Ebook Free Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), by Philip Moeller
Be the very first to download this publication Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller and also allow checked out by finish. It is very simple to review this e-book Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller considering that you do not have to bring this published Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller everywhere. Your soft file publication could be in our gizmo or computer so you could delight in checking out all over and also whenever if needed. This is why great deals varieties of people likewise read the publications Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller in soft fie by downloading the publication. So, be just one of them which take all advantages of checking out the publication Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller by on-line or on your soft file system.
Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), by Philip Moeller
Ebook Free Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), by Philip Moeller
Exactly how if there is a website that enables you to look for referred book Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller from throughout the globe author? Automatically, the site will be unbelievable finished. Numerous book collections can be located. All will be so simple without difficult point to move from site to site to obtain guide Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller desired. This is the website that will certainly offer you those requirements. By following this site you can obtain lots varieties of publication Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller collections from variations sorts of writer and also publisher preferred in this world. Guide such as Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller as well as others can be gained by clicking wonderful on web link download.
The perks to take for checking out guides Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller are concerning enhance your life high quality. The life top quality will not just concerning the amount of expertise you will certainly obtain. Even you read the fun or amusing publications, it will certainly help you to have improving life quality. Really feeling fun will certainly lead you to do something completely. In addition, guide Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller will certainly offer you the lesson to take as a good factor to do something. You might not be ineffective when reading this book Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller
Never ever mind if you don't have enough time to go to guide shop as well as look for the preferred publication to check out. Nowadays, the on the internet e-book Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller is involving offer ease of reviewing behavior. You might not should go outside to look the e-book Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller Searching as well as downloading guide entitle Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller in this short article will certainly provide you better option. Yeah, on-line publication Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller is a type of digital publication that you could enter the web link download provided.
Why should be this on-line publication Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller You might not need to go someplace to review the publications. You can read this e-book Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller whenever and also every where you desire. Even it remains in our spare time or feeling bored of the jobs in the office, this corrects for you. Get this Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller now and be the quickest person which completes reading this publication Get What's Yours For Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), By Philip Moeller
A coauthor of the New York Times bestselling guide to Social Security Get What’s Yours authors an essential companion to explain Medicare, the nation’s other major benefit for older Americans. Learn how to maximize your health coverage and save money.
Social Security provides the bulk of most retirees’ income and Medicare guarantees them affordable health insurance. But few people know what Medicare covers and what it doesn’t, what it costs, and when to sign up. Nor do they understand which parts of Medicare are provided by the government and how these work with private insurance plans—Medicare Advantage, drug insurance, and Medicare supplement insurance.
Do you understand Medicare’s parts A, B, C, D? Which Part D drug plan is right and how do you decide? Which is better, Medigap or Medicare Advantage? What do you do if Medicare denies payment for a procedure that your doctor says you need? How do you navigate the appeals process for denied claims? If you’re still working or have a retiree health plan, how do those benefits work with Medicare? Do you know about the annual enrollment period for Medicare, or about lifetime penalties for late enrollment, or any number of other key Medicare rules?
Health costs are the biggest unknown expense for older Americans, who are turning sixty-five at the rate of 10,000 a day. Understanding and navigating Medicare is the best way to save health care dollars and use them wisely. In Get What’s Yours for Medicare, retirement expert Philip Moeller explains how to understand all these important choices and make the right decisions for your health and wealth now—and for the future.
- Sales Rank: #2482 in Books
- Published on: 2016-10-04
- Released on: 2016-10-04
- Original language: English
- Number of items: 1
- Dimensions: 8.25" h x 1.00" w x 5.50" l, .0 pounds
- Binding: Hardcover
- 304 pages
Review
“The indispensable guide to Medicare that does for this essential program what Get What’s Yours does for Social Security.” (Jane Bryant Quinn, author of How to Make Your Money Last and Making the Most of Your Money Now)
“Medicare, like Social Security, has become ridiculously complicated. Which makes a new book about the health-insurance program all the more valuable. . . . [Get What's Yours for Medicare] should be required reading for everyone approaching age 65.” (Glenn Ruffenach The Wall Street Journal)
“Phil Moeller is my pick as travel guide for smarties who had no idea how many potholes we could encounter in the back roads and highways of elder care.”
