QUESTION: At the start of each year I get confused about the Medicare Part B deductible. I have several doctors and never know which one I should pay. Can you provide a simple explanation?
ANSWER: The key to understanding the puzzle can be found in your Medicare Summary Notice (MSN).
The Medicare Part B deductible is applied on a basis of first claim received, first claim applied to the deductible. This means that when the new year starts Medicare will apply your first claim or claims received to your deductible until the full deductible has been satisfied.
Keep in mind that the first claim Medicare receives may or may not necessarily be from the first doctor you saw in the New Year.
Your summary notice will show which provider’s services Medicare applied to the deductible, the amount of the deductible owed to that provider and how much of the deductible has been met for the year. You will receive a bill from the provider for the amount owed.
Once the deductible has been fully satisfied the subsequent summaries will indicate your deductible has been met for the year and Medicare will start to pay its portion of new claims as they come in.
Your provider may request the deductible amount at the time of your visit but because the status of your deductible may not be known at the time of your appointment, I suggest you wait until you receive your summary notice before paying anything. Better still wait for a bill from your doctor before you pay the amount – and the amount billed should be the same as the amount shown on the summary notice.
QUESTION: A neighbor recently returned home from the hospital and needed in-home assistance. I was told she had to pay for those services. Doesn’t Medicare pay for in-home care?
ANSWER: In-home care is a complex subject and you are not alone in your thinking. Medicare pays only for “medically necessary” services and does not pay for “custodial” care.
Custodial care essentially covers assistance with meeting activities of daily living. It includes help with walking, getting into and out of bed, bathing, dressing, eating and going to the toilet.
It could include preparation of special diets and supervision of taking self-administrated medication. It does not require the services of trained medical or paramedical personnel.
In contrast home health care is skilled nursing care and certain other services received in the home for treatment of an illness or injury. Medicare covers this care in the home if the patient meets eligibility requirements.
To qualify for home health care the patient must have a doctor order and present a plan for such care. The plan must show that either intermittent – not full-time – skilled nursing care or physical, speech or occupational therapy is required.
The patient must be homebound. This means the patient normally cannot leave home and that leaving home is a major effort. A patient who leaves home must do so rarely and only for a short period of time.
Last – the home health agency caring for the patient must be approved by the Medicare program and bill Medicare directly for their services.
Home health care can be covered under either Medicare Part A or Part B. There are no deductibles or coinsurance associated with home health care except for durable medical equipment in which case Medicare will pay 80 percent and the patient or other insurance will pay the remaining 20 percent.
TUESDAY – January 19 – 5:30 to 7:00 pm – Presentation – “Urber Assist – Uber WAV” (wheelchair accessible vans) – expanding transportation options in the area – at Senior Concerns Day Care Center, 401 Hodencamp Road in Thousand Oaks. For reservations call (805) 497-0189.
WEDNESDAY – January 20 – 9:00 am to 1:00 pm – 2nd Annual Wellness Fest – at Goebel Adult Community Center, 1385 E. Janss Road in Thousand Oaks. A day to meet Senior Service Providers – check out all your wellness needs under one roof.