What Are The 5 W’s of Medicare for Westchester, Fairfield, and Nassau County Seniors?

02 May What Are The 5 W’s of Medicare for Westchester, Fairfield, and Nassau County Seniors?

If you are turning 65 or are a caregiver for a parent or senior living in Westchester, Fairfield or Nassau Counties, Medicare Health Insurance was updated in 2019 to include non-skilled home care services as a supplemental benefit for Part C Medicare Advantage plans.  You can refer to our previous blog post for that initial info.  In this follow up post we'll delve into the issue a bit deeper.  

WHERE Can Get Medicare Info?

Westchester, Fairfield, and Nassau Counties offer information and support to senior residents.  Here are some helpful links:

WHO Can Receive Medicare?

Medicare is the government health insurance program for those who qualify by age or disability.

  • People age 65 or older.
  • People under age 65 with certain disabilities
  • People of all ages with End-Stage Renal Disease

WHEN Do I Sign Up for Medicare for Myself or a Loved One?

There are several times when you can enroll in Medicare plans. The Initial Enrollment Period (IEP) is the first time you can sign up for Medicare. The 3 months before your 65th birthday, the month of your birthday, and the 3 months after your birthday. If you miss the IEP or your Special Enrollment Period, you get another chance to enroll. You can sign up for Medicare Parts A & B between January 1 and March 31 each year. Your Medicare coverage would begin on July 1 of the same year. It is important to note that if you need to buy Part A, you must also enroll in Part B at this time. 

WHAT Are the Medicare Parts?

Part A  - Hospital Insurance - helps to cover inpatient care in hospitals, including critical access hospitals and skilled nursing facilities (not custodial or long-term care). It also helps cover hospice care and minimal home health care. Beneficiaries must meet certain conditions to get these benefits. Most people don't pay a premium for Part A because it was covered through their payroll taxes while working.

Part B - Medical Insurance - helps to cover doctors' services and outpatient care. It also covers some other medical services that Part A doesn't cover, such as some of the services of physical and occupational therapists, and minimal home health care. Part B helps pay for these covered services and supplies when they are medically necessary. Most people pay a monthly premium for Part B.

Part C - Medicare Advantage offers the option of receiving your Medicare Part A and Part B benefits through a private, Medicare-approved health insurance company. Medicare Advantage plans provide everything that Part A and Part B include (except for hospice care, which is still covered under Medicare Part A) and may offer additional benefits such as routine hearing care.

Part D - Medicare Prescription Drug Program - remains universal in 2019 and drug coverage is available to everyone with Medicare.  You must join a plan approved by Medicare that offers Medicare drug coverage.

HOW Can the Part C Medicare Advantage Plan Assist Us?

Medicare Advantage plans combine the different parts of Medicare parts A, B and D into a consolidated benefit. According to the Medicare website, Medicare Advantage Part C differs from original Medicare in that it is offered by private companies approved by Medicare. Medicare pays these companies to cover your Medicare benefits. Medicare Advantage is also different than a Medicare Supplemental Insurance policy. Some private insurance providers that offer MA Plans in Westchester County, and the White Plains, NY area, include Aetna, UnitedHealthcare, and MVP Health Care. 

CMS Administrator Seema Verma stated, “For the first time ever, Medicare Advantage beneficiaries can access significant new flexibility for additional benefits that can help them live healthier, more independent lives. In-home support services performed by a personal care attendant or by another individual that is providing these services consistent with state requirements will be covered..."

Some home care support services that will be covered include:

  • Approved personnel to help with activities of daily living (ADLs)
  • Supportive services by personal care attendants
  • Coverage for safety devices to prevent injuries in the home
  • In-home assistance for bathing, medication management etc.
  • Respite care for caregivers
  • Adult day care services

WHERE Does Medicare Advantage Cover?

While the new Medicare Advantage plans are available in over 20 different states in 2019, the Medicare coverage is expected to expand to other states over time. The Medicare Advantage coverage will only apply if there is a health-related issue, such as a medical diagnosis. If you are a caregiver for a Medicare recipient or are over 65 with a medically diagnosed condition, you may be interested in signing up for Medicare Advantage.

WHERE Can I Learn More About Medicare Info in Westchester, NY?

Senior Benefits Information Centers (SBICs) are a free Westchester County Senior Program that provide Medicare information at eight public libraries.  Introductory “Medicare Basics” workshops are also offered four times a year at the County Office Building. All workshops are free, but early registration is suggested, because the classes fill up quickly.

“Medicare Basics” 2019 Workshop Sessions

  • Sept. 25
  • Oct. 17
  • Nov. 13
  • Dec. 4

STEPS Home Care

Feel free to reach out to our STEPS Home Care Director of Patient Care, Barbara Moran, RN, at 914-618-4200 if you have any questions regarding Medicare or how you may have benefits to pay for home care services.