What is Medicare?

Medicare is a health insurance program provided by the federal government for qualifying individuals, including people age 65 and older, those with certain disabilities, and individuals with end-stage renal disease (ESRD).

Some people may confuse Medicaid and Medicare programs. The primary difference is that Medicaid is a needs-based insurance program while Medicare isn’t. Your income isn’t a determining factor for Medicare qualification.

There are monthly premiums for certain parts of Medicare. Additionally, Medicare does have some limitations and regulations on what it’ll cover for health care costs. Read on to learn more about each part of Medicare, what’s covered, and how to enroll.

Medicare Parts

When you become eligible for Medicare, you have choices to make. First, you must decide whether you’ll enroll in Part A and B or Part A only and defer Part B. Most people choose Part A because it is premium-free. If you’re enrolled in a health savings account (HSA), you won’t be able to continue contributing to it if you enroll in Part A. Once your A and B choices are made, you can keep Original Medicare and add a supplement and Part D plan or opt for a Medicare Advantage Plan.

Here’s what each part of Medicare covers and costs:

Medicare Part A
  • Medicare Part A is considered the hospital insurance portion of Original Medicare. It covers costs associated with hospital stays and limited stays at a nursing home, hospice care, and some costs for home health care.
  • You don’t have to pay a monthly premium for Medicare Part A if you or your spouse paid qualifying taxes during employment. If you don’t qualify for premium-free Part A, you can pay for it. The premium amount you have to pay varies based on how long you or your spouse worked while paying qualifying Medicare taxes. For instance, if you paid taxes for less than 30 quarters, you’ll pay $499 per month based on 2022 premiums. But if you worked and paid taxes between 30 and 39 quarters, you’ll only pay a $274 monthly premium.
Medicare Part B
  • Medicare Part B is considered the medical insurance portion of Original Medicare. It covers things like trips to the doctor’s office for a checkup or a sick visit, any outpatient care you might receive, certain medical supplies, and preventive care like an annual wellness visit.
  • Nearly everyone pays a monthly premium for Medicare Part B. The standard amount for 2022 is $170.10. If your gross income on your tax return is high enough, you’ll be required to pay both the standard monthly premium and an Income Related Monthly Adjustment Amount (IRMAA). You’re also responsible for 20% of the costs of your health services after your annual deductible ($233 in 2022) is met.
Medicare Part C
  • Medicare Part C, commonly referred to as Medicare Advantage, is offered by private insurance companies approved by Medicare. If you choose a Medicare Advantage Plan as an alternative to Original Medicare, it becomes your primary coverage. Think of Medicare Part C as a “Medicare bundle” because it covers everything that Part A and Part B do. Most Advantage plans include Part D prescription drug coverage. Some Medicare Advantage Plans offer additional coverage for dental and vision and even fitness memberships. For example, Medicare Part C covers in-patient hospital stays, stays in a skilled nursing facility, and home health care like Original Medicare Part A. Part C also covers outpatient care like Medicare Part B does, including doctor visits, lab tests. X-rays, outpatient surgery, and emergency services.
  • Original Medicare Part A and Part B only cover 80% of the costs of services received. Meanwhile, Medicare Part C plans cover everything Part A and Part B cover but charge a small copayment and coinsurance for services. Most Medicare Advantage plans also have maximum out-of-pocket costs per year, and many come with a $0 monthly premium, which can make these plans more affordable. The costs of Medicare Advantage plans vary since private companies offer them, but you can expect to pay both a monthly premium and a monthly Part B premium, unless the plan is a $0 premium plan. Plan costs can vary depending on whether other benefits like Part D, dental, vision, and hearing are included.
Medicare Part D
  • Medicare Part D refers to prescription drug coverage, so it’ll help cover the costs of medications prescribed for your health condition. Individual Medicare drug plans use a formulary developed by a pharmacy and therapeutics committee composed of pharmacists and physicians to regulate which medications they’ll cover. The United States Centers for Medicare and Medicaid (CMS) must approve the formulary. Part D plans are required to offer two medications in all categories necessary to treat your health condition. In most cases, if a name-brand medication isn’t covered, a generic will be.
  • Medicare Part D does have costs associated with it. The costs vary based on which type of plan you choose. In general, you can expect to pay a monthly premium ― this can be deducted directly from your Social Security if you choose ― and a yearly deductible. The deductible can’t be more than $480 in 2022. You’ll pay a copayment or coinsurance percentage for each drug after your deductible is met. If you have low income and resources, you may be able to get help with Part D costs through Extra Help.
Medigap
  • Medigap insurance is commonly known as Medicare Supplemental Insurance. As the name implies, it’s used as supplemental insurance to cover health care costs that Original Medicare does not. You can only purchase Medigap insurance if you’re enrolled in Original Medicare. It cannot be used with a Medicare Advantage Plan. Medigap insurance is offered through private insurance companies approved by Medicare.
  • You pay a monthly premium for Medigap as well as your regular monthly Part B Medicare premium. Your Medigap premium is paid directly to the private insurance company you got your Medigap policy through while the Part B premium is paid to Social Security.
  • Medigap insurance can help cover your deductible costs, copayments, and coinsurance under Original Medicare. For people newly eligible for Medicare on or after January 1, 2020, Medigap insurance can no longer cover the Part B deductible. If you were eligible for Medicare before January 1, 2020, you may be able to purchase Plan C or F, which will cover the Medicare Part B deductible cost. If you already have a Plan C or F, you can keep it. Medigap insurance can’t be used to cover the costs of certain health expenses, including long-term care, vision care, and eyeglass, dental care, hearing aids, or private-duty nursing care.

