Q: I recently applied for my Medicare benefits and soon after received a form to complete asking for information about employer’s health plans that I might be entitled to. Why would Medicare need such information?
A: Medicare needs to know about other health care coverage in order to establish your benefits file and to determine whether Medicare will be your primary coverage.
Usually when a person becomes eligible, Medicare serves as the primary health care payer. However, some people are entitled to other health care insurance, which preempts Medicare as the primary health care provider and shifts Medicare’s role to that of secondary payer.
Q: Over the holidays I will be spending some time with my dad, who lives in another state. For some time I have been concerned about him continuing to live alone. What signs might indicate that it may be time to seek assistance for him?
A: A number of activities could send up a red flag warning that all is not well in your dad’s household.
Since you didn’t mention what type of activities give you concern I will mention the more common activities or situations that might be a sign some type of assistance may be needed either now or in the near future.
First let’s look at the appearance of the home. An unkempt or cluttered house can signal changes in housekeeping that may come about because of a senior being depressed or physically tired and unable to keep up with the task.
Q: In the past I’ve heard about Medicare fraud and how important it is for everyone to fight it. I’m sure fraud occurs in all areas of care but am concerned with services provided by in-home agencies. What red flags would you suggest we look for?
A: You are correct. Fraud occurs in all areas of our health care system. Although most home health care agencies are honest, a few commit fraud.
To know if billing for services is correct you need to be aware of two things. First you need to understand exactly what services your doctor has prescribed for your care. You will also need to educate yourself as to what Medicare does and does not cover
If there is something in your care plan that you don’t understand, ask questions. Continue to ask until you are satisfied that you understand what services you are to receive and what to expect from those services.
Q: I am beginning to get more forgetful and wonder whether it is just old age or something more serious. Do you know where I might get some answers?
A: November is National Alzheimer’s Disease Awareness Month, and one of the events is National Memory Screening Day. This will be offered at more than 2,000 sites, including Senior Concerns’ day care center, 401 Hodencamp Road in Thousand Oaks, from 9 a.m. to 1 p.m. Nov. 15.
Memory screenings will be offered by reservation 9 to 10 a.m. and 11:45 a.m. to 12:45 p.m. The screenings will be administered in English and Spanish and will consist of a series of questions and tasks that will take five to 10 minutes. Reservations can be made by calling 497-0189.
Q: I am going to need in-home health care and wonder how to go about selecting an appropriate agency. Is there anything in particular I should focus on, and does Medicare have any special requirements in order for the care to be covered?
A: Medicare Part B 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, or certain health care professionals who work with a doctor, must see you face to face before a doctor can certify that you need home health services. A doctor must order your care and it must be provided by a Medicare-certified home health agency.