If you’re 65 years old, about to be 65 years old, or if you know somebody who is, here’s a message for you: Don’t wait to sign up for, or change, Medicare insurance plans - poor planning, procrastination and missed deadlines expedite the aging process!

The Medicare Open Enrollment Period is October 15^th through December 7^th, and it’s time to make decisions about your future now - changes made during this period will take effect January 1^st of next year.

Here’s a brief overview of some upcoming deadlines:

• Part A, B, D – Enrollment begins 3 months before and up to three months after you turn 65.
• Medicare Supplement Insurance (Medigap) – Medigap open enrollment lasts 6 months and begins when 1) You are 65 or older 2) Have enrolled in Medicare.
• Working past age 65 – You must enroll within 8 months of being unemployed or dropping your health plan.

What each part means:

Part A – Hospital insurance: Covers inpatient care, hospice, home health and skilled nursing care.

Part B – Medical insurance: Covers outpatient care, preventative services and medical equipment such as wheelchairs and walkers.

Part D – Prescription drug coverage

Medicare Supplement Insurance (Medigap) – Covers some of Medicare’s cost-sharing requirements and services not covered by Medicare.

Why you should take advantage of this enrollment period:

• Possibility of upgrading or downgrading plans (Medicare Advantage versus Original)
• Opportunity to reevaluate or change Part D
• Peace of mind knowing that you do not have to rely on COBRA or job security in order to be covered by insurance.

Good to know:

• The general enrollment period for Medicare is between January 1^st and March 31^st
• During the general enrollment period, coverage kicks in one month post-enrollment.
• You can apply for Medicare even if you are already covered elsewhere.
  
  

In Feds to deliver ‘positive news’ on Provider Relief Fund in coming days: Parkinson, McKnight's LTC News summarized recent comments from AHCA President and CEO Mark Parkinson at the Synergy Summit in Utah.

Among other things, Parkinson stressed managed care is not going away and encouraged senior care providers to embrace it by:

• Becoming a top provider in a given market
• Improving demographics
• Becoming part of a network
• Taking advantage of institutional special needs plans (I-SNPs)

Naturally, you may want to know more about I-SNPs and if/how you might take advantage of them. The below Q&A may be of help to you in assessing this.

What is an I-SNP?
I-SNP stands for Institutional Special Needs Plan and is designed for those who will live in a long-term setting for 90 days or more with no immediate plans for discharge

How does it fit within Medicare?
An I-SNP is a Medicare Advantage plan focused on the care of specialized populations. It replaces traditional Medicare to cover inpatient and outpatient services, plus prescription drugs (as a Part D service).

Who is eligible for an I-SNP?

• Reside in a long-term care facility with no anticipated discharge
• Currently enrolled in Medicare A/B
• Live in a county where I-SNP is licensed

*Check CMS' Special Needs Plan (SNP) Data to see who is operating in your state.

What are the highlights of an I-SNP?

• Nurse practitioners provide preventative and proactive care
• RN case managers coordinate care according to the Model of Care (MOC) required by CMS
• Residents are assigned a 'Risk for Hospitalization' level, which determines care plan and a schedule for proactive rounds
• Rounds occur as often as weekly or can be more frequent for high-risk residents
• Provider visits are not subject to medical necessity requirements of traditional Medicare, so they can be more proactive and frequent

How do I-SNPs benefit SNFs/residents?

• Increased provider visits; faster identification of conditions/treatment
• Treatment-in-place advantage – visits can happen in the nursing facility
• Proactive and preventative care; prevents unnecessary hospitalizations
• Reduce risks and stress associated with hospital stays

How can technology help facilities with I-SNPs?

• Case-to-contract management is essential to following an ISNP
• Our Managed Care MASTER software brings contracts online, PLUS pairs them with best-practice workflows and alerts
• With this automation, you can easily train anyone to act as a case manager and ensure reimbursement

If our Managed Care MASTER can help you 'manage' your managed care, including I-SNP contracts and care, let's connect.

Traditionally, Medicare hasn’t covered long-term care. And — spoiler alert — it still doesn’t. However, the rise of Medicare Advantage plans has opened a few doors that weren’t open before. While Medicare still doesn’t provide long-term care coverage — patients will have to subscribe to a different type of plan if they want that — it is beginning to provide coverage for certain aspects of long-term care.

So what “aspects” are we talking about?

What is the Difference Between Medicare and Medicare Advantage?

First, let’s dive into the difference between traditional Medicare (often referred to as Original Medicare) and Medicare Advantage. The first thing to understand is that Medicare Advantage, also known as Medicare Part C, is a private insurance plan. It replaces an individual’s Medicare Part A (hospital visits and inpatient care) AND Part B (physician appointments and outpatient care) with a plan from a private insurance provider. This plan must provide the same benefits as the Medicare plan it replaces. However, it also adds a lot of additional benefits not provided under Original Medicare.

What Types of Benefits Does Medicare Advantage Cover?

In addition to the benefits provided by Medicare Parts A and B, Medicare Advantage plans often offer dental, vision, and prescription drug coverage. Recently, insurance providers have expanded the coverage they offer to include benefits like meal delivery, home care services, rides to medical appointments, and home modifications like bathroom grab bars.

The benefits each plan offers varies based on the area it serves. In qualifying areas, Medicare Advantage plans can even cover grocery deliveries and transportation for non-medical needs for those with chronic illnesses. Some providers also offer options for gym memberships and fitness plans.

Are There Additional Costs with Medicare Advantage?

The cost of each Medicare Advantage plan depends on the plan itself. Most people who qualify for Medicare receive Part A benefits for free and pay a small monthly premium for Part B benefits. This is true for Medicare Advantage, as well. Some plans charge a monthly premium, while others do not. It all depends on which provider an individual chooses for their Medicare Advantage plan.

Custodial Care Vs. Skilled Care

Even with all the changes Medicare Advantage is bringing, it’s still limited in the kind of care it will cover in a long-term care environment. To understand what is covered and what isn’t, we must discuss the different types of care.

Medicare, along with most private insurance plans, pay for services that fall under “skilled care.” This includes medical services, rehabilitation, nursing, or medication administration. Medicare Advantage also covers specialized care, including stays in skilled nursing facilities, hospice care, and some home care services.

So what isn’t covered?

“Custodial care,” not typically covered by Medicare Advantage, includes services that are considered help with activities of daily living, or ADLs. These include eating, bathing, dressing, toileting, and other non-medical care. This is the type of care provided by most long-term care and assisted living facilities.

What Does This Mean for My Nursing Home?

Unless you have a contract with a Medicare Advantage insurance provider, Medicare Advantage will not cover most of the services your nursing home provides for long-term care. Stays in skilled nursing facilities and nursing homes are covered up to the first 100 days (though plans require coinsurance beyond 20 days). After that, residents are on their own. The plans should cover prescription medications and any therapies provided by your facility, however.

For nursing homes, the real benefit of Medicare Advantage is the coverage of prescription medications. Under Original Medicare, medications were not covered unless the resident was under a Part A stay. For many residents, that's a game changer.

While Medicare still doesn’t cover long-term care, the recent expansion of benefits under Medicare Advantage indicate that relief is on the way — and options could be opening up in the future.