What isn’t Covered by Medicare?

Original Medicare doesn’t cover certain health services and costs, including:

  • Long-term care
  • Dental care (with some exceptions)
  • Vision exams needed to prescribe glasses
  • Dentures
  • Cosmetic surgery
  • Acupuncture
  • Hearing aids and related exams
  • Routine foot care

How Do I Enroll in Medicare?

There are a few different ways to enroll in Medicare. Some people are enrolled in Medicare automatically, and others will have to sign up on their own. Everyone should check with Social Security three months before their expected start date to ensure everything is in order.

You’ll be enrolled automatically in Medicare if you:

  • Are already receiving Social Security benefits (at least four months prior to start)
  • Receive U.S. Railroad Retirement Board (RRB) benefits (at least four months prior to start)
  • Are under the age of 65 but have a social security disability for 24 months
  • Have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease or ESRD

You’ll have to enroll in Medicare on your own if you:

  • Are about to turn 65
  • Are already 65 but not receiving Social Security benefits

There are also some individual circumstances that may change the timing of your enrollment. For instance, if you have employer-sponsored insurance, you may be able to wait to apply for Medicare Part B instead of being required to apply when you turn 65.

Medicare enrollment periods

The Initial Enrollment Period (IEP) for Medicare is a seven-month period beginning three months before you turn 65, the month in which you turn 65, and three months after you turn 65. For example, if you turn 65 on June 14, your IEP is from March 1 through September 30.

If you don’t sign up during your initial enrollment period, and you aren’t covered by an employer health plan or are volunteering overseas for at least 12 months, you’ll begin accruing Part B late enrollment penalties. You’ll only be able to enroll during the General Enrollment Period (GEP). The GEP runs from January 1 through March 31 each year, with coverage starting July 1st.

Medicare Advantage plans cannot start before your Part B start date, so if you don’t enroll in Part B by the end of your IEP, you’ll have to wait until the GEP for Medicare Advantage enrollment also. If you enroll in Part B during the GEP, you can join a Medicare Advantage Plan or a Medicare Drug Plan (Part D) between April 1 and June 30. Your Medigap open enrollment period starts the first month you have Part B and lasts for six months.

When does Medicare coverage start?

Your Medicare coverage start date depends on when you enroll. Remember, during the IEP, you can enroll three months before you turn 65, the month you turn 65, and three months after you turn 65.

