Crawford County Council on Aging

Transcription

1 Senior Tidings Crawford County Council on Aging June 2015 Crawford County Council on Aging, Inc. 200 S. Spring St. Bucyrus, Ohio / or Hours: 8:30 a.m.-5:00 p.m. Monday-Friday website: crawfordcountyaging.com Topics of Interest Keep your Vision Healthy, pg. 2-3 Medicare Reminder- Hospital payment & SNF coverage, pg. 3-4 Quick Facts about Medicare Payment- Outpatient services & How it works, pg. 4-5 Marci s Medicare Answers-Coverage of Hospice & SNF care, pg. 5-7 Retiree & Medicare Prescription Drug Coverage, pg. 7-9 Guess What. The Nutrition Dept. received a 2014 Food Safety Award for their strong efforts in utilizing exceptional food safety practices in preparing and serving food in Crawford County. This was awarded to the following staff members in the Nutrition Department on April 15, 2015: Front row: Patty Metzger, Mary Agin, Gerri Scarbro, Brittany Locker Second row: Doug Horsley, Billy Yost, Lauri York, Ed Foght. Not shown: Wayne Erwin & Trudy Kempf Congratulations Mary Ellen Pauly!!! Happy retirement!! Mary Ellen worked in the Homecare department for over 13 years. You will be missed and we wish you the best. Mary Agin is our feature employee of the month. She has been our cook for the Home Deliv- ered Meal Program for 13 years. She prepares enough food to serve approximately 240 meals a day for our clients. Mary is married to Jack Agin who happens to be her High School Sweetheart. They have been married for 46 years and reside in Crawford County. Mary has 2 children, 3 grandchildren and 1 great grandchild to keep her busy on the weekends. Every day we are amazed at the job Mary does to fulfill all that is required for the meal program. Mary not only keeps track of how much to fix, she also has to watch out for how she fixes it to assure our clients receive the healthiest and tastiest meals we can provide. The Transportation Department is taking reservations for groups of people (i.e. residents of long-term care facilities) who are wanting to attend a restaurant, activity, or event with in Crawford County. Reservations are made on a first-come first-serve basis. Happy Belated Birthday to Jack Starcher!!! Bet you didn t know one of our oldest Transportation drivers is 80 years old? We celebrated Jack s 80th birthday by

2 2 giving him a surprise party. And here s the best part..we actually surprised him. He was speechless!!! Judy and Gregg Brinkman are our feature home delivered meal volunteer of the month. Judy was a longtime volunteer first for many years, and then she married Greg and brought him along to deliver meals every Friday. Gregg and Judy also volunteer for Home Care Matters, they visit Shut Ins regularly, and they also have some friends in need of a ride to the doctor s office now and then. Judy and Gregg also keep busy with exercise, walking every day, and taking care of their puppy. In addition to all of this, Gregg has taken over acting as Judy s Social Secretary. Now he s really busy! We are so happy and grateful to have these two volunteering for our Home Delivered Meal Program. Wondering about Senior Citizens Day at the Crawford County Fair? Mark your calendar for Thursday, July 24th, Be sure and watch for more ticket information in the upcoming July newsletter. Keep Your Vision Healthy. Learn About Comprehensive Dilated Eye Exams People of all ages should have their eyesight tested to keep their vision at its best. Children usually have vision screening in school or at their pediatrician s office. Adults, however, may require more than vision screening. Even if your vision seems fine, the only way to know for sure that your eyes are healthy is to get a comprehensive dilated eye exam. When you should start getting such exams depends on many factors, including your age, race, and overall health. Growing older puts you at risk for glaucoma, agerelated macular degeneration, and diabetic retinopathy the most common cause of vision loss from diabetes. These eye diseases tend to arise without any warning at their earliest stages. By the time you notice vision loss, it usually can t be reversed. Timely treatment may let you keep more of your vision longer. Yearly comprehensive dilated eye exams starting at age 60 are the most effective and thorough way to detect eye diseases while we can still minimize vision loss, says Dr. Paul A. Sieving, director of NIH s National Eye Institute. If you have diabetes, high blood pressure, or a family history of eye disease, you may need yearly comprehensive dilated eye exams earlier. African Americans have a higher risk and an earlier average onset of glaucoma compared to whites, and so are advised to have comprehensive dilated eye exams every 1 to 2 years starting at age 40. A visual field test gauges the scope of what you re able to see. Looking straight ahead and with alternating eyes covered, you ll respond each time you see a light or the