Experts Weigh in on How Medicare Could Improve Elder Care Benefits
We are all aware Medicare isn’t perfect, it never claimed to be. That is why many Medicare beneficiaries purchase a Medicare Supplement to go with their Original Medicare. Still, there are some changes, tweaks, or improvements that need to be made.
As the insured, I am sure you have had some ideas of your own. Well, we asked some experts what they think. Medicare could improve to give seniors and disabled people more comprehensive benefits and this is what we heard.
Medicare Eldercare: What Our Experts Had to Say
Coverage Flexibility for Home Health Services
“Medicare should be more flexible in providing coverage for home health services by waiving the “homebound” requirement and permitting coverage of services in the home where the cost of care is not greater than what Medicare would spend on institutional care. These changes would follow Medicaid standards that provide for coverage of cost effective home care.” – William A. Dombi – President of the National Association for Home Care & Hospice
Cost Effective Home Care
With Home Health Services not being greater than what Medicare would spend on institutional care; these changes would benefit Medicare recipients in need of cost-effective Home Care. Medicare shouldn’t follow all of Medicaid standards for coverage. They’re two different programs with different qualifications. However, Home Health Care should be more flexible and comprehensive.
Existence of the Donut Hole
“One of the major challenges of Medicare is the existence of the donut hole. This refers to a gap in prescription drug coverage that starts to take effect after a person reaches Medicare Part D coverage limit ($3,700 in 2017).”
Once in the donut hole, a person must pay $4950 (in 2017) in drug coverage out of pocket before benefits resume. This policy often keeps doctors from prescribing the best option for a patient to keep the patient’s costs low.” – Rebecca Gilbert, MD, PhD, APDA Vice President, Chief Scientific Officer.
The Coverage Gap is completely unnecessary. Insurance Agents will spend hours on the phone or in person. Explaining it to a beneficiary, just for them to pretend they understand it.
It must be so overwhelming for Medicare beneficiaries who reach this donut hole. As well as difficult for doctors who want to keep costs down for patients. But also want to prescribe the best option.
With the Bipartisan Budget Act of 2018, we are seeing the donut hole close some. It will be a victorious day for insurance agents and beneficiaries when the coverage gap no longer exists.
Reimbursement for Personal Care Services
“Reimbursement for personal care services, especially within the first two weeks of discharge from an acute care setting is a cost-effective way to decrease re-hospitalizations. Studies show that a patient is at risk for being re-hospitalized during the first seven to ten days after returning home, following a hospital or rehab stay. ”
“Having a personal care aide in the home during these first two weeks would dramatically reduce the risk of falls, CHF exacerbations, infection to a surgical site and would assist with proper medication management. Further improvements can be made by making resources more readily available, especially when DME, and orthotic devices are needed.”
“Approval and reimbursement for wheelchairs, walkers, oxygen, or other equipment often takes an excessive amount of time, which impacts the patient’s overall quality of care.” Sarah Deal – Director of Senior Services for Interim HealthCare of the Upstate
Designated Case Manager
20% of seniors who are discharged from a hospital are readmitted within 30 days. The first seven to ten days is the highest risk, seniors should have a personal care aid after hospitalization. Many families would be happy to know their elderly mom or dad are being taken care of and monitored.
All seniors should have a case manager that helps them with resources and getting what they need. These steps would positively impact the life and care of our elderly citizens.
Improvements for Dental, Vision & Hearing
“Medicare, by itself, is very good coverage, often much better than what most people are accustomed to as they age into Medicare. However, there is certainly room for improvement. Some of the aspects of medical care that are not covered, such as dental, vision and hearing for example, have often been discussed as possibly being added in to basic Medicare’s coverage.”
“That would certainly be an improvement to the coverage offered by “Original” Medicare. Other changes that would potentially improve benefits offered by Medicare are reductions in the amount of the Medicare deductibles and out of pocket costs. It’s difficult to see that change happening any time soon, however, and therefore most people on Medicare purchase some sort of coverage in addition to Medicare.” Garrett Ball – Medicare Specialist at Senior.com
We all remember the first time we learned about “Medicare.” Amazed at how affordable and comprehensive the plans were compared to my employer coverage.
If you are retired, have a fixed income or low income then Medicare could get expensive.
While we agree, there should be more benefits offered by Medicare, we also worry that by adding those benefits the costs of Medicare could rise.
What we see with any insurance policy is that if you lower the deductible, you increase the premium. If you add dental, your premium increases.
Hopefully, we can reach a point of comprehensive coverage, at an affordable rate for everyone. Especially seniors, disabled people, and low-income families.
Medicare Can Improve
We all know Medicare could make some improvements. Quality Home Health Care with flexible qualifications, removing the Coverage Gap, and Personal Aide Care after being hospitalized would certainly make a difference. These changes could be the driving force that fuels overall better coverage for beneficiaries across the nation.
While it is difficult to see Medicare reducing its deductibles and out of pocket costs, I hope to one day see that change. It is important that policymakers focus on fundamental reforms positive for both beneficiaries and taxpayers.
Cutting deductibles and adding dental, just to increase a premium or add a tax is counterproductive. Medicare needs to be thinking of prevention, having Personal Aide Care after hospitalization could reduce hospitalization future costs.