare Part A and Medicare Part B and you also have TRICARE for Life, you almost certainly do not need any other supplemental health insurance. TRICARE for Life[military.com] is a special program specifically designed for people who are also enrolled in Medicare...
   1 Expert Answer

9. How can I find assistance for a procedure not covered by Medicare?

   Question - It sounds from your question that the podiatrist is including Medicare in this statement about insurance. If so, you have to find out WHY your podiatrist believes that neither Medicare nor other insurance will cover the treatment. Extracorporeal shock wave is certainly an approved treatment for several medical conditions, including some bone spurs...
   1 Expert Answer

10. Will Medicare cover a non-routine lab test ordered by my doctor?

    Question - Whether Medicare covers a laboratory test doesn't depend on whether it's "routine" -- in fact, Medicare doesn't cover many routine lab tests -- but whether it's "medically necessary." Having the test ordered by your doctor is the first part of this process of deciding whether it's medically necessary...
    1 Expert Answer

11. How do we switch from private to Medicare?

    Question - If she had both Medicare and health insurance coverage through a large employer while she was still working, the employer-based insurance (in this case, Anthem Blue Access) paid first, with Medicare paying some of the remaining costs. Since she is no longer working, Medicare will become the primary payer, which means that medical bills go first to Medicare...
    1 Expert Answer

12. If I work full-time should I enroll in Medicare?

    Question - Whether it's to your advantage to enroll in Medicare Part B medical insurance or in a Medicare Part D prescription drug plan while you're still working full-time depends on the extent, cost, and rules of the health insurance coverage provided through your employment...
    1 Expert Answer

13. Can Medicare deny future coverage for similar issues if Mom signs herself out of a nursing home?

    Question - The fact that your mother's doctors or the nursing home are not ”signing her out" to leave the nursing home serves two purposes. One, they are formally letting your mother (and you) know that in their opinion she is not ready to go home, or that going home would be medically worse for her than stayaying in the nursing home...
    1 Expert Answer, 1 Community Answer

14. Will Medicare cover a hospital stay for dental work?

    Question - You're stuck in that no-man's land between medical care (which Medicare covers) and dental care (which Medicare doesn't cover). If your oral surgeon is not a physician, whether Medicare covers your treatment, including hospitalization, depends on the kind of procedure being performed...
    1 Expert Answer

15. FAQ: What Kinds of Home Equipment and Modifications Are Covered by Medicare, Medicaid, or the VA?

    Question - Excellent information on paying for medical equipment and home modifications. I would add that the limits for HISA grants have been raised to $6,800 for service connected disabilities and $2,000 for non service connected disabilities.
    FAQ 2 Expert Answers

16. Dose Medicare Part B pay for a person at a pharmacy to give me the flu shot?

    Question - Medicare Part B will pay 100 percent of the cost of an annual flu shot if provided by any medical provider who's licensed to administer the shot and who participates in Medicare. This includes your doctor, but for many people it means a walk-in clinic, a nurse at a temporary flu shot site at a grocery store or mall, or a pharmacist at your local drug store...
    1 Expert Answer

17. FAQ: What Are Medicare Part A and Medicare Part B Premiums, Deductibles, and Coinsurance Amounts for 2011?

    Question - Medicare premiums, deductibles, and coinsurance amounts change each year for Medicare Part A and Medicare Part B. (For people who receive their Medicare hospital and medical coverage through a Medicare Part C Medicare Advantage plan, premiums, deductibles, and co-payments are determined by the plan itself, not by Medicare...
    FAQ 1 Expert Answer

18. How do I know if there are better Medicare options out there for me?

    Question - Even if you are relatively satisfied with the Medicare Part C Medicare Advantage plan that you now have, at the end of each year (between November 15 and December 31) you may want to consider switching to a better plan -- or to traditional Medicare plus a Medigap supplemental insurance policy -- for the coming year...
    1 Expert Answer

19. Does Medicaid or Medicare cover a CNA to care for the blind?

    Question - Medicare and Medicaid are both set up to provide medical coverage, and unfortunately neither program provides much in the way of non-medical assistance with the activities of daily living (ADLs). However, Medicaid -- if someone meets the financial eligibility standards -- might provide very limited part-time assistance...
    1 Expert Answer

20. Do I need Medicare Part B if I am an active employee over 65 with health coverage through my employer?

    Question - With most employer-sponsored health plans, you don't need to enroll in Medicare Part B medical insurance while you're still an active employee. However, whether it's a good idea anyway to enroll in Medicare Part B depends on the extent of health insurance coverage provided through your employment, the...
    1 Expert Answer

21. Do we have to re-enroll Mom in her Medicare Advantage each year?

    Question - For most Medicare Advantage plans (also called Medicare Part C) there is no need to re-enroll every year. If your mother wants to remain with the same plan she has, she doesn't have to do anything. She'll remain enrolled in the same plan unless she actively enrolls in a different plan (between November...
    1 Expert Answer

