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Trying to help woman with medicare part A get more coverage, part b and d

 
 
HavaH
 
Reply Thu 13 Nov, 2014 10:26 am
I'm trying to help a woman who I live in the same building with and give rides to church - she is in her fifties and on disability. She has numerous health issues, and is unable to afford the medications she needs, and doesn't have a regular doctor. Its been difficult for me to understand the ins and outs of medicare in this situation. If anyone can help, here's a few details

In 2006 she started medicare part A. I want to get her on part B and D, or whatever is takes to get help on her medications and doctors visits. I created an account on mymedicare.gov and entered in the medications she has been ordering from canadian online pharmacies since it has been years since she has been able to get proper medical treatment, prescriptions, and the like.

I really don't know where to start, but I think surely she is eligible for more coverage. She went on disability some years back. She is diagnosed with countless medical conditions - some that she was born with, others that manifested in later years - and simply eating, getting around, everyday things are extremely difficult for her. Its hard to access her medical history because her financial and mental health status have kept her from getting consistent help. I don't want to try to enroll for a plan she can't afford, but she needs something more than what she has. Has anyone been in a similar situation with a loved one/family member, in which records were hard to come by and you had to basically to start from scratch? How did you enroll and get coverage for prescriptions and dr visits and get the best price, especially considering all the changes in healthcare policies over the past few years? Thank you
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Type: Question • Score: 2 • Views: 1,159 • Replies: 4
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Butrflynet
 
  1  
Reply Thu 13 Nov, 2014 10:59 am
@HavaH,
A social services counselor should be able to help her. Have you contacted any at a local hospital, the AARP, or local senior centers?
0 Replies
 
Woodworker766
 
  2  
Reply Thu 13 Nov, 2014 11:50 am
@HavaH,
You contact the appropriate State agencies and let them handle the issue. You've already, by your own admission, violated Federal law by creating an on-line account for her and now you are looking to mess with her benefits? Are you willing to be held responsible for any further financial mess you might get her into?

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roger
 
  1  
Reply Thu 13 Nov, 2014 03:16 pm
@HavaH,
Shouldn't be difficult to acquire parts B & D, but I understand it could be expensive if she doesn't have credible coverage from some other source. Something like a 10% premium increase for every year coverage was declined.

As a veteran, I have credible coverage at least for Part D.
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Butrflynet
 
  1  
Reply Thu 13 Nov, 2014 04:50 pm
@HavaH,
This Medicare Primer from Kaiser Foundation will help you learn the terminology so you can help your friend get the coverage she needs. Once you are familiar with these terms, you'll be better equipped to speak with various local social agencies to have them help her.

http://kff.org/medicare/issue-brief/medicare-a-primer/



It is in pdf format. Here is the table of contents so you'll get an idea of what all is covered:

Quote:
What is Medicare? .............................................................................................................................. 1

Medicare is a federal entitlement program that provides health insurance coverage to 47 million people,
including people age 65 and older, and younger people with permanent disabilities, end-stage renal
disease, and Lou Gehrig’s disease.

Who is eligible for Medicare?..............................................................................................................2

Individuals become eligible for Medicare when they reach age 65, if they or their spouse made payroll tax
contributions for 10 or more years. People under age 65 qualify for Medicare after 24 months of receiving
Social Security Disability payments, or if they have end-stage renal disease or Lou Gehrig’s disease.

What are the characteristics of people with Medicare? ..................................................................... 3

Medicare covers a diverse population. Most people with Medicare live on modest incomes and many
have multiple chronic conditions.

What does Medicare cover and how much do beneficiaries pay for benefits?...................................5

Medicare covers basic health services, including hospital stays, physician visits, and prescription drugs.
Many benefits are subject to deductibles and cost-sharing requirements. Medicare does not cover most
long-term care services, vision or dental care, or hearing aids.

What is the Medicare prescription drug benefit? ............................................................................... 7

Medicare helps cover the cost of prescription drugs offered through private drug plans. More than half of
all beneficiaries are enrolled in a Part D drug plan, with 90 percent having some source of drug coverage.

What is Medicare Advantage? ............................................................................................................ 9

Medicare Advantage plans are private health plans that receive payments from Medicare to provide
Medicare-covered benefits to enrollees. Nearly one-fourth of all beneficiaries are enrolled in a Medicare
Advantage plan.

What types of supplemental insurance do beneficiaries have? ....................................................... 11

Most beneficiaries have some type of supplemental insurance to help pay Medicare’s cost-sharing
requirements and fill gaps in Medicare’s benefit package. Primary sources of supplemental coverage
include employer-sponsored plans, Medicaid (for those with limited incomes and assets), Medigap policies,
and Medicare Advantage plans.

How do Medicare beneficiaries fare with respect to access to care?............................................... 13

The enactment of Medicare dramatically improved access to care for millions of elderly Americans.
Beneficiaries generally enjoy broad access to physicians, hospitals, and other providers, and report
relatively low rates of problems across a number of access measures.

How is Medicare financed? ............................................................................................................... 14

Funding for Medicare comes primarily from general revenues (40 percent) and payroll taxes (38 percent),
followed by premiums paid by beneficiaries (12 percent).

How much does Medicare cost and how is the money spent? ......................................................... 15

Medicare is estimated to account for 12 percent of federal spending in 2010. Inpatient hospital services
comprise the largest share of Medicare benefit payments (27 percent), followed by payments to Medicare
Advantage plans (24 percent) and physicians and other suppliers (18 percent). The drug benefit
accounts for 11 percent of total payments.

How is the health care reform law expected to affect future Medicare spending? ......................... 17

The 2010 health care reform law includes a number of provisions that are expected to reduce the
growth in Medicare spending over the next decade and beyond, thereby maintaining the solvency of the
Medicare Part A (Hospital Insurance) Trust Fund through 2029.

What are Medicare’s future financing challenges?...........................................................................19

With rising health care costs, an aging population, and a declining ratio of workers to retirees, financing
care for future beneficiaries remains a challenge.
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