Also: Medicare coverage for daily activities; spotting billing errors
This month’s article begins with a recommendation to prepare documentation of your personal desires as related to your medical situation and future health care needs. These can help convey your intentions should you not be able to voice them yourself. Next, a reminder that Medicare only provides coverage for services and equipment deemed medically necessary – you might find yourself in need of additional help with activities in your daily life. Finally, a mention regarding how hospice care provides end of life care with dignity and respect; unfortunately, some care providers abuse the system, hurting all of us who depend on Medicare. When you have questions about any of these topics, please call upon our certified counselors of the Medicare Information Office.
Prepare documents for your future health care needs
Many people assume that their family members would automatically be able to make decisions about medical treatments if they were to become incapacitated. This is where legal rules overlap with medical care. In some cases, the health care provider in charge of your care will make decisions unless you have appointed someone as your legal representative. If the decision falls to your family, they may not all agree on the best course of action. For these reasons, it is important to have a plan to avoid disagreements around treatment issues and ensure your wishes are honored if you are incapacitated. Here are different types of documents that can help you prepare for your future health care needs:
A health care proxy is a document that names someone you trust as your proxy, or agent, to express your wishes and make health care decisions for you if you are unable to speak for yourself.
A living will is a written record of the type of medical care you would want in specified circumstances.
An advance directive often refers to a combination of the living will and health care proxy documents. If you have an advance directive, be sure to give those documents to the hospital when admitted.
A power of attorney is a document that names someone you trust as your agent to make property, financial and other legal decisions on your behalf.
You do not need a lawyer to fill-out these documents, however an attorney can guide you through the completion of these documents, especially if you anticipate potential disagreements between family members. Consider contacting the Alaska Legal Services Corporation, at the phone numbers listed here in the Senior Voice (see the ad on the left).
The most important thing is to consider your health care decisions; the next most important thing is to share your decisions with those you love. Discuss and share the contents of these health care documents with trusted individuals including family members, health care providers, and anyone else you feel should know.
Differentiate between activities for daily living and medical needs
One of the most challenging things for Medicare enrollees (and family members) to realize is that Medicare generally does not pay for the additional assistance you may need after experiencing a debilitating medical condition or illness. This assistance is also known as one’s basic activities for daily living (ADLs), which may occur at home, or in a temporary assisted living residence, or in a long-term care facility. Medicare will pay up to 80 percent of the cost of necessary medical services, supplies and equipment; Medicare will not pay for additional assistance beyond these needs. A full understanding of this issue is beyond the scope of this article, but recognizing the difference between medical coverage and assisted living care is an important step to plan and prepare for future needs.
Recognize potential hospice billing errors or abuse
When a person is faced with a terminal diagnosis, it can be hard to make decisions about end-of-life care. The hospice program enables people to die with dignity and respect, while supporting their need for end-of-life care. However, hospice fraud and abuse can lead to patient harm, premature death, and big profits for dishonest individuals taking advantage of people and hospice.
Hospice fraud and abuse can occur when Medicare is falsely billed for any level of hospice care. It might occur if you are falsely certified as being terminally ill to be enrolled in hospice or if you are enrolled in hospice without your or your family’s permission. If you are eligible for hospice care, you could still experience fraud, errors or abuse if your plan of care is not being followed.
You can help stop hospice fraud by making sure a trusted doctor has assessed your condition and certified that you are terminally ill. Second, be wary of deals that seem too good to be true. Finally, report any potential fraudulent, erroneous or abusive hospice care coverage to our certified counselors at the Medicare Information Office.
If you find yourself overwhelmed by any Medicare issue (or if you would just like to ask some questions), please contact the State of Alaska Medicare Information Office at 800-478-6065 or 907-269-3680; our office is also known as the State Health Insurance Assistance Program (SHIP), the Senior Medicare Patrol (SMP), and the Medicare Improvements for Patients and Providers Act (MIPPA) program.
If you are part of an agency or organization that assists seniors with medical resources, consider networking with the Medicare Information Office. Call us to inquire about our new Ambassador program.
Sean McPhilamy is a volunteer and Certified Medicare Counselor for the Alaska Medicare Information Office.