22. What is the difference between a physical and a wellness exam covered by Medicare?

    Question - A Medicare wellness exam is a special type of physical exam specifically designed by Medicare for the needs of people 65 and older. Beginning in 2011, a Medicare beneficiary is entitled to one "Welcome to Medicare" initial wellness exam within the first 12 months after first enrolling in Medicare Part B, and then one wellness exam every year thereafter...
    1 Expert Answer

23. Does Medicare or Medicaid pay for home modifications?

    Question - The installing of a walk-in tub is a modification of a home that neither Medicare nor Medicaid usually covers. That's because it involves a physical change to the home, rather than the addition -- through purchase or rental -- of medical equipment or supplies, which Medicare Part B and Medicaid do cover...
    1 Expert Answer, 1 Community Answer

24. Can you get back Medicare Part A coverage if it has been dropped?

    Question - Your mother-in-law certainly can enroll in Medicare Part A, but the real question is whether she is entitled to Part A coverage without paying a high monthly premium. People age 65 or older who are eligible for either Social Security OR civil service -- including federal government employment -- retirement...
    1 Expert Answer

25. What is the first step in finding a new doctor who accepts Medicare Part B?

    Question - Medicare maintains a list of doctors and other providers who accept Medicare patients. The Medicare web site has a tool that gives you access to this list for doctors in your geographic area who accept Medicare patients. The tool also breaks down this list of doctors by their medical specialty...
    1 Expert Answer, 1 Community Answer

26. Is my disabled sister eligible for Medicare parts A&B?

    Question - CalOptima is a public health care agency in Orange County California that administers health care services for Orange County residents on Medi-Cal. If your sister has MediCal through CalOptima, she should be able to get any kind of medical care she needs for free, or for a very low copayment...
    1 Expert Answer, 1 Community Answer

27. Does Medicare pay for hospital beds for home use?

    Question - Yes, Medicare Part B can help pay for a hospital bed and other "durable medical equipment." For Medicare to cover it, an item of equipment must be "medically necessary" and prescribed by a doctor, and it must be supplied by a medical equipment provider who is officially approved by Medicare...
    1 Expert Answer, 1 Community Answer

28. Do I need to be in Medicare Part B for a year before I enroll with a private provider?

    Question - No, you don't have to wait. Anyone enrolled in Medicare Part A (hospital insurance) and eligible for Medicare Part B (medical insurance) can choose to receive coverage for both through one of the Medicare Part C Medicare Advantage managed care plans, which are operated by private health insurance providers, instead of directly through Medicare...
    1 Expert Answer

29. What is the best way to pay for short-term nursing home rehabilitation?

    Question - If your mother's stay is in a skilled nursing or rehabilitation facility while recovering from her injury, she might continue to qualify for Medicare's nursing facility benefits. This depends on whether Medicare considers that she is improving while in the facility, rather than merely being cared for because she needs assistance...
    1 Expert Answer

30. Will Medicare cover oral surgery that is related to diabetes?

    Question - Work by an oral surgeon on jaw or mouth bones will almost certainly be covered by Medicare Part B, whether the oral surgeon is a physician (M.D.) or not. On the other hand, work done solely on the teeth will not.
    1 Expert Answer

31. Medicare and Medicaid: Which Is Which?

    Question - Medicare and Medicaid are both government-funded programs that help pay for medical care. Medicare is run by the federal government's Centers for Medicare & Medicaid Services (CMS), although parts of the program are operated by private insurance companies. Each state's Medicaid program, on the other hand, is run by its own state agency...
    1 Expert Answer

32. What is the allowable amount for prescription eyeglasses under Medicare?

    Question - Medicare coverage for eyeglasses is handled through Medicare Part B. Medicare can pay for one pair of eyeglasses following your cataract surgery, if you had a new lens implanted in your eye. If you have two separate cataract operations, one on each eye, Medicare will cover new glasses after each surgery...
    1 Expert Answer

33. Does Medicare provide coverage for type 1 diabetes?

    Question - It certainly does. Medicare Part B covers much -- usually 80 percent -- of the cost of diagnosis, examinations, and medical care, including diabetes care from your doctor, diabetes screening, self-management training, nutrition therapy, and special diabetes related testing (such as hemoglobin, glaucoma and other eye exams)...
    1 Expert Answer, 1 Community Answer

34. Do I need Medicare Part B if I have retiree medical insurance through my former employer?

    Question - The answer depends in part on the rules of your retiree health coverage. Employers aren't required by law to maintain health coverage for retired workers. So, if they do provide coverage, they can make almost any rules they want. Some employer-sponsored health insurance plans require Medicare-eligible retirees to enroll in Medicare Part A and Part B...
    1 Expert Answer, 1 Community Answer

