More FAQ's You Should Ask

By Elie Harriett

Here are a list of 5 more common questions you should seek out answers to when choosing an insurance plan.

• What happens if I need to recover from an extended illness in a nursing facility? Medicare, under some conditions, gives limited coverage in a nursing home for purposes of recovery.  It is not all inclusive, and it is not long-term.  But the coverage does provide for a reasonable amount of time for people with acute illnesses to get back on their feet.  In general, Medicare leaves co-pays after a specified number of days when the coverage is available.  People with Medicare supplements generally have these co-pays paid for by their insurance for as long as Medicare continues to approve the stay.  Once Medicare’s coverage stops, so will the supplement’s.  People with Medicare Advantage plans generally have a daily co-pay and should contact their insurance company to find out how much they will expect to be billed.
• What if I need home care? Medicare covers medically necessary part-time or intermittent skilled nursing care, and/or physical therapy, speech-language pathology services, and/or services for people with a continuing need for occupational therapy. A doctor must see you face-to-face before you can be certified that you need home health services.  A doctor must order your care, and a Medicare-certified home health agency must provide it. You must be "homebound," which means both of these are true:
  • You’re normally unable to leave home and doing so requires a considerable and taxing effort. 

  • Because of an illness or injury, leaving home isn’t medically advisable or isn’t possible without the aid of supportive devices, use of special transportation, or the assistance of another person. 

• What about Long-term care? Long-term care includes non-medical care for people who have a chronic illness or disability. This includes non-skilled personal care assistance, like help with everyday activities, including dressing, bathing, and using the bathroom. Medicare and most health insurance plans, including Medicare Supplement Insurance policies or Medicare Advantage, don’t pay for this type of care, sometimes called “custodial care.” Long-term care can be provided at home, in the community, in an assisted living facility, or in a nursing home. It’s important to start planning for long-term care now to maintain your independence and to make sure you get the care you may need, in the setting you want, in the future.  But you will not get it through Medicare.
• Will Medicare cover my diabetic testing supplies? Generally yes.  Medicare Part B covers blood sugar monitors, test strips, lancets, and sometimes therapeutic shoes as part of its basic benefit, meaning a Medicare Supplement generally covers the remainder of the costs.  Those with Medicare Advantage plans should consult their company to learn the applicable co-pays.  Insulin and syringes are generally not covered by Medicare Part B, but are instead covered under Part D, although there are specific exceptions where Part B will cover it.  When in doubt, contact Medicare or someone knowledgeable about the rules to learn which would apply to your specific situation.

These are a few more questions we feel clients should ask when choosing health insurance.  If you have specific questions you would like to get answers for, please give us a call.  Or use the “ask a question” box on this page.