We recently received a question about Medigap and Medicare coverage.
Question: I have chronic inflammatory demyelinating polyneuropathy. I have to get IVIGs of gamunex-C. I have a nurse who comes in and gives me the IVIG which takes 6 hours. I am not house ridden, so is this covered by home health care? It is very expensive and I am very lucky my supplemental health care in New York covers this after I meet the deductible. I will be moving to North Carolina at the end of December and need to find out what Medicare covers and if there is a supplement that will help with the payment.
Answer: In order for Medicare to pay, you would have to be homebound. Patients are considered homebound if they meet these two criteria:
- Patients either need supportive devices such as crutches, canes, wheelchairs, and walkers; special transportation; or help from someone else in order to leave their home because of illness or injury, OR have a condition that makes leaving the home medically inadvisable.
- “There must exist a normal inability to leave home; and leaving home must require a considerable and taxing effort.”
You can check into Medigap, supplemental insurance through Medicare. Medigap is sold by private companies and can help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Also look into Medicare’s prescription drug benefit (Part D).
For more information check out these sites:
Premiums for Medicare Part B, which covers medically necessary and preventive services, will continue at $104.90 a month for 2014.
Premiums for Medicare Part B will stay at $104.90 a month for 2014, the same as in 2013, according to the Center for Medicare Services. Premiums have either decreased or stayed the same for the past three years. The deductible will also remain at $147.
Medicare Part B covers medically necessary services, as well as preventive services.
“We continue to work hard to keep Medicare beneficiaries’ costs low by rewarding providers for producing better value for their patients and fighting fraud and abuse,” said CMS Administrator Marilyn Tavenner in a statement. “As a result, the Medicare Part B premium will not increase for 2014, which is good news for Medicare beneficiaries and for American taxpayers.”
The Medicare Part A premium will drop $15 in 2014 to $426. Part A pays for inpatient hospital care, skilled nursing facilities and some home health care services, but 99% of Medicare users do not pay premiums for Part A.
The Quarterly Medicare Provider Compliance Newsletter [Volume 4, Issue 1] Educational Tool (ICN 908950) was released and is now available in downloadable format.
Avoid common billing errors and other mistakes when dealing with the Medicare program.
This educational tool is designed to provide education on how to avoid common billing errors and other erroneous activities when dealing with the Medicare Program. It includes information on corrective actions that health care professionals can use to address and avoid the top issues of the particular quarter.