(Ellen Goodman)
About the Author
Journalist Philip Moeller writes about retirement for Money and authors the Ask Phil Medicare column for PBS. He also is a Research Fellow at the Center on Aging & Work at Boston College and the founder of Insure.com, a leading site for insurance information.
Excerpt. © Reprinted by permission. All rights reserved.
Get What’s Yours for Medicare 1 NO ONE TOLD ME
Glen didn’t retire until he turned 70 in 2010. He and his wife, Margie, were covered until then by his employer’s health plan. Glen read the annual Medicare & You guide put out by the Centers for Medicare & Medicaid Services (CMS). His clear understanding from the guide was that he had been automatically enrolled in Medicare since he turned 65.
This was not true. Glen made a big Medicare mistake by not asking anyone to confirm his understanding. In fact, Glen had no Medicare coverage as of 2010. Neither did Margie. But they didn’t know this.
“No one told me” is a scary cautionary Medicare tale that could be the subtitle of this book. It is repeated in countless calls for help from people like Glen and Margie (not their real names) to Medicare consumer counselors and call-center staffers around the country. And it is voiced even by people who consider themselves otherwise smart and well informed.
As it turns out, there can be little about Medicare that is automatic or clear or, especially in the midst of a medical emergency, logical or perhaps even fair. Despite widespread contrary beliefs, people are free never to get Medicare and can simply pay their own health bills without insurance. However, if you forgo Medicare and later change your mind, there can be steep late-enrollment penalties and many months may pass before Medicare insurance takes effect.
Even for people who want health insurance, Medicare usually isn’t even required at age 65 or, indeed, at any later age, so long as a person—or their spouse—is still working and has group health insurance coverage from a current employer. Social Security is supposed to send out Medicare cards to some people when they turn 65. Maybe it did send out a card to Glen. Maybe he thought this meant he was covered. But this doesn’t always happen, especially when a person has not yet started taking their Social Security retirement benefit.
There are three really big deals about getting Medicare right:
1. Enroll at the right time. Medicare has a bewildering mix of enrollment periods. You need to use the right one.
2. Choose the right mix of Medicare coverage. There are only two main paths here. One is Original Medicare (Parts A and B), perhaps with a Medigap supplemental policy, plus a Part D prescription drug plan. The other is a Medicare Advantage plan, usually including a Part D plan.
3. Understand what these various parts of Medicare cover and how to use them.
For nearly four years, Glen and Margie had no health problems serious enough to have caused them to file a claim with Medicare and learn about their earlier mistake. But then, in 2014, Margie got sick and was diagnosed with terminal cancer. They then began trying to file claims for what eventually would be enormous medical expenses. That’s when they found out that neither of them had Medicare coverage. Glen called the nonprofit Center for Medicare Advocacy seeking help.
Glen had missed his original window to sign up for Medicare after he retired in 2010. Margie may have assumed she was automatically covered by Medicare as well. The details aren’t clear, although it became clear in hindsight that they never really understood that there is no family coverage under Medicare, as is routinely the case with employer health insurance.
Glen and Margie needed to file individually for Medicare. When they realized their error in 2014, they had missed one of the many enrollment periods available during the year, and were told they had to wait until the beginning of 2015 to file for Medicare. Under its rules, their coverage would not become effective until July 2015.
Glen and Margie had to face her cancer with no insurance whatsoever. Instead of being able to focus on Margie’s care and spending as much quality time with her as possible, Glen’s life instead included the prospect of crushing medical bills and the need to worry about how he would pay for his wife’s care. Medical expenses are, sadly, a leading cause of personal bankruptcy.
After the center said it had no immediate solution to their problem, Glen broke off contact. More than a year later, the center reached him again. “He is a defeated man,” a staffer recalled. “Things had turned out terribly. He did, indeed, lose his wife.”
And he still didn’t know if he had Medicare.
CAROL
The Medicare rules say that private Medicare Advantage insurance plans must cover at least the same things that Original Medicare (Parts A and B) covers. Many people naturally assume this means the two approaches to Medicare are the same.
