recently diagnosed with Chronic Obstructive Pulmonary Disease (COPD). Are there
any plans that can help with my specific needs?—Wind
are Medicare Advantage (MA) plans called Special Needs Plans (SNPs). A SNP is a
Medicare Advantage plan (private health plan) that exclusively serves at least one of the
live in a nursing home or Intermediate Care Facility for the Mentally Retarded
(either specific nursing homes or those in a certain area) and people who live
in the community but require an institutional level of care;
have both Medicare and Medicaid (dual eligibles);
have a specific chronic, severe or disabling condition defined by the plan
(such as diabetes or heart disease).
Medicare-covered health care and services that are designed to meet the special
needs of people in the groups they serve. In your case you would choose a SNP
that is designed for individuals with COPD. Be sure to call the plan and ask
about the additional services they will provide to help you manage your
condition. You should also compare the costs of the SNP plan to your Original
Medicare costs to see what works best for you.
include drug coverage (Medicare Part D) as part of their benefits packages. —Marci
Medicare pay to replace my walker? —Trudy
Medicare will replace your walker or any other piece of Durable Medicare
Equipment (DME) if the item has
been in your possession its whole lifetime and your doctor certifies that you
still need it. The definition of lifetime varies depending on the type of
equipment but is never fewer than five years from the date that you began using the equipment. In addition,
the item must be so worn down from being used on a day-to-day basis that it can
no longer be fixed.
you lose equipment
that you rent or own, if it is stolen, or if it suffers irreparable
damaged in an accident or a natural disaster, Medicare should cover a new
piece of equipment with proof of the damage or theft.
refers to the replacement of one item with an identical or nearly identical
item (for example, one manual wheelchair for another, not to switch from a
manual wheelchair to an electric wheelchair or a motorized scooter). —Marci
I have been
an inpatient in a hospital for a week and am being transferred to a skilled
nursing facility for admission. Will Medicare cover the cost of my ambulance
will pay for ambulance transport only if you are confined to your bed or your
health requires transport by an ambulance. Your trip from the hospital to the
skilled nursing facility (SNF) is considered a non-emergency ambulance service
because your health is not in immediate danger. Medicare Part B covers emergency
and non-emergent ambulance services differently. An emergency is when your health is in
serious danger and every second counts to prevent your health from getting
worse. Medicare will generally cover emergency transport because during most
emergencies, ambulance is the only safe way to transport you.
cover non-emergency ambulance services if
confined to your bed (unable to get up from bed without help, unable to walk,
and unable to sit in a chair or wheelchair); or
vital medical services during your trip that are available only in an
ambulance, such as administration of medications or monitoring of vital functions.
important to remember that if you are receiving SNF care under Part A, any
ambulance transport should be paid for by the SNF. The SNF should not bill
Medicare for this service.
residents who have exhausted their Part A benefits, Medicare may cover regular,
scheduled ambulance trips. For Medicare to cover these trips your doctor must send
the ambulance supplier a written order ahead of time to show that your health
requires ambulance transport. For unscheduled or irregular non-emergency
trips, a doctor’s order may be required within 48 hours after the transport if
you live in a SNF.
You should also note that
lack of access to alternative transportation alone will not justify Medicare coverage. Medicare will never pay for
ambulette services. An ambulette is a wheelchair-accessible van that provides
non-emergency transportation for people with disabilities.
Medicare will pay for 80 percent of its approved amount for the ambulance
service. You or your supplemental insurance policy will be responsible for the
remaining 20 percent. All ambulance providers must accept Medicare assignment,
meaning they must accept the Medicare-approved amount as payment in full. —Marci
Marci’s Medicare Answers is a
service of the Medicare Rights Center
(www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare.
To speak with a counselor, call (800) 333-4114. To subscribe to “Dear Marci,”
the Medicare Rights Center’s free
educational e-newsletter, simply e-mail firstname.lastname@example.org. To learn more about the services
that Medicare will cover and how to change plans, log on to Medicare
Interactive Counselor at the Medicare Rights Center’s website at www.medicareinteractive.org.