As flu season approaches there are sure to be headlines in newspapers and segments in the evening news about the costs associated with flu shots. People with Medicare benefits are often curious as to how their flu prevention costs will be affected from year-to-year, with good reason. This year the government has offered a new program that you may not have heard of, courtesy of the Medicare.gov website:

“Seniors who get the flu can get help paying for antiviral medicines under a new demonstration project. The Influenza Treatment Demonstration provides coverage to all Medicare beneficiaries for FDA-approved drugs for the treatment and targeted prevention of influenza.” This could be very good news to people who are on Medicare and qualify for the project.

If you qualify for this new trial project Medicare benefits may cover your anti-viral medicines related to symptoms of influenza, as a prevention measure for a person who has been exposed to a person with influenza, or in an institution where there has been an outbreak. If you feel like you qualify for this project and it sounds like something that you are interested in doing you should contact your local Medicare offices or visit the official Medicare website.

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What is the Influenza Treatment Demonstration?

Medicare has multiple special enrollment times for different people and different situations and you have to be aware when your time has come. If you or your spouse was working AND had group health coverage through a current employer or union or you are disabled and working, or you have coverage from a family member there are special enrollment rules. There are a few situations where the special enrollment period applies.

If you are still covered by an employer or union group health plan or through your spouse’s employer you can enroll in the special enrollment period. Or, if you are in the 8 months following the month when the employer or union group health plan coverage ended or when the employment ends. This may be confusing, but a Medicare specialist at your state insurance office should be able to provide guidance.

Talk to your benefits office to help you decide when to enroll in your Part B coverage if you are working and plan to keep your employer’s group health coverage. There are some other things, such as your Medigap coverage, that could be affected if you have made this decision. As with any decision involving your Medicare enrollment you should consult an expert before making any final decisions.

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Is There a Medicare Special Enrollment for the Working Aged?

There is an endless amount of ways that you can get in to financial trouble trying to pay your insurance premiums, one being paying for prescription drugs. In the past there was no relief for anyone hitting the coverage gap known as the donut hole, you hit it and you were out money. For this year only there is help for you and if you have hit the coverage gap you will be receiving a $250 payment in no time.

There are some things that you should know about this payment, that will arrive in June if you have hit the coverage gap, so you don’t get scammed. There is nothing due by you to anyone to have this payment initiated or sent to you, instead this is something that Medicare will automatically send out. If anyone calls you asking for your personal information to get the payment, do not give it to them, it is a scam.

Everyone’s coverage gap will depend on the coverage they have and how much money they have paid out for prescription drugs. When you receive your explanation of benefits it should tell you where you stand and if the payment is coming. If you are at the coverage gap already your check will arrive in late June, if you reach the gap after the program has begun you will receive your check within 45 days after your gap is reached.

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Getting the $250 Donut Hole Rebate for Medicare Part D

There is nothing scarier in our mortal human lives than going to the hospital for the simple reason that the consequences will be unknown. The consequences or repercussions could be on the medical end of things, or it could be that your finances have been thrown a massive curveball. If you are a subscriber to Medicare Part A you should know what will be paid for with your hospital stay in 2010.

• The first 60 days you will not have to pay coinsurance for as this period is handled differently. You will have to meet a $1,100 deductible and that is just for the initial 60 day period.
• For days 61-90 in the hospital you will be required by Medicare Part A to pay a whopping $275 per day. This is something you will want to discuss with your doctor before the bill arrives for you.
• After day 90 this amount doubles and you will be expected to pay an unbelievable $550 per day to keep your hospital stay. This is an exorbitant amount that will likely affect your life in profound ways.
• After your “Lifetime Reserve Days” (60 days you get to use that Medicare will pay for in your lifetime) you will be expected to foot the entire hospital bill without any help.

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Medicare Part A and Your Hospital Stay

Medicare has about as many twists and turns as a road in the Rocky Mountains and this causes a lot of facts to fall through the cracks. Instead of waiting for a time to cover everything about certain services in a separate article we decided to throw a few random things into one group. Here are a few random things you may or may not know about Medicare Part B:

1. If you have to have any work done that is a qualified clinical laboratory service you owe nothing for the service. This could be many different procedures or testing that has to do with your blood or general well being.
2. When home health services come in to play you pay nothing for Medicare approved services and only 20% of the amount for durable medical equipment. This will help with anyone who is struggling with the decision of assisted living or staying home.
3. Mental health services are available to you and Medicare will pay 55% of approved services, meaning you are left with 45% to pay on your own. This can be sometimes worked out with your therapist if you are not able to make timely payments.

