Insurance FAQs
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What You Know About Health Insurance and Elder Care
Health insurance can help cover some of the costs of your senior loved ones. You should understand what a policyholder is entitled to and what to know about the coverage. Long-term planning and knowing the limitations of coverage are essential to prevent misconceptions about who will pay for care in the future.
What are Medicare insurance benefits for Elder Care?
Medicare will only pay for medical care; it does not cover the cost of personal care. It does not pay for care assistance your loved one needs to perform daily living and activities (bathing, grooming, eating, and mobility).
Medicare does cover nursing home care and some personal care is provided in nursing homes. However, Medicare does not cover nursing home care at 100% and Medicare only pays for a limited time.
Medicare offers benefits for medical equipment, supplies, and medications. These items are medically necessary if prescribed by a physician and on the list of approved items.
Medicare pays for 80% of the cost. Medicare Part D will pay for certain medications however, there are deductibles and coverage gaps.
Individuals who choose to age at home as opposed to in residential care receive little assistance from Medicare. It does not pay for home modifications of any kind.
Unique programs in some locations are called PACE or LIFE in which all of a participating senior’s medical needs are covered by Medicare.
What is a Supplemental Insurance?
Supplemental insurance policies for Medicare are designed to help with co-payments and deductibles. It reduces the out-of-pocket costs for items and services which are largely covered by Medicare.
Understanding TRICARE for Life and CHAMPVA for Life
Active military members, retirees, and the family members of military veterans who are at least 65 years of age may take advantage of TRICARE for Life and CHAMPVA for Life.
These programs simply help to cover co-payments and deductibles and function very much like a Medicare supplemental insurance policy in that they do not extend the benefits of Medicare.
is MEDICAID right for you?
Medicaid assists low-income individuals living with limited financial assets. Unlike Medicare, Medicaid offers significant benefits for eldercare including non-medical care.
It pays for unlimited nursing home care and through each state’s HCBS waivers. It’s possible Medicaid will pay for some home care, assisted living, adult day care, and medical alert services.
How to Maximize Your Insurance Plan
Know Your Benefits
Be Proactive with Your Doctor
Make sure your doctor writes very prescriptions that include the specific reasons why an item, brand, procedure, therapy, or type of care is necessary.
Supporting Documentation
Laboratory test results, statements of medical justification, official letters which describe a patient’s need can all serve as additional supporting documentation. More information is better than too little.
Benefit Patient Advocate
Patient advocates are third-party individuals or organizations that help patients navigate the health care system. They focus on education, health plans usage, and how best to obtain care based on your needs. There are private, fee-based advocates, but there are also organizations that provide these services at no charge including American Cancer Society, the Alzheimer’s Association, or one’s local Long Term Care Ombudsman.
Contact Your State Protection and Advocacy Program
If you are denied by your insurance company, there are two programs in each state that work to protect your rights. The Protection and Advocacy for Assistive Technology (PAAT) and Protection and Advocacy for Individual Rights (PAIR) can help you. Note that they are more focused on fighting denied claims for medical equipment than for care services.
SHIPs
State Health Insurance Assistance Programs (SHIPs) are free advisory services provided to serve to help residents better understand and receive benefits from their insurance policies including Medicare, Medicare Advantage, Medicare Supplemental, and Medicaid.
Request a Consultation
Fill out this short form and a Kina'ole Case Management representative will contact you within 2-3 business days. If you need immediate assistance, please call (808) 369-1620.