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Medicare and its Savings Program

Medicare  Savings Programs  is also known as Medicare Buy-In programs or Medicare  Premium  Payment Programs ,  this helps you pay your Medicare costs if you have limited income and savings.  There are three main programs each with different benefits and eligibility requirements: Qualified Medicare  Beneficiary  (QMB) : Pays for Medicare Parts A and B  premiums. If you have QMB, typically   you should not be billed   for Medicare-covered services when seeing Medicare providers or providers in your   Medicare Advantage   Plan’s   network . Specified Low-income Medicare Beneficiary (SLMB) : Pays for Medicare  Part B  premium. Qualifying Individual (QI) Program : also pays for Medicare Part B premium. If you will enroll, you will also automatically get  Extra Help.   To qualify for an MSP, you must have Medicare  Part A  and meet income and asset guidelines.  If you do not have Pa...

Medicare and Living Abroad

Medicare   enrollment  can be complicated if you live outside the United States. This means that you do not live inside the  50 states of the U.S, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, or the Northern Mariana Islands. Although Medicare does not typically cover medical costs you receive when you live abroad, you still need to choose whether to enroll in Medicare when you become eligible or to turn down enrollment.  This is subject to consideration as well; Whether you plan to return to the U.S. Whether you are working or volunteering outside the U.S. The potential costs of delayed enrollment If you are  65 or older and qualify for Medicare , you can enroll in Medicare Parts A and B, also known as  Original Medicare , either before or after you leave the U.S . However, you must remember that Medicare will typically not cover medical care you receive outside the U.S.  Part A coverage is the best to keep eve...

Medicare and Hospital Discharged Planning

Hospital  discharge  planning is a process that determines what kind of care you will need after you leave the hospital. This discharge plans can help prevent future readmissions , and they should make your move from the hospital to your home or another facility as safe as possible. Medicare  requires hospitals to screen  inpatients  and provide discharge p lanning for those who need it. But this  is only mandatory for hospital inpatients, if you are an  outpatient, possibly  on  observation status,   Medicare will not require screening or discharge planning. However, there are some states that provide outpatients with rights to discharge planning services. For more information on discharge planning in your state, please contact your  State Health Insurance Assistance Program (SHIP) . Your  discharge plan  should include information about where you will be discharged to, the types of care you need, and who will provi...

Medicare and Rehabilitation Care

Rehabilitation hospitals are specialty hospitals or parts of acute care hospitals that offer intensive  inpatient  rehabilitation therapy . This kind of care is intended for patients  recovering from a serious illness, surgery, or injury and requires a high level of specialized care that generally cannot be provided in another setting. Common conditions which may qualify for care in a rehabilitation hospital include ; stroke spinal cord injury brain injury.  Hip or knee replacement is not covered by Medicare, especially if you  have no other complicating condition. Medicare -covered services offered by rehabilitation hospitals include: Medical care and rehabilitation nursing Physical, occupational, and  speech therapy Social worker assistance Psychological services Orthotic and prosthetic services To qualify for a Medicare-covered stay in a rehabilitation hospital, your doctor must state that this care is  medic...

Lifetime Reserve Days

There are  90 days of  inpatient  hospital care coverage on Original Medicare for each  benefit period , In addition, you also have an additional 60 days of coverag e , called LIFETIME RESERVE DAYS .   These Lifetime Reserved Days  can be used only ONCE, and you will pay a  coinsurance  for each of it. To have a better understanding of it, let’s imagine an individual who had a 120-day  Medicare -covered inpatient stay, this means that they used 30 lifetime reserve days. After they have been out of the hospital for 60 days in a row, they will be eligible for another 90 days of hospital coverage because they will be in a new  benefit period . However, if they need  inpatient care  beyond the benefit period maximum, they will only have 30 of their 60 lifetime reserve days remaining. The above example illustrates that lifetime reserve days do not have to be applied to the same hospital stay. If you need to stay in the hosp...

Benefit Period

The benefit period is the length of time during which a benefit is paid. It   measures your use of  inpatient  hospital and  skilled nursing facility (SNF)  services. This  begins the day you are admitted as an inpatient, or to an SNF, and ends the day you have been out of the hospital or SNF for 60 days in a row. After you meet your  deductible ,  Original  Medicare  will pay in full for days 1 to 60 that you are in a hospital. The remaining days, 61-90 , you will have to pay a  daily coinsurance. If your 90 days of hospital coverage has been consumed but you need to stay longer, Medicare covers up to 60 additional lifetime reserve days and yo u will also have to pay a daily  coinsurance . These days are nonrenewable , meaning you will not get them back when you become eligible for another benefit period. If you run out of days during your benefit period, Medicare will stop paying for your in-patient related ho...

Part D Coverage on Nursing Homes

If you are in a  nursing home  or another qualified institution  and receive   long-term care , you should know how your   prescription  drug   coverage may be affected. Different rules will apply as to when you can switch plans and how you can access drugs. Note: During a  Part A -covered nursing home stay, prescription drugs are covered by Part A, not  Part D . The information below is only applicable to Part D coverage of drugs in a nursing home setting. Nursing homes work with specific pharmacies , thus you should choose your plan wisely. If your plan does not work with your nursing home’s pharmacy because it is out of  network  or not preferred , you may end up paying higher costs for prescriptions. If you are in a nursing home, you can switch your drug coverage outside regular  enrollment  periods.  Specifically, you  can make plan changes when; You enter a nursing home Once a month while ...