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CMS Proposes New Medicare Payment Adjustment for Home Healthcare

The U.S. Centers for Medicare & Medicaid Services (CMS) has proposed a permanent payment adjustment to the home healthcare 30-day period payment rate. The change would decrease Medicare payments to home health agencies by $810 million next year. Home healthcare providers have concerns that this will put the stability of home healthcare at risk, and are pushing a new bill to hold off any payment reductions until 2026. Because these pay cuts would mean home healthcare providers would lose a lot of their funding, home healthcare agencies would lose staff and more, which would ultimately affect Medicare beneficiaries’ care.

The New Proposal

CMS is proposing a new Medicare payment adjustment under the Home Health Prospective Payment System. The adjustment would decrease payment rates to home healthcare providers and facilities by 4.2%, or $810 million, compared to 2022 rates.

Providers Not Happy

Home healthcare providers are arguing that the proposal does not take into account multiple factors, such as increased home healthcare labor costs and the high inflation rate.

“We are very disappointed in the CMS proposed rule issued today,” William A. Dombi, the president of the National Association for Home Care & Hospice (NAHC), wrote in a comment shared with Home Health Care News. “The stability of home health care is at risk as a consequence of CMS proposing the application of a fatally flawed methodology for assessing whether the PDGM payment model [Patient-Driven Groupings Model, which uses 30-day periods as a basis for payments] led to budget neutral spending in 2020. That has been made clear to CMS in the 2021 rulemaking and in multiple discussions since.”

blue boxing gloves — *A new bill that would prevent CMS from reducing home health payments until 2026 was introduced in the Senate.*

“With significantly rising costs for staff, transportation, and more, home health agencies across the country cannot withstand the impact of the proposed rate cut,” Dombi said. “Reliable analyses prove that PDGM underpaid home health agencies. We will be taking all steps to protect the home health benefit as this proposed rule advances and have fully prepared for congressional action and more.“

Fighting Back

With pay cuts like this, home health agencies will be underpaid, which could result in fewer workers to help care for Medicare beneficiaries who need home healthcare. But a new bill that would prevent CMS from reducing home health payments this year – and until 2026 – was introduced in the Senate on July 25.

“The bill is set up so that CMS is blocked from reducing payment rates until 2026,” Dombi told Home Health Care News. “And the purpose of that, essentially, is to create what we hope is an opportunity to correct where CMS is at in terms of their methodology. And to deal with even some of the questions around transparency relative to the data that we’ve asked for.”

Do Military Retirees Have To Pay for Medicare?

Military personnel generally get special healthcare benefits while they are serving, and after they are retired. But if you’re a veteran, and you’re about to turn 65, you might be wondering if you can continue to use your military healthcare alongside Medicare, or if you will have to switch to Medicare. The short answer to this is that military retirees can use their Veterans Affairs benefits alongside Medicare.

Medicare Isn’t Mandatory

invoice in an envelope with a hand next to it with money — *Medicare is not mandatory, but you will have a penalty to pay if you choose not to enroll.*

Medicare is not mandatory for anyone, so you can choose not to enroll at all. But if you choose to wait, and then enroll outside of your Initial Enrollment Period (and don’t qualify to delay your enrollment), you could face late enrollment penalties. In other words, you don’t have to enroll in Medicare if you have VA benefits, but you can, and should if you think you might want the benefits. In fact, the Veterans Administration actually recommends veterans enroll in Medicare when they become eligible, so they can have both types of benefits available to them.

Should You Have Both Medicare & VA Benefits?

So why enroll in Medicare if you already have VA benefits? Your VA benefits may not pay for everything you need, so it’s wise to have both types of plans. Having both means that you can use your VA benefits to receive care at a VA hospital facility, and your Medicare benefits at a Medicare facility. Be aware, though, that you cannot use Medicare benefits at a VA facility and vice versa.

How Benefits Work, and Extra Coverage Options

If you are a military retiree and are 65, you can enroll in Medicare, which requires that you meet annual deductibles, and pay a monthly premium and coinsurance (for Part B). But you will also be automatically enrolled in the VA’s Tricare for Life, a no-cost insurance package that can help fill these gaps in Original Medicare coverage.

If you need more help paying for what Original Medicare does not cover, you also have the option of enrolling in a Medicare Supplement Plan. It’s important to note that Medicare Part B only covers 80% of the cost of treatments, which means you will have to pay the remaining 20% out-of-pocket. This can be quite expensive, even with VA benefits, if you plan to see doctors who are outside of the VA system. Fortunately, though, you can save money on medical expenses and get extra coverage by purchasing a Medicare Supplement Plan.