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Random Facts About Medicare Part B

Many people are confused by Medicare and what the Medicare benefits pay for and what they don’t as it appears to be an endless maze. While it is true that the government doesn’t make anything easy and wants you to work to find out what is covered, it is pretty easy to discern at times. Try to discern between what is absolutely necessary and what isn’t. Chances are the first one is covered and the second isn’t.

For a perfect example, Medicare will cover your ambulance services when an emergency happens and it is the only logical way to go to the hospital. Medicare will not pay for services when you elect to have cosmetic surgery done to make yourself look younger. This makes pretty good sense as one is vital to your life while the other is not vital as much as you think it may be.

Some services may first appear that they are not covered but later be covered because of a doctor’s special request. This does happen at times as doctors must consult the people who approve the claims to advise them that the services were necessary. Don’t think that there is no chance of a procedure or appointment happening, just realize it may not be as soon as you think.

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Medicare Benefits Cover what is Necessary

Any type of coverage of anything at all that is offered by the government will have its fair share of exclusions. These exclusions generally exclude things that are not completely vital for a human being to function from day to day. Sure, they may help you live a happier and enjoyable, more care-free life but they are not completely necessary to life itself.

Generally, weight loss drugs are excluded under Medicare Part D because they are not completely necessary to day-to-day functioning. These drugs could help you lose weight which may indirectly cause happiness to be more attainable, but they are not completely necessary. Weight loss can generally be attained through other means, though it may not be as quick and painless.

Erectile dysfunction drugs are also not usually covered under Medicare Part D because everyone can agree they don’t sustain your life. They can improve your enjoyment of life and may give you something to look forward to, but that is not what health insurance is about. There are a few other excluded drugs under Part D, including benzodiazepines and barbiturates, but none are as discussed as these two.

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Are there any Drugs Excluded in Medicare Part D?

Medicare is like most health insurance carriers in that they provide benefits for services that will improve your health or quality of life. Two services that fall under this realm are speech-language therapy and occupational therapy as they help you handle day to day stresses and frustrations. These benefits will help you incur the financial strain involved with getting therapy.

Medicare defines these services as follows: “…Speech-language therapy (pathology services) includes exercise to regain and strengthen speech skills. Occupational therapy includes exercise to help you do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and perform other usual daily activities. You may continue to receive occupational therapy if ordered by your doctor even if you no longer need other skilled care…”

If you feel that you qualify for these services you should talk to your doctor or another medical professional as soon as possible. You could be paying for services that are covered under the Medicare policy that you have and are paying premiums for. Ask your doctor specifically if you qualify for these services and make a point of telling him or her that you think this could improve your quality of life. Don’t quit trying to get the services that you are contractually able to receive.

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Speech-Language and Occupational Therapy Benefits through Medicare

There are times in a person’s life when survival or just good quality of life depends on the expertise of medical professionals. When you are in this case and have Medicare coverage it is possible that your care will be completely covered. You must still qualify for home health benefits by meeting the four standards of home health coverage, but once you do the following skilled nursing benefits will apply.

Medicare’s website states the following about skilled nursing services allowed covered by policies: “…Skilled nursing care on a part-time or intermittent basis. Skilled nursing care includes services and care that can only be performed safely and correctly by a licensed nurse (either a registered nurse or a licensed practical nurse)…” This is a relatively liberal interpretation of the coverage, which is a good thing for you, the policy holder.

What you must do now is find someone that qualifies to provide this service and will do work through Medicare policies. If your doctor is the one that is recommending that the services be done he or she will likely be able to recommend someone to you that can care for you. If not, contact your local Medicare or Social Security office and ask for a referral to a skilled nursing professional that performs this work in the area.

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Skilled Nursing Care and Your Medicare Benefits

When you get any kind of insurance coverage, including that of Medicare coverage of any kind, you will be required to pay a premium for the payment. Premium is just a fancy word for a monthly bill that will be required to be paid in order to keep your coverage valid. You will not always get a bill for your Medicare premium, but if you do it is very easy to pay.

First, understand that you will always receive a bill for your Medicare Part A insurance premiums, regardless of your situation. If you are receiving checks from the Railroad Retirement Board (RRB), Civil Services, or SSA (Social Security Administration) the Part B premium will be deducted from your check. If not you will receive a bill for your Part B and Part A premiums that you must pay on time.

All you have to do when you are ready to make your payment is to send the check to the Medicare payment processing center. You can mail your premium payments to the Medicare Premium Collection Center, P.O. Box 790355, St. Louis, MO 63179-0355. If you get a bill from the RRB, mail your premium payments to RRB, Medicare Premium Payments, P.O. Box 9024, St. Louis, MO 63197-9024.

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When do you have to pay your Medicare Premium?