New Medicare Benefits Thanks To CHRONIC Care Act

Last month, Congress introduced the CHRONIC Care Act. The title “CHRONIC” stands for “Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care.” It is designed to help seniors and Medicare beneficiaries with chronic illnesses and disabilities and those who benefit from both Medicare and Medicaid.

New Medicare Advantage Benefits

With the CHRONIC Care Act, Medicare Advantage plans can now cover “nonmedical” benefits. Before the act passed, your Medicare Advantage plan would only cover “Durable Medical Equipment (DME).” DME includes items like blood sugar monitors, wheelchairs, hospital beds, and other items deemed medically necessary and durable (reusable for at least three years). Now, Medicare Advantage plans can cover home modifications (like wheelchair ramps, chair lifts, and bathroom handlebars) if medically necessary.

Additionally, Medicare Advantage plans can now provide more telehealth services. That means that your plan may provide coverage for virtual health services, like talking to your doctor via phone or video chat. Previously, Medicare had very strict guidelines about who was eligible to receive coverage for telehealth from Medicare. Now, the CHRONIC Care Act is expanding telemedicine.

Additional Home Care

The CHRONIC Care Act also expands your access to home care. Kidney disease patients can now access in-home dialysis treatments. This means that in the future, it may be easier for your doctor to come visit you.

Additionally, the Independence at Home program is expanding from 10,000 patients to 15,000. Independence at Home is a small program that allows doctors to visit patients on house calls and receive Medicare coverage. The program increases care quality and lowers care cost.  While the program is still quite limited, this expansion means that more and more chronically ill patients are gaining access to home care.

Better Care Coordination

Lastly, the new act allows Accountable Care Organizations (doctor and hospital groups) to pay patients up to $20 when they come in for primary care services. This is an incentive to get people to visit Accountable Care Organizations. While ACOs may not be the best solution for everyone, they are beneficial because you can find all your doctors and providers located in one convenient place.

All of these updates and changes mean that it’s going to be much easier for seniors and Medicare beneficiaries with chronic conditions and illnesses to access the best possible care and coverage.

We are making every effort to help people like you enroll in the right plan with the right coverage.

Looking for help picking a plan? Give us a call at 1-844-431-1832.

Is Medicare Better Than Individual Plans?

Are you turning 65 soon and preparing to switch from your individual marketplace plan to Medicare? Or are you eligible for Medicare but trying to decide if you want to keep an alternative form of coverage? Generally, there are four types of health care plans and it can be hard to figure out which one you need. Your options are employer coverage, private coverage, Medicaid, and Medicare (additionally, Tricare and VA coverage for Veterans). Some people can have more than one of those options at any given time.

Let’s talk about the differences.

Employer Coverage

You can purchase health insurance through your employer, as long as it meets the coverage limits set by the federal government.

Private Coverage

You can purchase insurance from an exchange like Healthcare.gov, directly from your state, or directly from a health insurance company. Generally, purchasing private insurance is more expensive than employer coverage, and much more expensive than Medicare and Medicaid.

Medicaid

Medicaid is a federal health program. Each state has slightly different rules and each state has its own funding. It can cover any person of any age with low income (according to the Federal Poverty Level). Most Medicaid beneficiaries will have either no or very small premiums. If you have a low monthly income AND are over 65, you may qualify for both Medicaid and Medicare!

Medicare

Medicare is a federally funded health program for adults with disabilities, end-stage renal disease, or kidney failure. It also covers any person over the age of 65. Some parts of Medicare are free, while others require premiums. Most people will not have to pay nearly as much for Medicare as they would with an individual or private health plan.

You may think that individual plans provide more coverage due to the higher premiums, but that is not always the case. All Medicare plans include preventative services. Plus, you can choose to enroll in Medicare Advantage, which is like a private plan for Medicare. With Medicare Advantage, you can roll all your benefits – medical, dental, vision, prescription drugs, and even fitness – into one convenient plan.

We specialize in Medicare and serving the underserved senior and Medicare-eligible population. Do you or a loved one need help selecting a Medicare plan that truly helps? Set up a free appointment with one of our licensed agents in your area to get bias-free assistance. Call us to set it up at 1-844-431-1832.

How Seniors Can Combat Addiction

Are you or a loved one suffering from addiction? It’s actually quite common for seniors to suffer from addiction to drugs or alcohol due to lack of mobility, isolation and loneliness, and depression. Plus, seniors are more likely to have prescriptions for addictive drugs and are more likely to receive prescriptions that they don’t really need and become overmedicated.

The Recovery Process

The recovery process for seniors to combat addiction is not much different than the process for younger adults. There are two steps to every addiction recovery process: physical and psychological. Affected seniors will have to train their bodies to not be dependent on alcohol, drugs, or whatever they’re addicted to, but that starts with psychologically training the mind to not want those items. Most affected individuals will go through a withdrawal period that can bring symptoms like nausea, shakiness, sweating, loss of appetite, and anxiety.

Treatment centers often coach not only the affected senior but also the person’s family members or friends. That way, people can learn how to take care of their loved ones. Group therapy options are also available.

Treatment Coverage

Mental health and addiction treatment is one of the ten required services under the Affordable Care Act. That means that Medicare marketplace plans are required to cover addiction treatment. As long as services come from a provider or facility who participates in Medicare and a doctor states that the services are medically necessary, addiction treatment must be covered.

The Breakdown 

Medicare Part A will pay for any hospitalization related to substance abuse and addiction treatment, but out-of-pocket costs (according to your individual plan) will apply. That means that you have to pay any copays or deductibles that you are normally responsible for. However, there is a limit. Medicare will only cover up to 190 days spent in a psychiatric hospital for an entire lifetime.

Medicare Part B will pay for substance abuse and addiction treatment at a doctor’s office or if you are a hospital outpatient. As usual, Medicare will pay 80% and you will be responsible for the other 20%. This coverage includes things like therapy, hospital follow-up visits, and hospital drugs. For other drugs, you will need a Part D or Medicare Advantage plan.

Are you or your loved one covered?

If you or someone you know has a problem with substance abuse or addiction, we can help make sure they have the best coverage possible. Our agents are licensed to sell products from multiple carriers, so we can supply the unbiased care they deserve. Call to set up a no-cost appointment at 1-844-431-1832.