There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans in minutes for you at no cost. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

Does Medicare Cover Parkinson’s?

Nearly 1 million Americans are living with Parkinson’s disease, and that figure is expected to climb to 1.2 million by 2030. While this disease can affect anyone, it is more common in older adults: it affects around 1% of the population over 60. If you are an older adult, especially if you have a family history of Parkinson’s disease, you might be worried that you could be diagnosed with this condition; you might also be worried about how you would pay for treating it. Medicare can help ease the financial burdens of paying for care, especially if you purchase a Medicare Supplement Plan.

Understanding Parkinson’s Disease

hand that appears to be shaking — *Parkinson’s disease is caused by a loss of nerve cells in the part of the brain, which causes tremors.*

Parkinson’s is a progressive neurological disease that causes nerve cells in the area of the brain that control movement to weaken and/or die. It is the second most destructive degenerative neurological disorder after Alzheimer’s disease, but unlike Alzheimer’s, which primarily affects memory and cognitive skills, Parkinson’s affects movement, balance, and mood.

Parkinson’s disease is caused by a loss of nerve cells in the part of the brain called the substantia nigra; scientists believe this loss of nerve cells is triggered by a combination of genetic and environmental factors. You might be at higher risk of developing Parkinson’s disease if one or more of your family members has it: around 15 to 25% of people living with Parkinson’s have family members that have had it as well. In terms of environmental factors, studies have shown that Parkinson’s is more common among people living in rural areas, leading experts to believe that exposure to pesticides may increase the risk of developing Parkinson’s.

Parkinson’s Disease Symptoms

There are four main symptoms to keep an eye out for when it comes to Parkinson’s:

Tremor or trembling in the hands, arms, legs, jaw, or head
Slow movements
Stiffness of the limbs and trunk
Impaired balance and coordination

Medicare Coverage For Parkinson’s

Medicare will help cover some of the costs of treatment for Parkinson’s disease. Medicare Part A will provide coverage for any inpatient hospital stays, which can be beneficial for people who have more advanced cases of Parkinson’s. It will also cover up to 100 days in a skilled nursing facility, as well as any surgery needed.

Medicare Part B will cover your doctor visits. It will also help cover the cost of physical therapy, injections, therapy for any accidents related to Parkinson’s, and any medical equipment needed to manage symptoms. Medicare Part B might also cover parts of Duopa therapy, an innovative procedure used to treat motor symptoms in advanced Parkinson’s. In this procedure, medication is delivered through a tube directly into the patient’s intestine.

Extra Coverage

A Medicare Supplement Plan can help cover any extra costs that Original Medicare does not cover, including the 20% coinsurance that you will have to pay out-of-pocket for every Part B expense. One of these plans could cover 100% of your Part A coinsurance and hospital costs, as well as 100% of Part B coinsurance and copayments, for one low monthly premium price.

Early Detection of Macular Degeneration Can Help Save Your Central Vision

Macular degeneration is a leading cause of vision loss in the US, especially in older adults. The risk of developing advanced age-related macular degeneration increases from 2% for those aged 50-59, to nearly 30% for those over the age of 75. That means it’s vitally important that you get your eyes checked regularly as you age, since doing so could help save your vision. August is National Eye Exam Month, so this month we wanted to talk about macular degeneration, how you can avoid this disease, and how Medicare can help.

Age-Related Macular Degeneration

blurred vision — *Macular degeneration causes blurred or reduced central vision.*

The macula is the center of the retina, and is responsible for vision clarity. Over time the macula can thin, known as age-related macular degeneration (AMD), causing blurred or reduced central vision. This condition can develop in one or both eyes, but will eventually affect both eyes.

If you are diagnosed with macular degeneration, you will not lose your sight entirely, but you could lose your ability to read, drive, and even recognize faces. The best way to avoid macular degeneration as you age is to have regular eye exams. During exams, your ophthalmologist can detect the early signs of macular degeneration and find the best solutions for minimizing its effects.