Big mistake.
Carol’s husband, Ernesto, had a Medicare Advantage plan in Texas, when he was diagnosed in June 2014 with pancreatic cancer. Little more than six months later, Ernesto would be dead following complications from surgery. During this time, when Carol wanted to spend as much time as possible with her partner, she instead had to fight insurance company rules and respond to unexpected surprises about what his Medicare Advantage plan did not cover.
Her problems stemmed from the fact that Medicare Advantage plans restrict coverage to those doctors, hospitals, and other caregivers who are in the plan’s provider network. Original Medicare, by contrast, insures covered medical services from any provider who accepts Medicare. When Carol was forced to take over as the main caregiver for her husband, she didn’t know about these restrictions. Even after she learned about some limitations, new ones kept cropping up.
“The gastroenterologist who diagnosed my husband met with us, explained the diagnosis, and called MD Anderson [the University of Texas MD Anderson Cancer Center] to refer him to a specialist. He was told that neither the doctor nor the facility accepted Medicare Advantage. Medicare, yes; Medicare Advantage no,” she recalls. His insurer said it could not help her find a center with pancreatic cancer expertise, and that Carol would have to make these calls herself, which she did. “All the time I took to figure out how to track down information, and to do it, took time away from being with my husband.
“We even found that the local oncologist we chose told us that he would accept the plan and was ‘in-network,’ ” she adds, “but for the entire six months he saw my husband for chemotherapy and related studies,” the benefit statements from the insurer showed he was not. Inaccurate billing statements flew back and forth, making it impossible for Carol to keep up with expenses and payment schedules.
“In the meantime we paid bills, got refunds, and completely lost track—if there really was a track—of where we were on the maximum out-of-pocket payments,” she says. “Incidentally, this was not how I wanted to spend my time, and was not what either my husband or I needed in order for him to continue to live well and enjoy life as long as he possibly could.”
Carol, not surprisingly, thinks that no one should ever get a Medicare Advantage plan. But millions of people do and find no problems with their coverage and service. However, if a serious medical issue arose, they may be no more equipped to deal with possible shortcomings in their plan’s provider network than was she. “It can be difficult in the midst of a crisis to figure out what you can control and what you cannot,” she cautions.
“My husband and I shared a great life,” Carol now says. “He lived well up until the moment he died, and even his manner of dying was a gift to me. Mostly what I relive are warm and appreciative memories. Occasionally, of course, the bad stuff surfaces. . . .”
PHYLLIS
Let this story be your cautionary guide for the more practical roadblocks that Medicare may erect. Phyllis is pretty much always the sharpest tack in the box. While she loved being a partner in a big corporate law firm, she finally retired from the firm when she turned 75. Like many sharp tacks, however, Phyllis was no match for Medicare. And when she explained her problems to me, she repeatedly used the phrase “No one told me.”
Fortunately, Phyllis’s efforts to properly enroll in and use Medicare have not had disastrous consequences—no financial or health care catastrophes. She got covered in time, seems to have avoided late-enrollment penalties, and more or less got the coverage she wanted. But as she makes clear, these results are due primarily to her remaining healthy and needing to take a grand total of one prescription medication—an inexpensive blood pressure pill.
Phyllis’s employer did provide her notice of the impending end of her employer health coverage. But its statement did not explain the specifics of her existing coverage and the things she would need to replace with Medicare.
Phyllis never would assume what a legal client needed or how opposing lawyers might behave. But she, like too many other Medicare newcomers, did assume that Medicare was a relatively straightforward process.
“I absolutely did” make that assumption, she recalls. “My assumption was that thirty days or so before I needed Medicare, I could go and apply” and everything would be taken care of.
At the outset, she didn’t know she needed to contact Social Security and not Medicare to enroll in Medicare. She didn’t know about prescription drug coverage or that it was called Part D of Medicare. She didn’t even know that Medicare Advantage plans existed. And she didn’t know that her cell phone needed to have a full charge before calling Medicare for help, because her wait times often would be so long that her phone would run out of juice while she was still on hold!