For example:

When You EnrollWhen Coverage StartsExample: Turning 65 on May 10
The three months before you turn 65The first day of the month you turn 65May 1
The month you turn 65The first day of the month after you turn 65June 1
The month after you turn 65Two months after you sign upAugust 1
Two or three months after you turn 65Three months after you sign up

October 1 (if you enroll in July)

November 1 (if you enroll in August)

If you enroll during your IEP, you can coordinate your ancillary coverage, that is, Medigap and Medicare Part D or Medicare Advantage to start the same day as your Medicare Part A and B coverage.

If you enroll during a Special Enrollment Period, coverage generally starts the month after your sign-up.

When you’re ready to apply for Medicare, you can fill out an online application through the Social Security website or in-person at your local Social Security office.

 

This article was originally published by Medicareplans.com and republished here with permission.

The Caregiver’s Role

You may not think of yourself as a caregiver, but anyone who helps someone else because that person is no longer able to manage some or all of the activities of daily life is considered a caregiver. Whether the caregiver is a relative, spouse, friend, neighbor, volunteer, or medical professional, it is important to identify the caregiver role. Your journey in the caregiving role may include a wide variety of experiences. While there are often many intrinsic benefits to caregiving – spending time with a cherished loved one, feeling needed, the opportunity to serve – there may also be challenges and special considerations you must take. Your role as a caregiver is very important, as another individual depends on you. If your well-being suffers, you may become unable to care for another. So, if you’ve accepted the caregiver role, you also have a special responsibility to take care of yourself. That means assessing and taking care of your own physical, emotional, mental, spiritual, interpersonal, and financial needs. When you have attended to your own needs, you will have so much more to give to the person you’re caring for.

hand holding weight, pink background

Physical health is a key caregiver concern. This begins with adequate rest every night. If this is not always possible, then try to fit in naps or break periods during the day. A regular bedtime and a light snack or warm milk may help you fall asleep. Beyond daily rest, you may need periodic breaks from caregiving, and you can plan for a period of respite, such as a long weekend. Discuss this option with a member of your hospice team. Physical exercise is also important. Regular exercise, for instance, will strengthen you for the rigors of caring for another who needs assistance with their own movement. Generally, physical exercise will help you rest better. It is recommended that you aim for a minimum of 20 minutes of exercise four times a week. Fresh air and sunshine can also lift your spirits, and nature is a great healer. Good nutrition will facilitate your own health and vigor and support a healthy immune system. If you receive offers of help from others during this time, request a nutritious meal – it is a simple way for others to support you. Any physical illness or healthcare needs should be attended to promptly in order to shorten your recovery time.

Emotional needs

Woman thinking

Emotional health is closely related to overall health, but may be overlooked. Caregivers experience the full range of human emotions – including anger, guilt, impatience, depression, helplessness, love, loneliness, and isolation – sometimes all at the same time. At times you may tell yourself that some of these feelings are “good” and others “bad.” Rather than label them, it is important to know that all these feelings are normal. Acknowledge your feelings. Accept them. Realize that your situation is not unique and many other caregivers share these feelings. It may help to have a close friend or confidant you can call daily. It helps to talk to another person so you don’t become overwhelmed. You might choose to create a list of people you can call. Remember, your Pasco SW team is also available to listen and act as a resource for emotional support – we are here not only for the patient but for family and caregivers as well. Due to the number of tasks that need to be completed, stress is almost inevitable in caregiving, and it is often compounded by inadequate rest. While there is often little to be done to change the circumstances creating stress, there are many ways to cope with it.The following are some suggestions to help alleviate some of your stress: Keep a journal or diary. Writing about your feelings can reduce stress.

