What You Need to Know About Medicare – Part 7 of 8

Josh Mungavin, CFP® Principal, Wealth Manager

Josh Mungavin, CFP®
Principal, Wealth Manager

Unforeseen healthcare costs can be one of the most destructive forces to an individual’s financial and retirement plan.  With appropriate forethought, one may reduce the risk of the financial devastation that a large health care bill can cause.  This article discusses the steps one should take to compare Medicare plans and some of the basic plan details with which one will need to be familiar in order to make an informed decision.

Please send this article out to friends and family so that they can forward it to the people in their lives that need this information.  The following will be useful to anyone who is over 60, disabled, has kidney failure, or Lou Gehrig’s disease.

PACE Coverage

The PACE program was created to provide an alternative for those who prefer not to move into a nursing home, but whose medical problems make it impossible to stay at home without medical help.  PACE is provided by a not-for-profit or public entity for those who are frail enough to meet their state’s standards for nursing home care. PACE is a relatively small program (not available in all states) that is intended to allow patients to continue living at home while they receive service instead of being institutionalized.  A PACE application can take nine months to be approved but enrollment in the program is effective on the first day of the calendar month following the date the PACE organization receives the signed enrollment agreement.  However, any services provided are not considered PACE services until the effective date of enrollment after approval.  Services provided by PACE before the effective date of enrollment will only be covered to the extent that the patient’s health care insurance covers them.  Once enrolled you will be charged a monthly premium to cover the long term care portion of the PACE benefit and a premium for prescriptions.  There is never a deductible or co-payment for any drug, service, or care approved by the PACE team.  If a PACE enrollee joins a separate Medicare drug plan they will lose their PACE health and prescription drug benefits.

You can join PACE if:

  • You are 55 years old or older.
  • You live in the service area of a PACE organization.
  • You are certified by your state as meeting the need for nursing home level care.
  • You are able to live safely in the community with the help of PACE services when you join.

PACE services generally include but are not limited to:

  • Support for family members and other caregivers with caregiver training, support groups, and respite care to help families keep their loved ones in the community
  • Primary Care (including doctor, dentist, and nursing services)
  • Hospital, Home, Nursing Home, and Adult Day Care
  • Medical Specialty, Mental Health, Emergency, Social, Laboratory, and X-ray Services
  • Physical, Occupational, and Recreational Therapy
  • Nutritional and Social Work Counseling
  • Prescription Drugs
  • Meals
  • Transportation

For a listing of PACE organizations visit http://www.npaonline.org/custom/programsearch.asp?id=209&title=Find_PACE_Programs

Where to Go For Extra Information

The Medicare Handbook http://medicare.gov/publications/pubs/pdf/10050.pdf

New Enrollee Checklist http://www.medicare.gov/welcometomedicare/checklist.html

The State Health Insurance Assistance Program (SHIP) is funded through grants to help provide information, counseling, and assistance to Medicare beneficiaries and their families with questions related to Medicare, Medigap, Medicare Advantage, Medicare Savings programs, Medicaid, Long Term Care Insurance, and other health insurance issues.

Your State Department of Insurance can be a good source of information with regard to Medicare policies available in your area.

Medicare provides informational resources online at www.Medicare.gov or over the phone at (800) 633-4227.

National PACE Association www.npaonline.org.

The Social Security Administration provides information on Extra Helpwww.socialsecurity.gov/extrahelp or by phone at (800) 772-1213.

Check out our next blog post for more on Medicare. As always feel free to contact Josh Mungavin with any questions by phone 305.448.8882 or email: JMungavin@ek-ff.com