No one told her. “I had Part A,” because she already was receiving Social Security retirement benefits. “I thought all I needed was Part A. I thought I could get Part B automatically. I didn’t know I needed to apply to Social Security for Part B.”
Phyllis’s first phone call with the Social Security Administration (SSA) began to make her see that thirty days was a laughably short time frame, even for someone as skilled as she in figuring out how things worked. Social Security, it turns out, does a lot of Medicare enrollment work and is the official Medicare traffic cop when it comes to determining if people have enrolled for various parts of Medicare on a timely basis.
Adding Part B, which covers doctors, outpatient and medical equipment expenses, along with Part A hospital insurance, would provide her with what’s called Original Medicare coverage. It also would qualify her to purchase other types of Medicare insurance, including a Part D drug plan and either a Medigap policy or a Medicare Advantage plan.
After waiting on hold for more than an hour, Phyllis was told by the SSA representative that she could apply for Part B online. She was uncomfortable with that, so the rep provided her detailed instructions about how to download and complete a Part B application form. This guidance included how she should address and mark the envelope to make sure it went to the right place. She did this weeks in advance of her employer coverage ending. After waiting and waiting for a response, she finally called the local office again, waited on hold for more than an hour a second time, and was told no one at that office had ever seen her application form.
During the first of what became three trips to a Social Security office, Phyllis tried to sign up for Medicare. The office was located in a congested area, with street parking whose meters permitted no more than two hours of parking time. So, Phyllis thought it would be prudent if she scheduled an appointment. The Social Security website provides information on how to do this, but she was told by someone in the local office that it did not do visits by appointment.
Being a walk-in, as she later learned, guaranteed long delays. And when she wanted to go refill her parking meter and avoid a possible parking ticket, she was told she would lose her place in line if she left the office. Phyllis found another Social Security office farther away, where parking was not a problem.
While she was signing up for Part B, no one told Phyllis about the need for Part D prescription drug coverage or even about the existence of Medicare Advantage plans, which are formally designated as Part C of Medicare. They have become an increasingly popular alternative to Original Medicare, and now are the choice of more than 30 percent of Medicare users. More than 40 million people have Part D drug plans. But the first that Phyllis learned about signing up for a Part D plan was shortly before being dinged with a late-enrollment penalty. Four months after signing up, she had still not seen any evidence that she actually had a Part D plan, and acknowledged that penalties might still be possible.
Phyllis wound up with Original Medicare, the hoped-for Part D plan, and a Medigap policy. This is one of two classic paths into Medicare. The other involves a Medicare Advantage plan, usually bundled with Part D drug coverage. She later admitted she chose her Medigap insurer because it was the only company that answered the phone when she called.
“All my assumptions were wrong,” she says. Although her coverage didn’t begin until August 2015, Phyllis quickly realized she might have made key mistakes, and began a new round of research to get ready for Medicare’s annual open enrollment period, which runs each year from October 15 to December 7.
Open enrollment is the annual equivalent of a Medicare do-over. It permits people to choose new plans, usually with no adverse coverage or pricing consequences. It’s a great deal, but like much else about Medicare, people often don’t understand how it works.
No one told them.
Read on, and consider yourself told.
Most helpful customer reviews
42 of 43 people found the following review helpful.
You really have no idea, and the more you know, the less you know
By David Wineberg
From those wonderful people who brought you Get What's Yours For Social Security, (see my review) comes the companion volume on Medicare. Social Security handles Medicare registration, which sadly does not simplify the process, and often complicates it as we start those programs at different ages. The bizarre healthcare system, which is the biggest cause of personal bankruptcy in the USA, is not simplified by the act of turning 65 or retiring. The games just change. Hence the screaming need for this book. New games. New hurdles. New penalties. We all need to know what we’re getting into, and precious few of us do. Philip Moeller has plumbed the depths for us, and he’s not happy about all the entanglements he found. Here are some samples:
-Medicare Part B has a 20% copay that is never satisfied. Patients with multiple appointments and procedures continually pay 20%. And 20% these days can bankrupt you by itself.
-Only 25% purchase Medigap insurance to cover the copays.