Risk Factors

There are multiple risk factors for developing macular degeneration, including:

Having a family history of AMD
Being Caucasian
Smoking cigarettes
Eating a diet high in saturated fat
Being overweight
Having hypertension or high blood pressure
Having heart disease and/or high cholesterol
Being over the age of 50

Unfortunately, there is no cure for macular degeneration, but a healthy lifestyle can help reduce the risk of developing it, and can slow down its progression. For example, to reduce your risk of AMD, you should quit smoking if you are a smoker, exercise regularly, eat a healthy diet, and protect your eyes from UV rays with sunglasses and a hat.

Medicare Coverage for Macular Degeneration

If you begin to experience wavy, blurry, or dim vision, it’s important to contact your eye doctor immediately. If you are diagnosed with macular degeneration, treatment will depend on the stage of the disease. In the early stages, called dry macular degeneration, you will most likely be told to take supplements, which are generally not covered by Medicare.

But if your AMD is in a more advanced stage, known as wet macular degeneration, Medicare Part B will cover diagnostic tests and treatments, including drops and injections. You will, though, have to meet your Part B deductible first, as well as pay a 20% coinsurance for the Medicare-approved amount of the treatment.

Extra Coverage

Medicare Part B will only cover the cost of services or treatment for any condition at 80%, leaving you to pay for the other 20% out-of-pocket. If you need ongoing treatment for a condition like macular degeneration, this can become quite expensive, especially if you are living on a fixed income, as many Medicare beneficiaries are. Fortunately, though, you can save money on all your medical expenses and get extra coverage by purchasing a Medicare Supplement Plan.

There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans for you in minutes at no cost to you. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

What Medicare Doesn’t Cover: A Look at Some of the Most Common Out-of-Pocket Expenses

When you turn 65 and enroll in Medicare, you might find that you need to adjust to Medicare after having private insurance. But you’ll most likely be pleased with the switch! With that being said, though, there are things that Medicare doesn’t cover, meaning you’ll have some out-of-pocket expenses to budget for, as you would with a private health insurance plan. Some of these expenses change every year; it’s important to be up-to-date so you can plan for them, as well as know what type of Medicare Supplement Plan will help keep your out-of-pocket expenses to a minimum.

Medicare Out of Pocket Costs

hundred dollar bills floating around — *You will have some Medicare out-of-pocket expenses, which is important to know so you can prepare and budget for them.*

Medicare Part A Costs

Medicare Part A is hospital insurance, which covers most inpatient hospital services. Most people don’t pay a Part A premium, because this is covered by the Medicare taxes you have paid while working. But if you don’t qualify for free Medicare Part A premiums, you will have to pay up to $499 each month for hospital insurance.

For Medicare Part A, your biggest out-of-pocket expense is your annual deductible, which you will have to meet if you are admitted to the hospital. For 2022, the Part A annual deductible is $1,556, and covers your share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. If you go over 60 days, you’ll have to pay a coinsurance of $389 per day for the 61st through 90th day of hospitalization in a benefit period, and $778 per day for lifetime reserve days. If you need a skilled nursing facility, your daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $194.50 in 2022.

Medicare Part B Costs

Medicare Part B covers outpatient medical services, including durable medical equipment. There are a few more out-of-pocket expenses for Part B than there are for Part A: you will have to pay a monthly premium, coinsurance, and meet your annual deductible. Each year, these costs change slightly. For 2022, the standard monthly premium for Medicare Part B enrollees is $170.10, the annual deductible is $233, and coinsurance will remain at 20% of the Medicare billable amount of services.

What Medicare Typically Doesn’t Cover

In addition to the out-of-pocket expenses associated with Medicare Parts A and B, there are other things that Original Medicare does not cover, including:

Most dental care, including dentures and dental implants
Most vision care, including eye exams for glasses and contacts
Most hearing care, including hearing aids, exams, and fittings for hearing aids
Long-term or custodial care
Most cosmetic surgery
Massage therapy and acupuncture
Routine foot care
Personal comfort items and services
Medical expenses outside the U.S.
Prescription medications

Medicare also will not pay for services and supplies that your doctors consider medically unnecessary.

Extra Coverage

As we pointed out above, Medicare Part B will only cover the cost of services or treatment at 80%, leaving you to pay the other 20% out-of-pocket. If you need to have major surgery, like a heart transplant, this can be quite expensive, especially if you are living on a fixed income, as many Medicare beneficiaries are. Fortunately, though, you can save money on all your medical expenses and get extra coverage by purchasing a Medicare Supplement Plan.