examiner s hand held at the periphery of your vision. A screen or apparatus might also be used. Loss of peripheral vision may be a sign of glaucoma, which damages the optic nerve responsible for carrying visual messages from the eye to the brain. A visual acuity test detects how well you see at various distances. Looking at an eye chart about 20 feet away, you ll read aloud the smallest letters you see, first with one eye covered, then the other. The results can help assess disease progression or response to treatment, and may reveal a need for lowvision aids. Next, the eyes are dilated by placing drops in each eye to widen the pupil, which allows more light to enter the eye. A magnifying lens is used to examine the tissues at the back of the eye, including the retina (light-sensitive tissue), the macula (the central region of the retina required for straight-ahead vision), and the optic nerve. Damage to these areas 2

3 3 may be a sign of diabetic retinopathy, glaucoma, or age-related macular degeneration. Tonometry measures the eye s interior pressure by sending a quick puff of air onto its surface. High intraocular pressure is a risk factor for the optic nerve damage associated with glaucoma. And that s it. You re good to go. Check out this video for a glimpse of what your eye care provider can see during a comprehensive dilated eye exam. Wise Choices Healthy Eyes at All Ages Know your family s eye health history. Learn if any eye conditions affect your family members. Eat right. Fruits and vegetables (especially dark leafy greens like spinach or kale) and fish high in omega-3 fatty acids (like salmon or tuna) may help your eyes. Maintain a healthy weight. Excess weight raises your risk for diabetes and other conditions that can harm vision. Wear protective eyewear. Wear eye protection specially designed for sports, home improvement projects, and other activities. Wear sunglasses. To protect your eyes from sun damage, choose glasses that block at least 99% of both UV-A and UV-B rays. Quit smoking or never start. Smoking is linked to an increased risk for several eye diseases. Clean your hands and your contact lenses. Avoid infection by washing your hands thoroughly before putting in or taking out contact lenses. Disinfect and replace lenses as instructed. S o u r c e : N I H, N e w s i n H e a l t h, newsinhealth.nih.gov, May Medicare Reminder. If you have Original Medicare, Part A determines coverage and costs of inpatient hospital care and skilled nursing facility care based on benefit periods. A benefit period begins the day you enter a hospital and ends when you have not received inpatient hospital or Medicare-covered skilled care in a SNF for 60 days in a row. If you go into the hospital or SNF after one benefit period has ended (more than 60 days after you left), a new benefit period begins. You must pay the Part A deductible for each benefit period. There is no limit to the number of benefit periods you can have or to the length of an individual benefit period. For example, if you enter the hospital as an inpatient on May 1st and go home on May 15th (14 days in the hospital), but you need to go back into the hospital on June 30th (after 46 days out of the hospital), you are still in the same benefit period. You do not have to pay another hospital deductible. If you have a Medicare Advantage plan, it may have different rules for how it covers hospital and skilled nursing facility care. Contact your plan to learn more. How much will Medicare pay if I am in the hospital? After you pay a deductible each benefit period, Original Medicare will cover you in full for days 1 to 60 that you are in a hospital. For days 61-90, you pay a daily coinsurance. Medicare pays for up to 60 additional hospital days in your lifetime with a high daily coinsurance, after you have used up your 90 days of hospital coverage in a benefit period. After you use up your 60 lifetime reserve days, Medicare will no longer pay for any coverage until you start a new benefit period. A benefit period begins when you enter a hospital or a skilled nursing facility, and ends when you have been out of the hospital or skilled nurs- 3

4 4 ing facility (SNF), or stop receiving Medicarecovered skilled services at the SNF, for at least 60 days in a row. If you buy any Medicare supplemental insurance policy (Medigap plans A-L) it will pay all your hospital coinsurance plus provide up to 365 additional lifetime reserve days. Plans B-J also pay your full hospital deductible. Medicare coverage of skilled nursing facility (SNF) care Medicare may help pay for skilled nursing facility care if: You need skilled nursing care seven days a week or skilled therapy services at least five days a week; You were formally admitted as an inpatient to a hospital* for at least three consecutive days. You must enter a Medicare-certified skilled nursing facility within 30 days of leaving the hospital; You have