Peace Haven

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Peace Haven
Medicare Workshop
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Medicare has offered a Christian Science benefit
since 1966

• President Lyndon Johnson signed Medicare
  amendment to Social Security Act on July 30, 1965.

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MEDICARE PART A

• Part A Hospital Insurance covers stay in a
  Religious Nonmedical Health Care Institution or
  Hospital.
• Christian Science Nursing Facilities are called
  RNHCIs.

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MEDICARE PART A

• Most people receive premium-free Part A coverage.
  Part A is available for no cost at the age of 65
  if
• You are eligible for benefits from Social
  Security or the Railroad Retirement Board
• If you or your spouse worked at least 40
  quarters, or
• You or your spouse had Medicare-covered
  government employment
• Those few who will want to purchase Part A, will
  pay up to 426 each month.

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MEDICARE PART A

• If you're under the age of 65, you may be
  eligible for Part A if you are disabled or have
  other specific healthcare needs.
• The website www.medicare.gov explains the
  specific requirements.
• In most cases, if you choose to purchase Part A,
  you must also have Medicare Part B and pay
  monthly premiums for both.

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MEDICARE PART A

• Some individuals will automatically be enrolled
  in Medicare Part A and B.
• If you are automatically enrolled, you will
  receive your Medicare card in the mail 3 months
  before your 65th birthday.

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MEDICARE PART A

• Some individuals are not automatically enrolled
  in Medicare and will need to sign up for Medicare
  Part A and B.
• This includes those who arent receiving social
  security benefits yet because they are working.
• If you need to sign up, contact the Social
  Security Administration or a Social Security
  Office 3 months before your 65th birthday.

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MEDICARE PART A

• If you were still working at the age of 65 and
  were covered by your employers insurance plan,
  you may want to contact the Medicare Coordinator
  of Benefits and let them know that you are no
  longer working so they can record Medicare as
  your primary payer.

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MEDICARE PART A

• How to Sign Up for Part A and B
• Apply online at Social Security
• Visit your local Social Security office
• Call Social Security at 1-800-772-1213
• If you worked for a railroad, call 1-877-772-5772
• You dont need to sign up for Medicare annually.
  However, each year you can review and change your
  benefits.

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MEDICARE PART B

• Part B Medical Insurance which includes medical
  procedures, doctors, equipment, ambulance
  services, etc
• Most people pay a monthly premium currently
  between 104.90 to 335.70 per month, based on
  income.
• Automatically enrolled in Part B, unless you
  specifically decline.
• Part B cannot be used in a Christian Science
  Nursing Facility.
• Medigap or Medicare Supplement Insurance policy
  may require that you have Part B coverage.

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MEDICARE PART B

• How to Drop Part B
• If your Medicare coverage hasnt started yet
• And you were automatically enrolled in both Part
  A and Part B and sent a Medicare card, follow the
  instructions that come with the card, and send
  the card back. If you keep the card, you keep
  Part B and will pay Part B premiums.
• Or if you signed up for Medicare versus being
  automatically enrolled, contact Social Security
  to drop Part B.  

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MEDICARE PART B

• If your Medicare coverage has already started
• Contact Social Security for instructions on how
  to submit a signed request to drop Part B. Your
  coverage will end the first of the month after
  Social Security gets your request.
• You generally wont be able to re-enroll in Part
  B until the next enrollment period (January 1
  March 31st) and you will have to pay a late
  enrollment penalty, which can be substantial.  

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MEDICARE PART C

• Part C includes Managed Care Organizations,
  also known as HMOs (health maintenance
  organizations) and PPOs (preferred provider
  organizations)
• Require prior written authorization for coverage
  in a Christian Science Nursing Facility which can
  be difficult to obtain.
• Authorization must happen before admission or
  immediately upon arrival.

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MEDICARE PART D

• Part D Prescription Drug Service most people
  pay a monthly premium. Insurance provided by
  private companies.
• Part D cannot be used in a Christian Science
  Nursing Facility.

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REQUIREMENTS FOR MEDICARE COVERAGE

• For Medicare to cover Christian Science Nursing
  Care at a Christian Science Nursing Facility, the
  beneficiary (patient) must
• sign an election form
• have a condition that would qualify him or her
  for inpatient care in a hospital or a skilled
  nursing facility
• A skilled nursing facility is not the same as a
  nursing home

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MEDICARE ELECTIONS

• When a patient is admitted, the patient will sign
  an election upon admission so it is available for
  Medicare.
• The election form is only sent to Medicare if the
  patients care level qualifies for Medicare.
• Once an election is sent to Medicare it is in
  effect until it is revoked by the patient.

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MEDICARE ELECTIONS

• Prior to the filing of an election form, a
  Christian Scientist can use Medicare for medical
  services or supplies and it wont impact the use
  of Medicare in a Christian Science Nursing
  Facility.
• After an election is filed, there are
  consequences associated with using Medicare for
  medical services and supplies.

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MEDICARE ELECTIONS

• Receiving medical care after an election is
  established
• Once no waiting period.
• Twice 1 year waiting period.
• Three Times 5 year waiting period.
• A revocation doesnt occur again until a new
  election is filed.