There are 10 different Medicare Supplement Plans to choose from, each offering different coverage options and rates. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans for you in minutes at no cost to you. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

Questions to Ask Yourself Before You Choose a Medicare Plan

Medicare is different from private health insurance plans in some ways, but similar in others. For example, there aren’t as many choices to make when it comes to Original Medicare as there are with private health insurance, but you will have at least one big choice to make: if you should get a Medicare Supplement Plan, and if so, which one. The answer to the first question is easy: yes! Original Medicare has quite a few out-of-pocket expenses associated with it, like Part B’s 20% coinsurance, so having a Medicare Supplement Plan is important to help you keep your medical expenses under control.

But the second question might seem harder, since there are 10 different Medicare Supplement Plans to choose from. So if you’re wondering which one is right for you, you should ask yourself the following questions.

What Is A Medicare Supplement Plan?

Medicare Supplement Plans are similar to the private health insurance you’re probably used to: you choose a plan, pay a monthly premium, and in return, the plan pays most of your expenses not covered by Medicare Parts A & B.

For example, if you have a $4,000 ambulance bill, and you have already met your Medicare Part B annual deductible, Medicare Part B will pay 80% of the bill. That means you’ll have to pay the remaining 20%, or $800, out-of-pocket. But if you have a Medicare Supplement Plan that covers Part B copayments and coinsurance, your plan will pay that $800.

How Do You Get a Medicare Supplement Plan?

While you can enroll in a Medicare Supplement Plan at any time, the best time to purchase a plan is during your Open Enrollment Period. This is the six-month period that starts on the first day of the month that you turn 65 and are enrolled in Medicare Part B. During your Open Enrollment Period, you can enroll in any Medicare Supplement Plan offered in your service area with guaranteed issue, meaning that insurance companies are not allowed to deny you coverage or charge you more because of pre-existing conditions. There are many different types of Medicare Supplement Plans to choose from, with varying levels of coverage and different price points.

Questions To Ask

If you’re looking for a Medicare Supplement Plan, you might be tempted to choose the most inexpensive plan because you want to save money, but that might not be the best option for your needs. You will need to take into consideration your current and future health care needs, and any additional expenses that might come up.

So before you purchase a Medicare Supplement Plan, you should ask yourself:

What is my budget?
What are the maximum out-of-pocket expenses for each plan?
What are the copays and deductibles for each plan?
Would I rather pay more in monthly premiums and have lower out-of-pocket expenses, or pay a lower premium and have a copay each time I see the doctor?
Am I okay with a plan that requires me to stay within a network of doctors? Or do I want a plan that has no networks?
Do I want a plan that doesn’t require me to get a referral from my primary care physician to go to a specialist?
Do I plan on traveling?
Do I take any infusion drugs? (Many plans only cover 80% of infusion drug costs.)
Are extra benefits such as prescription drugs or dental, vision, and hearing important to me? Or can I purchase a separate plan?

Looking For More Information?

If you need help answering these questions, an EZ agent can help you! Our agents work with the top-rated insurance companies in the nation and can go over each plan available in your area while helping you answer all of the above questions to find the plan that best meets your needs.

Because there are 10 different plans to choose from, we guarantee to find you the perfect fit. It’s worth looking into a Medicare Supplement Plan to save as much money as you can, so speak to an EZ agent for all of your options. EZ’s agents work with the top-rated insurance companies in the nation and can compare plans for you in minutes at no cost to you. To get free instant quotes for plans that cover your current doctors, simply enter your zip code in the bar on the side, or to speak to a licensed agent, call 888-753-7207.

Tag: medicare insurance

CMS Proposes New Medicare Payment Adjustment for Home Healthcare

The New Proposal

Providers Not Happy

Fighting Back

Do Military Retirees Have To Pay for Medicare?

Medicare Isn’t Mandatory

Should You Have Both Medicare & VA Benefits?

How Benefits Work, and Extra Coverage Options

Does Medicare Cover Parkinson’s?

Understanding Parkinson’s Disease

Parkinson’s Disease Symptoms

Medicare Coverage For Parkinson’s

Extra Coverage

What Medicare Doesn’t Cover: A Look at Some of the Most Common Out-of-Pocket Expenses

Medicare Out of Pocket Costs

Medicare Part A Costs

Medicare Part B Costs

What Medicare Typically Doesn’t Cover

Extra Coverage

Questions to Ask Yourself Before You Choose a Medicare Plan

What Is A Medicare Supplement Plan?

How Do You Get a Medicare Supplement Plan?

Questions To Ask

Looking For More Information?

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