Medicare Roundup: Courts widen coverage of skilled care; experts give enrollment advice

Nov 3 2010

The New York Times: "Two federal courts have ruled that the Obama administration is using overly strict standards to determine whether older Americans are entitled to Medicare coverage of skilled nursing home care and home health care." District courts in Vermont and Pittsburgh said that "Medicare will pay for those services if they are needed to maintain a person's ability to perform routine activities of daily living or to prevent deterioration of the person's condition. ... Skilled care may be reasonable and necessary and covered by Medicare even if the person's condition is stable and unlikely to improve." Medicare officials had previously determined that people with chronic conditions were not eligible for skilled care unless they were expected to get better over time. The ruling may be relevant to those with chronic conditions or disabilities such as Alzheimer's, multiple sclerosis or broken hips (Pear, 11/1).

Kaiser Health News: Meanwhile, "[t]his month marks the beginning of the annual enrollment time when (Medicare Part D) beneficiaries can try to pick the plan that provides the best coverage for their prescription drugs." Some seniors may be reluctant to change plans, but may want to take time during the Nov. 15 to Dec. 31 enrollment period to reevaluate their options, given that "there are some changes in the Part D program that may affect your out-of-pocket costs and coverage for 2011," in part due to the health-care overhaul law.

"Part D premiums are going up an average of 10 percent, to $40.72 monthly. But plans may depart significantly from that average, depending on such factors as deductibles, coinsurance and whether they cover prescription drugs while a beneficiary is in the so-called doughnut hole. There will be some new plan options as well. … If your plan is being eliminated in 2011, you'll be automatically assigned to another plan in your area. Don't assume that this replacement is the most cost-effective choice for you" (Andrews, 11/2).

The Washington Post: "Medicare eligibility begins at 65, and it's wise to get onboard immediately, even if you're still working." Waiting too long will delay coverage. It's "free to anyone who has paid Medicare taxes for more than a decade or is married to someone who has." After you stop working, sign up for Part B as soon as possible; those who sign up late will incur a permanent premium penalty. Part B isn't free, but it "covers most other medical expenses except prescription drugs." Other pertinent advice: "Don't confuse original Medicare and Medicare Advantage;" "find out how your retiree plan works with Medicare;" check the Medigap coverage rules in your state, and "recheck your Plan D formulary every year" (11/1).