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Choosing a Medicare Managed Care Plan

The PA Health Care Cost Containment Council and the PA Department of Aging are offering a guide to provide consumers with information about Medicare managed care options.  The booklet, "Choosing a Medicare Managed Care Plan" is availabe in regional versions (Central, Western and Southeastern) and contains comparisons of the out-of-pocket expenses that beneficiaries will incur, and benefits offered by each of the different managed care plans.

New for this year's guide is information to help people learn more about the prescription drug card options.  The report also includes measures that will help consumers compare the quality of plans such as members' satisfaction with each plan and several disease management options. 

These booklets would be excellent resources to agencies' consumers.  If your agency is interested in receiving copies, PHA has secured several copies or you can contact the PA Health Care Cost Containment Council directly at 717-232-6787.

Medicare Home Healthcare Coverage

In order for Medicare to reimburse for home health, a physician must certify that there is a medical need for the care and that the patient is homebound and needs a skilled service such as nursing or therapy, including physical, occupational or speech.

This certification is done for a 60-day episode of care. There are no limits to the number of episodes a beneficiary can receive as long as he/she meets eligibility criteria.

Hospice Coverage Paid for Under Medicare

In order for Medicare to reimburse for hospice care the physician must:

Verify that the patient's life expectancy is less than six months. A written statement from the physician certifying that the individual is terminally ill with a life expectancy of six months or less if the terminal illness runs its normal course is required for every hospice certification and subsequent periods.

Sign and date the statement. The certification statement must be signed by both the hospice medical director and attending physician before services are billed. This statement must be included in each certification period.

If written certification is not obtained within two days after hospice care begins, a verbal certification must be obtained.

Once a beneficiary elects the hospice benefit, all care is assumed by the hospice agency including drug costs, supplies, hospitalizations and physician billing.