-COBRA does not delay the need to sign up for Medicare
- Health Savings Account contributions must cease six months prior to Medicare enrollment
-Although Social Security will send money anywhere in the world, Medicare is only available in the USA
-The penalty for late registration of Part D (drugs) is 1% per month you are late – added to all your monthly payments for life.
-On the other hand, if you take no drugs, you save nearly $1000 a year in the premiums and deductibles of Part D coverage.
-Unlike original Medicare, private Medicare Advantage plans usually end at the state line. They are the same sort of network HMO plans we despise, and that many can’t wait to abandon for Medicare. But they are subsidized by Medicare ($10,000 per person) and so have smaller premiums than Medicare.
-Even if they’ve dropped a drug from the formulary, plans are supposed to provide transitional fulfillment, and/or your doctor can apply for a continued supply.
-All Part D plans provide free Meds Therapy Management for those with multiple conditions and prescriptions. This can help prevent meds battling each other or causing unintended new conditions.
-If a provider tells you in advance you are not covered, you must ask them to file a claim with Medicare anyway. That puts you in the appeals process. If they don’t apply, you have nothing to appeal.
-Only 1% of appeals come from beneficiaries. 99% come from providers. There is a separate track for beneficiaries that takes them to the head of the line.
The endnotes in Get What’s Yours for Medicare are much more valuable than usual. They include deep links to the specific webpage where the form or information is available, stats that show how many people choose what plans, how much they spend and so on. They are a valuable tool themselves.
There isn’t a person in the world who has a complete understanding of Medicare. This book is critical to having an overview of the paths, the pitfalls, and the misconceptions about the program. And fortunately, it is easy and engaging reading.
David Wineberg
13 of 13 people found the following review helpful.
No Useful New Knowledge From This Book
By jkhickel
I'm looking for a book that simplifies Medicare. After reading this book, I'm still looking.
Philip Moeller is the co-author of a book called Getting What's Yours for Social Security, which was very valuable when it was published. But it became largely obsolete when a lot of the Social Security loopholes were closed, so this appears to be Moeller's attempt to move his existing audience to his new area of expertise: Medicare.
I'm about to turn 65, and eagerly pre-ordered this book before it was even published, thinking that Moeller would provide the same simple, common sense guide to Medicare that he provided for Social Security. Well, having done some basic internet research on Medicare before the book arrived, I can say that I literally did not pick up a single bit of useful new knowledge from the book. A lot of it seems to be basic Medicare tables and instructions, written in a slightly breezier and more readable style. But I'm not looking for re-packaged information that I could easily Google. I'm looking for answers to questions like:
WHEN SHOULD I IDEALLY FILE FOR WHICH DIFFERENT PARTS OF MEDICARE? An easy-to-understand flowchart or table would have been nice, but this book pretty much buries the information in paragraphs of text, just like the instructions you get on the internet.
SHOULD I GET A MEDICARE SUPPLEMENT PLAN? The book says that "most consumers realize" that the answer is yes, and seems to take that answer for granted, but doesn't really provide an objective analysis that explains why. I'd like to see the math: Does a typical retiree really need a supplement plan? Or are we being led down a sparkling golden path by insurance providers that get a "bonus" from the government for signing us up?
IN TERMS OF MEDICARE SUPPLEMENT PLAN OPTIONS, SHOULD I CHOOSE A MEDIGAP PLAN OR A MEDICARE ADVANTAGE PLAN? Few answers here. Medigap and Medicare Advantage each get their own chapters, with little comparative information.
Not that there isn't some interesting information in this book. The author goes on compare-and-contrast digressions between Social Security and Medicare, but I'm not on Social Security so this doesn't mean much to me. He also rants several times about the fact that the government has forbidden itself from negotiating Medicare drug prices with the manufacturers. That's outrageous, but how does that help me Get What's Mine for Medicare? He throws in a few little interesting tidbits like "Medicare does not cover ambulance service if the patient dies before the ambulance arrives." Yes, that is intriguing. So, in order to Get What's Mine for Medicare, am I supposed to try not to die until the ambulance gets here?
BOTTOM LINE: The well-written, understandable and interesting stuff in this book isn't particularly useful, and the potentially useful stuff isn't particularly well-written, understandable and interesting.