Medicare Part A before you are discharged from the hospital; and You need care that can only be provided in a SNF. If you meet these requirements, Medicare should cover the skilled nursing facility care needed to improve your condition or maintain your ability to function. Although you may hear otherwise, Medicare should cover skilled care that helps you maintain your ability to function or helps prevent or slow you from getting worse. *Note: If you are admitted to the emergency room under observation or only receive emergency room services, this time does not count toward meeting the three-day prior hospital requirement for SNF coverage. Source: Medicare Watch, Vol. 6, Issue 18, May 14, 2015; medicarewatch@medicarerights.org. Quick Facts About Medicare Payment. Payment for Outpatient Services for People with Medicare Part B Medicare pays for covered hospital outpatient department services if you have Medicare Part B (Medical Insurance) and Original Medicare. If you re in a Medicare Advantage Plan (like an HMO or PPO), the plan s rules apply. Medicare Part B pays for many of the outpatient services you get in hospitals, like X-rays and emergency department visits. Part B also pays for partial hospitalization services in hospital outpatient departments and community mental health centers under the outpatient prospective payment system. How the outpatient prospective payment system works Under the outpatient prospective payment system, hospitals are paid a set amount of money (called the payment rate) to provide certain outpatient services to people with Medicare. For most services, you must pay the yearly Part B deductible before Medicare pays its share. Once you meet the deductible, Medicare pays most of the total payment and you pay a copayment. For some services, you don t need to meet the yearly Part B deductible before Medicare pays (for example, screening mammography). The payment rate isn t the same for all hospitals because it s adjusted to reflect what people are paid to work in the area where the hospital is located. It s also adjusted for other factors each year. Part B services paid for under this system include, but aren t limited to, the following: X-rays (radiology) Stitches for a cut The hospital charge for an emergency department or hospital clinic visit (doesn t include an amount for the doctor s services) Getting a cast 4

5 5 Surgery that s safe to perform on an outpatient basis Observation to decide if you need inpatient care for an illness or injury The administration of certain drugs that you usually can t give yourself Medicare also uses the outpatient prospective payment system to pay for some services you get from other facilities, including the following: Splints, antigens, and casts you get from a home health agency if you re not under a home health plan of care Splints, antigens, and casts when provided for a hospice beneficiary, for a condition unrelated to his or her terminal illness and related conditions Partial hospitalization services you get from a hospital outpatient department or community mental health center. What you pay For most services, you (or your supplemental coverage) pay the following: The yearly Part B deductible if you haven t already paid it for the year. A copayment amount for each service you get in an outpatient visit. For each service, this amount generally can t be more than the Part A inpatient hospital deductible. If you get hospital outpatient services in a critical access hospital, your copayment may be higher and may exceed the Part A hospital stay deductible. All charges for items or services that Medicare doesn t cover. Example: Mr. Davis needs to have his cast removed. He goes to his local hospital outpatient department. The hospital charges $150 for this procedure. His copayment amount for this procedure, under the outpatient prospective payment system, is $20. Mr. Davis has paid $85 of his $155 Part B deductible. To have his cast removed, Mr. Davis must pay $90 ($70 remaining deductible amount + $20 copayment amount). The amount you pay may change each year. The amount you pay may also be different for different hospitals. Note: If you have a Medigap (Medicare Supplement Insurance) policy, other supplemental coverage, or employer or union coverage, it may pay the Part B deductible and copayment amounts. If you paid more than the amount listed on your Medicare Summary Notice After Medicare gets a bill from the hospital, you will get a Medicare Summary Notice. This notice will show how much you have to pay for the services you got. It will also show how much Medicare paid the hospital for the services. If the amount you paid the hospital or community mental health center at the time of service is more than what was listed on the Medicare Summary Notice, call the provider and ask for a refund. Tell them you paid more than the amount listed on the Medicare Summary Notice. If you paid