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MEDICARE ELECTIONS

• Example a patient receives Christian Science
  Nursing Care and signs an election form. The
  patient then receives medical care.
• This creates one revocation.
• After the revocation occurs the patient can
  receive as much medical care as they need or
  want.

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MEDICARE ELECTIONS

• Then the patient returns to a Christian Science
  Nursing Facility. After discharging the facility
  the patient purchases a wheelchair and uses
  Medicare to pay for the purchase. The patient has
  just created a second revocation. Now the patient
  must wait one year to re-enter a Christian
  Science Nursing Facility under Medicare.

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DETERMINING COVERAGE

• Medicare does not require a medical diagnosis for
  Christian Scientists receiving care in a
  Christian Science Nursing Facility.
• Using guidelines from Medicare, a Christian
  Science Facility Nurse will determine if a
  patients care needs qualify for Medicare.

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MEDICARE COVERS

• Part A Includes Christian Science Nursing
  Services
• Room and meals
• Most nursing supplies

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MEDICARE DOES NOT COVER

• Christian Science Nursing Care that does not
  require a Journal-listed Christian Science Nurse
• Christian Science Practitioners
• Personal items such as telephone and hairdresser
  charges
• Rest and study
• Private duty or home nursing

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PART A WHAT YOU PAY (2014 Rates)
Initial Period 60 days
1,216 Deductible
Co-insurance Period 30 days
304 per day
Lifetime Reserve 60 days
608 per day
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PART A COVERAGE

• Medicare is designed for short term stays and
  ends when the patient no longer has a condition
  that would qualify for Medicare coverage in a
  hospital or a skilled nursing facility.
• Christian Science nurses expect quick healing.
  This progress may result in nursing determining
  that the patients condition no longer warrants
  Medicare coverage.

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EXAMPLE OF COVERAGE

• Days 1 to 60 - all inclusive flat rate - 420/day
• -------------------------------------------------
• Month 1 (30 days) x 420 12,600
• Month 2 (30 days) x 420 12,600
• Total Charges 25,200
• You Pay 1,216
• Medicare pays 23,984

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USING MEDICARE AGAIN

• Although Medicare is a short-term program, it may
  be used more than once.
• If 60 days has passed between stays in a
  Christian Science Nursing Facility, another
  deductible must be paid by the patient.
• If less than 60 days has passed between stays in
  a Christian Science Nursing Facility and the
  patient has Medicare days remaining, then
  Medicare picks up where it left off when the
  patient discharged.

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USING MEDICARE AGAIN

• Medicare may be used again at a Christian Science
  Nursing Facility if
• The patient is out of the facility for 60 days
  and does not use Medicare anywhere.
• Or, the patient remains in a Christian Science
  Nursing Facility but at a lower level of care for
  60 consecutive days.

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MEDICAID VS MEDICARE

• Medicare
• Age 65 or older or disabled
• Short term
• Skilled care
• No financial requirements
• Medicaid
• Age 65 or older or disabled
• Short or long term
• Includes skilled and non-skilled care
• Less than 1,500 in financial assets (Ohio)

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MEDICAID

• Two states with Christian Science Nursing
  Facilities ther offer Medicaid coverage to
  Christian Scientists
• Ohio
• California (MediCal)

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PHONE NUMBERS WEBSITES

• Medicare 1-800-633-4227
  www.medicare.gov
• Social Security Administration 1-800-772-1213
  www.socialsecurity.gov
• Peace Haven 1-314-965-3833
  www.peacehavenassociation.org

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FACILITY PAYMENTS

• It is important to understand that neither
  Medicare or Medicaid cover 100 of the facilitys
  costs to operate and provide care.
• An inherent amount of benevolence is given to all
  those who have Medicare or Medicaid as their
  payer.

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INSURANCE FOR CS

• Three major types of insurance
• Medigap (Medicare Supplement)
• General Health Insurance Policies
• Long Term Care (LTC)

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MEDIGAP

• Medicare Supplement Insurance

• This covers the Medicare deductible and
  coinsurance. It may also cover care after
  exhaustion of Medicare benefits.

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HEALTH INSURANCE POLICIES

• Can be challenging to bill for coverage.
• Make sure Christian Science care is specifically
  mentioned in the policy.
• Dont just accept that the policy will pay
  because the insurance agent says so.

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LONG TERM CARE (LTC)

• Long Term Care Insurance
• No diagnosis is usually required
• Patient must need assistance with at least 2
  Activities of Daily Living (ADLs)
• Examples of ADLs are mobility, eating, dressing,
  etc
• Insurance companies generally only ask for proof
  that care is being provided
• Benefits are usually significantly less than
  other Health Insurance coverage (100 - 200 a
  day)

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INSURANCE COMPANIES

• Peace Haven does not recommend insurance, but the
  following companies have paid in the past
• United Health Care (Medicare Supplement)
• AARP (Medicare Supplement)
• UNUM (LTC)
• SCS/Monumental (LTC)

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CONCLUSION

• Questions Answers
• Followed by a quick Affordable Care Act Update