63 of 70 people found the following review helpful.
Watch out... the hospice option is not a good plan but it is presented here as if it were
By J. Al-hashimi
Here's the objection and it's in regard to end of life. When people switch over to the Medicare hospice plan is not at all obvious what people are getting. This is barely covered in the book, probably because the author doesn't understand how it really plays out and is simply copying the managed care hype. The fact is that there are numerous for-profit businesses taking people'e entire Medicare option into their profit stream and while on the hospice plan, people have no way to simply walk into an ER because the hospice is then responsible for all the bills. So the person dying at home is given a button, a 24 hour dispatch will answer and then they will call a family member or the social worker in charge of the case. This is in lieu of calling 911 or walking into an ER. A social worker is assigned t each case and will advise comfort measures like adjusting pillows or checking the last time the pain med was given.
While managed care is a worthy approach to health care in general, in the reality of needing care this is a farce that no educated and intelligent person would opt for. If you are indigent and also have Medicaid, you will get more free nursing than the 1-3 hours per week the hospice plan provides of unprofessional level nurses aides . Lay people tend not to recognize the education difference between professional nurses and nurses aides but nurses aides last job may well have been making Big Gulps at the mini-mart gas station or hosing down cars at the car wash and if they have any health care education it is a course that lasts only weeks.
But if you have any assets, you will need to go thru them in order to qualify and there is a 5 year review of assets by Medicaid so if anything has been transferred, say to your children, watch out, because that is fraud even if it is in a joint account. So, with the sick person at home unless the family can provide the required care, and it may end up to be quite intense and 24/7, the family will have to hire nurses aides at the minimum out of pocket.
I worked in hospice in 1979 and that was 4 years after the first hospice in the US (1975). I was a head nurse in a hospice unit. Hospice was not just a "die at home concept" but was a comprehensive program of in-house care by professional nurses and drugs as needed although dying at home remained an option. However especially nowadays a lot of people have insufficient people in the family who will function as performing, almost entirely, the bulk of nursing care and will turn their house into a hospital with a sick and dying person at the center of it. Most people have no idea of end of life illness which often includes dementia, incontinence, vomitting of blood, bile, and feces, multiple meds, pain, etc., along with no end of dressing changes, bed changes, food preparation, bathing the patient, oral care, turning the patient, emotional outbursts, hostile outbursts, mental confusion etc., along with not sleeping at night, needing assistance to the bathroom or with catheters and bed pans.
While the Medicare covered patient can opt out of the hospice plan at any point, the romaticization of "dying at home" starts at the onset when the hospice asks the dying person to sign a form that says he/she wants to die naturally. Versus what? Unnaturally? This is the beginning of distancing nurses aides and people at the desk who are not that interested in what happens next.
Once the doctor (who is incentivized to recommend Medicare hospice to the patient) sets the patient up with a home assessment visit, the patient and family gets a 2 hour visit by the hospice he recommends at the home. What they don't realize is that this is a sales pitch, not a health assessment. Also, promises are made that often turn out to be untrue. For instance, they may say that the 24 hour alert button for the patient is free but later you find out that there is a fee. They often make promises that nursing care will be provided as needed but, according to many stories of people who were sorry they went this route, that is not what happens.
When, 6-8 years or so ago, the media picked up on the fear of "death panels" they were referring to this kind of thing which starts with the doctor getting an $86 fee for recommending Medicare hospice and a second fee of $75 for discussing it a second time. This is incentivization. These hospice recommendation codes with a fee schedule for doctors were passed in Jan 1, 2016, without fanfare tho either because people got used to the idea or because it was buried in generalized managed care rhetoric.
And here's more news. Your doctor may not even be close to accurate when he tells you you have 6 months or less to live. While hospice has had the criteria of a 6 month or less prognosis, in face on Medicare hospice there is no limit. They have a 90 day period, another 90 day period and then an infinite amount of 60 day periods. So the doctor giving the dire dx of "you have less than 6 months to live" may not be even close to accurate, especially if you pursue modern medicine options. Granted, if you stop all action to hold disease at bay you will likely die quicker and perhaps your quality of life will be so miserable without modern medications that you wish to die. But the average person has no idea of all of these differences and will assume that the doctor and systems are acting in their best interest. In fact, the doctor is will be compensated for telling you this. The code goes on the chart, the box gets checked on the Medicare billing form, and the money transferred to the doctor's account.