35. Do we need Medicare Part D?

    Question - Many people who have other health insurance that covers some drug costs find that a Medicare Part D prescription drug plan doesn't save them money. But if your husband's prescription drugs cost you $1,200 out of pocket last year even with your other insurance coverage, then getting a Medicare Part D insurance plan is probably a good idea...
    1 Expert Answer

36. How much will Medicare cost me?

    Question - Medicare Part A is free for most people. If you're 65 or over and eligible for Social Security, Railroad Retirement or civil service retirement, or dependents or survivors benefits, you're also eligible for Medicare Part A without paying any premium...
    1 Expert Answer, 2 Community Answers

37. Can you use benefits from VA and Medicare coverage in conjunction?

    Question - Your stepfather can use both. For any specific medical treatment, he can choose to use either the Medicare or VA system. And sometimes he can use both for the same treatment. Here's how it works. If he's treated at a VA facility, Medicare cannot pay any of the copayments that the VA charges him...
    1 Expert Answer

38. Where can I find the rule regarding Medicare and COBRA coverage?

    Question - Since your husband has Medicare because he's over 65, Medicare is the primary payer of his covered medical bills, with COBRA coverage through your work being a secondary payer. You can find this rule explained in the Medicare booklet Medicare and Other Health Benefits: Your Guide to Who Pays First ...
    1 Expert Answer

39. Does Medicare pay for shingles vaccine?

    Question - No, it won't. In general, Medicare doesn't do a very good job of covering preventive medical care . The only immunizations it covers are a yearly flu shot, the pneumonia vaccine, and the vaccine against hepatitis B (if you are at medium or high risk for contracting the disease).
    1 Expert Answer, 1 Community Answer

40. Are accidents in a foreign country covered by Medicare?

    Question - Original Medicare (Part A and Part B) doesn't cover any medical care in Europe, but a Medicare Part C Medicare Advantage plan or a Medigap supplemental insurance policy might.
    1 Expert Answer

41. Do I have coverage from Medicare when traveling to Canada?

    Question - Medicare doesn't normally cover regular or emergency medical care in Canada, whether you're living or vacationing there. Medicare can cover medical care in Canada in a few very limited circumstances. They are: (1) If you're in the U.S. when an emergency arises but a Canadian emergency room is closer than any in the U...
    1 Expert Answer

42. FAQ: Can Medicaid Coverage Be Retroactive?

    Question - Yes, Medicaid (called Medi-Cal in California) medical, home care, and nursing home coverage can be retroactive. If someone is approved for Medicaid, coverage can go back not only to the date of application but also to three months prior to the application. But retroactive coverage is not automatic...
    FAQ 1 Expert Answer, 1 Community Answer

43. Can I Get Paid to Be a Family Caregiver?

    Question - It's possible to get regular payments for providing care for a housebound family member, depending on the family member's income and assets, need for care, and the state he or she lives in. Public assistance programs in many states can provide payment directly to a low-income person who is determined to need in-home care...
    FAQ 1 Expert Answer, 14 Community Answers

44. Will Medicaid take the proceeds of the house before we get our inheritance?

    Question - Your situation is a difficult one, and presents several different sets of questions. Some of those questions concern coverage for your brother's upcoming nursing home care. Other questions concern whether and how you and your sister can get repaid the money you've lent your brother. Let's take them one at a time...
    1 Expert Answer

45. Will selling a home mean Medicaid repayment?

    Question - I, myself, am currently researching this the best answer I found was this page http://www.ssa.gov/OP_Home/cfr20/416/416-1212.htm basically say that u have three months to buy another home to live in or would be considered a resourse.
    1 Community Answer

46. Does Medicare cover companion care?

    Question - Medicare only covers medical care -- it doesn't pay anything for non-medical companion care. One of the only situations in which Medicare pays for any kind of non-medical care is when it provides short-term home health care, which is primarily nursing care but can include a small amount of help with...
    1 Expert Answer

47. What are our options after Medicare benefits are exhausted?

    Question - It sounds like you and the social worker had a misunderstanding. Certain specific Medicare Part A inpatient hospital benefits may run out temporarily, and one part of Medicare Part A's long-term hospital coverage may end, but overall Medicare coverage does not become exhausted...
    1 Expert Answer

48. How does Medicare define "confine to home"?

    Question - A patient being "confined to home" is one of several requirements Medicare Part B sets for coverage of in-home care. For purposes of Medicare Part B coverage, confined to home means that the patient can't leave home without difficulty, and to do so needs the assistance of another person or of a medical device such as a wheelchair...
    1 Expert Answer

49. Does Medicare cover driving evaulations?

    Question - Medicare Part B could cover a "driving evaluation" at an outpatient rehabilitation facility if it's prescribed by a doctor. Medicare Part B covers some rehabilitation services following an injury, illness or other change in a patient's condition. These services can be physical therapy, occupational therapy, or both...
    1 Expert Answer, 1 Community Answer