Dear reader:
This week I received a text message from a local Toni Says Medicare customer that I wanted to share with you.
“Toni, I need to have a recovery plan with 24/7 home health care after my liver transplant.The surgery is over a year away and I would appreciate any advice on how to plan for this medical event. Thank you.” — Name withheld.
To our readers:
Reading this article made me realize how unprepared America is for life-altering medical needs like transplants.
Fortunately, my client has Original Medicare with Medicare Supplement, so he and his medical team know which skilled nursing/rehabilitation facilities and home health agencies to utilize during his recovery from a liver transplant. You can choose together.
Page 52 of the 2024 Medicare & You Handbook, “Transplants and Immunosuppressants,” states that Part A must be in place at the time of a covered transplant and Part B must be in place at the time of administration of immunosuppressants. It is stated that there is. You pay 20% of the value of the drug approved by Medicare and your Part B deductible applies. Medicare drug coverage (Part D) applies when Part B does not cover immunosuppressive drugs.
Toni Says readers, if you don’t work full-time or are eligible for benefits from your or your spouse’s employer, we recommend that you apply for Medicare Parts A, B, and D (Medicare prescription drug coverage). plan).
Whether you are applying for Original Medicare for the first time or changing Part D plans during Medicare’s annual enrollment period of October 15 to December, you must have a Medicare Part D prescription before enrolling in a Medicare Part D plan. Get a complete consultation regarding your medication plan. Seven times a year.
Make sure the Part D plan you choose covers all your transplant medications, as well as your daily prescriptions. If your Part D plan doesn’t cover transplant prescription drugs, who will pay? You will! (Chapter 5 of Toni’s Medicare Survival Guide Advanced Edition provides more information about Medicare Part D and how to properly enroll.)
The Medicare Handbook also states, “Medicare covers physician services for heart, lung, kidney, pancreas, intestine, and liver transplants under certain conditions, but only at Medicare-certified facilities.” I am.
The handbook continues: “If you are considering joining a Medicare Advantage plan and are on the transplant waiting list or think you need a transplant, please review your Medicare Advantage plan and consult your physician, other Check to see if your health care provider or hospital is in your plan’s network. Also, check your plan’s coverage rules for prior authorization and living donor coverage. ”
Regarding my client’s question about Medicare paying for Toni Sez’s home health care while he recuperates from a liver transplant, I didn’t have good news for him.
Original Medicare pays zero for home care while recovering from a transplant or illness. Medicare will pay for home health visits if your doctor orders them and you meet Medicare’s medical requirements.
Medicare only pays for skilled nursing or rehabilitation facility care. If you do not meet the Medicare skilled nursing qualification, you will be responsible for paying 100% of the cost out of pocket.
I told Mr. Toni Sez’s client to start talking with home care provider services, friends, and family about getting 24-hour care assistance at home to help him and his wife. . If he has long-term care insurance, any costs not paid by Medicare may be collected.
Toni King is an author and columnist on Medicare and health insurance issues. She has worked as a top sales leader in this field for nearly 30 years. If you have questions about Medicare, please email [email protected] or call (832) 519-8664.Her books are available at www.tonisays.com Includes bundle discount for Toni readers.