The fraud is immense in this field because now it is a concept, a romanticized and an idea representing what looks like social fiscal responsibility more than anything else. There are Medicare hospice orgs that have no in-facility beds at all. Importantly, Medicare hospice does NOT provide accommodation and does NOT provide professional nursing and the couple hours a week of a nurses aide that may come to the house is not worth talking about when people face end of life illness. Meanwhile, EVERY DAY THAT PATIENT IS ENROLLED IN THE MEDICARE HOSPICE PLAN, THE HOSPICE BILLS MEDICARE $160-$1000. Again, the code goes on the form and the money is transferred to the hospice org regardless if they did nothing that day. Because they take all the Medicare money for that person and are expected to pay out all expenses so they are incentivized to avoid the ER or anything that represents a withdrawal from their revenue stream or to be frank with the patient and his family regarding their option to leave this plan entirely. There are hospices that don't even have a facility for care at all because it is a concept not a facility. And even for those who do, the average stay in a hospice for those who have a facility is 3-5 days. And the patient's family is told that the patient is expected to die at home and not to bring them into the facility in the final days.
This is very very different that 20 years ago when people could spend months in and out of a professionally staffed care facility or even a few years ago when people brought them in for the final days or weeks. The continual shift to doing nothing is appalling but the average person in this situation is unaware of the lack of care, lack of medications, lack of modern medicine he/she is signing up for. Why would anyone refuse modern medicine and essentially go back to a primitive time before all of these things were created and refined and why would anyone not get specialist care when they need it? Why would anyone allow a person who is in it for the profit to decide what they get off of their own Medicare plan? I worked in pharm drug approval research for years and it is incredibly difficult work to get any drug through all the scientific processes and continue to monitor outcomes. The idea that drugs are overdone or that science is bad is like the concept of the noble primitive, the romantic notion that things were better or people are better without science, accrued knowledge, or civilization. This is utter nonsense.
This post may trigger "my hospice social worker was great" or that "government needs to save money via managed care and this is one way to do it" responses, but that's not the point here. The point is that this book says none of this and the author purports to be giving us an advantage in making decisions but he is citing pro cost cutting measures in general and in a general way sings the praises of this Medicare hospice option which amounts to a "die in a box" type of do-it-yourself home care program, with lack of professsional assessment and intervention, lack of caregiver physical assistance or modern medicatoins,, equipment and therapies. If you doubt any of this do your own research and also look up the horror stories of families who chose this Medicare hospice option this in their home and later describe an awful experience, broken promises, lack of help, and lack of medicine and infusions that may have prolonged life or better alleviated symptoms or led to a more comfortable death.
The recently enacted experimental managed care Medicare hospice program which is being implemented in 140 hospices in the US which allows some treatment drugs for only four conditions, instead of eschewing absolutely all treatment drugs. I would find this aborted list of meds allowed ridiculously inadequate even if I had one of these four diseases and were in one of the 140 hospices.
I have worked as a professional nurse in a number of areas including ICU and hospice. I understand managed care and have a MBA in addition to being a RN and did cancer clinical trial research at UCLA and have run a clinical research organization with 27 studies of drugs in development for HIV. I've witnessed a lot of people die and been involved in their care in the months leading up to it. It's usually not like you see in the movies. Be aware that the Medicare hospice plan is almost entirely a concept, a romanticized "die at home" no treatment medication concept which purports to save the government money when in fact it is providing huge profits to for-profit and not-for-profit.organizations.
Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), by Philip Moeller PDF
Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), by Philip Moeller EPub
Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), by Philip Moeller Doc
Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), by Philip Moeller iBooks
Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), by Philip Moeller rtf
Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), by Philip Moeller Mobipocket
Get What's Yours for Medicare: Maximize Your Coverage, Minimize Your Costs (The Get What's Yours Series), by Philip Moeller Kindle
Tidak ada komentar:
Posting Komentar