less than the amount listed on your Medicare Summary Notice If you paid less than the amount listed on your Medicare Summary Notice, the hospital or community mental health center may bill you for the difference if you don t have another insurer who is responsible for paying your deductible and copayments. Source: CMS, Centers for Medicare & Medicaid Services, CMS Product No Marci s Medicare Answers. Dear Marci, My mother has several serious health complications, and her condition has deteriorated in the past few weeks. Her doctor has diagnosed her as terminally ill and recommended that we consider transitioning her to hospice care, but I am concerned about the costs and coverage. How does Medicare cover hospice care and what are the costs? William (Trenton, NJ) 5

6 6 Dear William, Medicare covers hospice care if you meet certain criteria. Hospice care is comprehensive care for people who are terminally ill that includes pain management, counseling, respite care, prescription drugs, inpatient and outpatient care, and services for the terminally ill person's family. In order to qualify for the hospice benefit, you must meet the following criteria: Have Medicare Part A; The hospice medical director (and your doctor, if you have one) must certify that you have a terminal illness, meaning that your life expectancy is six months or less; You sign a statement electing to have Medicare pay for palliative care, such as pain management, rather than care to try to cure your condition; Your terminal condition is documented in your medical record; and You receive care from a Medicare-certified hospice agency. If you are considering hospice care, speak with your doctor about finding a Medicare-certified hospice agency. The hospice medical director and your doctor will certify your eligibility. You must sign a statement electing hospice care and waiving curative treatments for your terminal illness. The hospice team of providers must consult with you to develop a plan of care. The team includes a hospice doctor, a registered nurse, a social worker and a counselor. Hospice can be provided in the home or in an inpatient facility; you do not have to be homebound to qualify for the hospice benefit. The hospice benefit covers the following services related to your terminal condition: Nursing services Skilled therapy services Home health aide services Durable medical equipment and medical supplies Short-term inpatient care to give relief to your caregivers Short term inpatient care to manage symptoms and control pain Medical social services Some prescription drugs Spiritual or religious counseling care Nutrition and dietary counseling The hospice benefit is always covered under Original Medicare. Even if you have a Medicare Advantage plan, Original Medicare Part A will cover your hospice care. Your Medicare Advantage plan will continue to pay for your care that is unrelated to your terminal condition. Original Medicare covers most costs associated with hospice care. You will be responsible for paying up to $5 for outpatient prescription drugs covered through the hospice benefit (prescription drugs related to pain relief and symptom control). You also will pay a copay of no more than 5 percent of the Medicare approved amount for each day of inpatient respite care. While you have hospice, you can still get Medicare coverage for treatment of all illnesses and injuries unrelated to your terminal condition. However, the costs you usually pay for services will apply. Medicare will cover the hospice benefit as long as you continue to qualify for hospice care. If you receive 180 days of hospice care, you must have a face-to-face meeting with a hospice doctor or nurse practitioner to confirm that you still qualify for hospice care. You also can end hospice care at any time and elect to receive curative treatments for an illness. Dear Marci, Marci I was recently hospitalized after breaking my hip, and my doctor recommended that I go to a skilled nursing facility for continued therapy treatments. My doctor told me 6

7 7 that Medicare will only cover this care in certain circumstances. When does Medicare cover care received in a SNF? Dear Alex, Alex (Tampa, FL) Medicare may help pay for skilled nursing facility (SNF) care if you meet the following requirements: You need skilled nursing care seven days a week or skilled therapy services at least five days a week. Skilled nursing services include wound care, tube feedings, and IV drug administration. Skilled therapy services include physical, occupational, and speech therapy; You were formally admitted as an inpatient to a hospital for at least three consecutive days. You must enter a Medicare-certified SNF within 30 days of leaving the hospital; You have Medicare Part A before you are discharged from the hospital; and You need care that can only be provided in a SNF. If you meet these requirements, Medicare should cover the SNF