  • Read a book or listen to music. These activities provide a pleasurable diversion.
  • Take a long, relaxing bath with bath salts or aromatic oils.
  • Consider getting a therapeutic massage; even a backrub from a friend can help.
  • Listen to relaxation tapes – you can find them at a public library.
  • Exercise. Physical activity naturally produces chemicals in the body that help reduce tension, anxiety and depression.
  • Stay focused in the present moment. Don’t fret about work when you are caregiving or worry about your loved one when you are away.
  • Take a few moments in nature to lift your spirits.
  • Stroke or brush a pet – this is a therapeutic activity for you and the patient.
  • Laughter is healing –watch a funny movie or read a humorous book.
  • Pursue a creative outlet or enjoy a hobby, such as playing a musical instrument, singing, sketching or painting, or writing a short poem. These activities can do much to relieve stress and express emotions.
  • Perform spiritual practices such as prayer, meditation or inspirational reading.
  • Join a support group.
  • When offered time off, take it without guilt or worry. The break will refresh you and help you be a better caregiver.

Spiritual Needs

woman meditating

Spirituality is highly personal, widely defined, and important to many individuals. Some find their time as a caregiver reinforces and strengthens their spirituality. Others may be challenged to find the time to participate in their previous spiritual or religious practices while busy with the demands of caregiving. If your personal spirituality is important to you, you may need to temporarily adjust your caregiving. You might add a regular quiet time to your day for prayer, contemplation, or meditation. Time spent in nature can be rejuvenating. Inspirational reading or music may help you stay connected to your spiritual source.

Making It Happen

Who has time for all of this? Keep in mind that one activity may help to achieve balance in your life. For example, a walk with a friend provides physical exercise and social interaction and is emotionally and spiritually uplifting. Hobby groups may relieve stress and allow you to discuss current events. Singing in a choir provides a change of scenery, a creative outlet, and social contact.

The most important thing is to begin. It may be difficult to make many changes all at once, so select at least one or two areas to work on right away. Set a realistic goal for yourself to maintain your own well-being and regain a sense of control and balance. Pasco SW team members know all about the caregiver role and can help you through any challenges you may encounter during this journey. Don’t hesitate to use them as your own resource.

Respite Care

Elderly woman kissing her adult sons cheek

How Respite Care Helps

Respite care services provide temporary in-home care for elderly or disabled individuals, allowing family caregivers to take some time off from their caregiving role while ensuring that their loved one is well cared for. At Pasco SW, our in-home care program matches your loved one with one of our friendly and compassionate caregivers. Our professional staff can visit for a few hours a day or several times a week to provide family caregivers with the opportunity to run errands, go to work, take a vacation, or simply rest and recharge.

How We Help

You can feel exhausted while caring for an older adult loved one who needs help 24-hours a day. During these situations, Elite Home Health and Hospice can provide well-deserved respite services for family caregivers and offer necessary assistance to their loved ones. Our professional respite care services will restore your peace of mind and you can rest assured that you or your older adult loved one is in the caring hands of skilled professionals, 24-hours a day, 7-days a week.

When our caregivers visit, they will quickly put your loved one at ease. While engaging in friendly conversation, caregivers can also provide assistance with a wide variety of home care needs. Our caregivers can help your loved one with dressing and bathing, transferring assistance, and other personal care needs. They can also help around the house performing simple chores and preparing healthy meals. The valuable care we provide makes it easy for your loved one to look forward to these visits and can help relieve the anxiety or guilt you may feel by stepping away for a few hours.

Labor of Love 

Caring for an elderly or disabled loved one is a labor of love that can prove stressful over time. Respite care can help prevent the troubling symptoms of caregiver burnout, including:

  • Stress
  • Depression
  • Fatigue
  • Anxiety
  • Anger
  • Decline in overall health
  • Disinterest in once loved activities

 

Therapy At Home

Measurable Results at Home

No matter your health needs, the Pasco/SW Rehabilitation Team is ready to help you. Our therapy team is passionate about bringing the latest techniques and programs to our patients. Through continuing education, our physical and occupational therapists apply the latest research to improve balance and reduce fall risk. They also utilize therapeutic modalities combined with a full-service therapy program for strengthening, balance training, pain reduction, wound care, urinary incontinence, and increasing patients’ range of motion.

Our Holistic Approach

Our therapists work together with your physician, nursing, social services, the business office, families, caregivers, and local communities to assess functional potential, and collaborate on the unique goals for every patient.