care needed to improve your condition or maintain your ability to function. It is important to note that if you are admitted to the hospital under observation or only receive emergency room services, this time does not count toward meeting the three-day prior hospital requirement for SNF coverage. When you qualify for a Medicare-covered SNF stay, Medicare covers a semiprivate room, meals, nursing care, therapy services, medical social services, mental health services from clinical social workers, dietary counseling, medications, medical equipment and supplies, and ambulance transportation (when other transportation would be dangerous to your health) to the nearest supplier of needed services that are not available at the SNF. Original Medicare will pay the full cost of the first 20 days and part of the cost of another 80 days of care in a Medicare-certified SNF each benefit period as long as it is medically necessary. A benefit period is how Original Medicare measures hospital stays. It begins the day you start getting inpatient care and ends when you ve been out of the hospital or SNF for 60 days in a row. If you have a Medicare Advantage plan, your plan s coverage of SNF stays may be different. Contact your plan directly to confirm costs and coverage of SNF stays. In order to find a SNF that meets your needs, you should speak to your doctor and the hospital discharge planner about your SNF care needs. Ask them to find a Medicare-certified SNF in your area that will best meet your needs after you leave the hospital. If you are in a Medicare Advantage plan, you should contact your plan to find out which SNFs are in their network. A network is a group of doctors, hospitals and pharmacies that contract with a managed care plan to provide health care services to plan members. Marci Source: Marci s Medicare Answers is a service of t h e M e d i c a r e R i g h t s C e n t e r ( Vol. 14, Issue 9, May 4, 2015; Vol. 14, Issue 10, May 18, Retiree & Medicare Prescription Drug Coverage. How Retiree Coverage Works with Medicare Prescription Drug Coverage Note: The information listed below only applies to retiree coverage. Different rules and options apply to people who are actively working. Everyone with Medicare is eligible for Medicare prescription drug coverage, including retirees and their family members who have Medicare but are covered by employer- or unionsponsored health plans that offer prescription drug coverage. Medicare works with plan sponsors to offer a variety of options for people with Medicare who 7

8 8 have retiree drug coverage. Medicare also provides incentives to help employer and union plan sponsors continue to offer drug coverage to their Medicare-eligible retirees. Joining a Medicare drug plan could affect a person s current drug and/or health (doctor and hospital) retiree coverage. ALL people with retiree coverage should make sure they understand how that coverage works with Medicare before deciding whether to join a Medicare drug plan. Some people may not be able to drop their retiree prescription drug coverage to join a Medicare drug plan unless they also drop their retiree health (doctor and hospital) coverage. Keep in mind that if someone drops retiree health coverage, family members covered by the same plan as their dependents also must drop the health coverage. It s possible that they and any family members covered by the plan may not be able to get that coverage back. Group health plan sponsors have different options. All employer and union plans are different, but in general, they offer these options: Payment of part or all of a plan s retirees Medicare drug plan premiums. Employers and unions may choose this option regardless of whether they also provide retiree drug coverage. Customized coverage, consisting of Medicare drug coverage with additional retiree prescription drug coverage. The employer or union buys drug coverage from a Medicare drug or health plan, or contracts directly with Medicare to become a Medicare drug plan itself. The retiree gets both Medicare drug coverage and retiree supplemental coverage from the same plan. To get the additional coverage, the retiree must join the Medicare drug or health plan the employer or union chooses. A retiree plan that provides drug coverage instead of coverage under a Medicare drug plan. Usually provided as part of retiree medical coverage that pays after Medicare pays, retirees with this drug coverage generally don t join a Medicare drug plan because their retiree drug coverage is creditable that is, it s expected to pay, on average, as much as standard Medicare drug coverage. Also, some retiree plans may cancel a retiree s medical and drug coverage if the retiree joins a Medicare drug plan. Some of the group plan structures described above also may include split retiree-family enrollment, where spouses and dependents are allowed to continue getting coverage from the retiree plan even when the retiree joins a Medicare drug plan. People should check with their plan administrator to learn whether this is an option. Where can people with Medicare learn about their specific options? The best source of information about a person s retiree coverage is his or her employer or union, or the plan that administers his or her coverage. Medicare doesn t have information about a person s individual employer- or union-based coverage, or details about how it ll work with Medicare drug coverage. Retirees should look for materials from their employer or union about their current coverage, and read them carefully. If retirees have questions, they should visit the plan s website, or call the phone number in the communications materials. If a phone number isn t listed, they should call their plan or benefits administrator, or call the office that answers questions about their benefits. Employers must tell whether coverage is creditable. Unless it s offering a Medicare Prescription Drug Plan (Part D), all employer and union drug plan sponsors must tell all people eligible for Medicare who join or wish to join their plan including active workers, disabled workers, people on CO- BRA, and retirees and their dependents whether their current drug coverage is creditable. Creditable prescription drug coverage is drug coverage that s expected to pay, on 8

9 9 average, at least as much as Medicare s standard prescription drug coverage. If a person has creditable coverage and is happy with it, he or she generally doesn t need to join a Part D plan, since Part D coverage would duplicate what he or she already has. Medicare-eligible retirees need to know whether their non-medicare drug coverage is creditable. If they have creditable prescription drug coverage, they can wait to join a Medicare drug plan later and not pay a penalty, as long as they don t go without creditable prescription drug coverage for 63 continuous days or longer. Plan sponsors can put the creditable prescription drug coverage disclosure in with other plan materials, but they must give this information in writing at least once every year and upon request. You won t have to pay a late enrollment penalty if you can show you didn t get sufficient information about whether your drug coverage was creditable. Should people keep retiree coverage if they qualify for Extra Help? People with limited income and resources may qualify for Extra Help paying for Medicare drug coverage, even if they already have creditable retiree drug coverage. With Extra Help, Medicare drug coverage may pay more drug costs than retiree coverage, so it may make sense for people who qualify for Extra Help to consider joining a Medicare drug plan. However, people should remember that before they make any decisions, they need to know if they ll lose retiree benefits (including any non-drug health coverage) for themselves and/or their spouse or dependents if they join a Medicare drug plan. Some retirees with Medicare and Medicaid are automatically enrolled in a Medicare drug plan. People who qualify for both Medicare and full Medicaid benefits automatically qualify for Extra Help. These people will be automatically enrolled in a Medicare drug plan unless they ve chosen a plan on their own, they ve opted out of auto-enrollment, or their employer is getting the Retiree Drug Subsidy (RDS). People who ll be automatically enrolled in a Medicare drug plan will get a yellow letter from Medicare (CMS Product No or 11429) letting them know which plan they ll be enrolled in and explaining their options. These retirees should make sure they understand how Medicare drug coverage will affect their current retiree drug and health coverage. If an employer or union plan is getting the RDS from CMS, the retiree will NOT be automatically enrolled in a Medicare drug plan. These retirees will get a letter on white paper from Medicare (CMS Product No ) letting them know that they qualify for Extra Help and explaining their options. They may want to consider whether they ll get better coverage with their retiree plan or by joining a Medicare drug plan. How to opt out of automatic enrollment. If a person who was automatically enrolled in a Medicare drug plan wants to disenroll from that plan, they can call MEDICARE ( ). TTY users should call They should tell the customer service representative that they decline Medicare drug plan enrollment. People with Medicare also can opt out of auto-enrollment permanently by calling MEDICARE. Source: CMS, Centers for Medicare & Medicaid Services, CMS Product No P, Revised March Nellie Clady Norma Hill Floyd Rinehart Linda Schiefer James Stump Edward Wise 2015 Council on Aging Board of Trustees Officers Jerry Shawber, President Donald Wilson, Vice President Miechelle Warner Baker, Secretary Ed Snyder, Treasurer Board Members Elaine Henderson Lois Kehres Dr. Antonio Rondon Maxine Shifley Dr. Donald Wenner 9