  • Physical Therapists (PT) & Physical Therapy Assistants (PTA)
  • Occupational Therapists (OT) & Certified Occupational Therapy Assistants (COTA)
  • Speech and Language Pathologists
Our team works holistically with one goal in mind: to maximize your comfort and health.

 

Physical Therapy

The physical therapist’s role is to evaluate the patient’s condition, determine barriers and develop a plan of care to work towards goals.

  • Strengthening
  • Conditioning Exercise
  • Mobility Training
  • Home Exercise Programs
  • Joint Replacement Rehabilitation
  • Orthotic / Prosthetic Training
  • Gait training/ Ambulation
  • Transfer Training
  • BIG Therapy for Parkinson’s

Occupational Therapy

The focus of Occupational Therapy is to improve your quality of life by maximizing function, safety, and independence in activities of daily living.

  • Improve activities of daily living including dressing, bathing, grooming.
  • Use of special equipment training
  • Orthotic / prosthetic training
  • Muscle re-education
  • Home modifications and equipment
  • Therapy for Parkinson’s

Speech Therapy

Speech-Language Pathologists work to improve communication and cognitive skills. Speech Therapists also work with patients to improve their ability to safely eat and swallow.

  • Language and word-finding
  • Communication Therapy
  • Treatment for cognition and memory
  • Swallowing Therapy
  • LOUD Therapy for Parkinson’s

Understanding The Grief Process

Emotional

Physical

Behavioral

  • Shock
  • Anxiety
  • Depression
  • Panic
  • Guilt
  • Anger (at God, medical personnel, yourself, the deceased)
  • Fear (of being alone, of leaving the house, of being in the house)
  • Relief
  • Yearning
  • Gradual Hope
  • Tightness in chest
  • Breathlessness
  • Lack of energy
  • Changing in eating habits
  • Stomach aches
  • Lump in throat
  • Headaches
  • Inability to sleep
  • Lack of motivation
  • Inability to concentrate
  • Unpredictable and uncontrollable tearfulness
  • Forgetfulness
  • Social withdrawal
  • Busyness to evade reality
  • Preoccupation with the life of the deceased
>You may find yourself busy immediately following your loved one’s death. It is important during this time to take things slowly and enlist the help of friends and family. You can expect to experience grief for a long time. Be prepared for the possibility of unexpected feelings of bereavement months and even years after your loved one’s death. This is normal. Grief is a normal, healthy, and human response to loss. It is painful and can seem unbearable at times. Many emotions come and go. The length and difficulty of the grieving process varies from person to person. Grief does not follow a timeline, but it does ease over time. This process can offer an opportunity for personal growth. A mourning period of a year or more is quite normal, but society often finds it difficult to tolerate a person’s grieving for more than a week or two. Family, friends, and colleagues may become concerned or even impatient if the grieving continues. Support from friends and family may decrease after the funeral/memorial service. You do not have to go through the grieving process alone. The Pasco SW bereavement Team is available to you. They can offer support in any way you might find helpful. If you need support immediately and have not heard from a member of our team, do not hesitate to call the Pasco SW office.

HEALING AND GROWTH

When ignored grief can continue to cause pain. It is important to recognize grieving, even though it is very difficult work. Allow yourself to feel all emotions that arise and be patient with yourself.”>
  • Realize your grief is unique
  • Get your rest
  • Journal
  • Meditate
  • Seek out friends who can encourage and support you
  • Get involved in a support group
  • Postpone all major decisions
  • Give in to your pain
  • Realize that grief has no timetable
  • Talk about your sorrow
  • Forgive yourself
  • Eat well and exercise
  • Indulge yourself by doing something that is frivolous and distracting that you enjoy
  • Prepare for holidays and anniversaries
  • Take steps to create a new life for yourself
  • Change traditions that may no longer be comfortable
  • Levels of Care

    Elite Home Health and Hospice provides high-quality care through individualized, compassionate service. At the heart of hospice care, you will find a deep appreciation and understanding of the special needs of our patients. We believe strongly in the dignity and value of the human soul. Hospice care focuses on comfort and quality of life, rather than cure.

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