Medicare & Medicaid

Centers for Medicare and Medicaid Services: Home Health Quality Measures Explained

by Gilbert Guide

The Centers for Medicare & Medicaid Services (CMS) is part of the federal government's Department of Health and Human Services. Because many Medicare and Medicaid recipients are elderly, much of the funding goes to nursing homes or eldercare services. Home health agencies that receive certifications from Medicare undergo an assessment every three years. CMS assesses these home health agencies via quality measures and publishes each agency's results. CMS & Home Health CMS provides scoring for all Medicare-certified home health...Read the rest of this article »

PACE (Program of All-inclusive Care for the Elderly) Explained

by Gilbert Guide

One variation on Managed Care plans that acts as a Medicaid alternative is the nationwide PACE program. The San Francisco-based On Lok program that provides housing, long-term care and programming for the area's senior population led to the development of the larger PACE program. The program aims to keep seniors who normally would require placement in a skilled nursing facility a chance to stay in the wider community by providing a breadth of interdisciplinary services. By utilizing adult day health...Read the rest of this article »

Medigap Supplemental Insurance Explained

by Gilbert Guide

Medigap, also known as Medicare Supplemental Insurance, is a health insurance policy sold by private insurance companies that fills the gaps that Medicare fails to cover, such as coinsurance, co-payments and deductibles. There are ten distinct Medigap policies, Medigap Plans A-J. There are also two other Medigap policies, K and L, which only pay a portion. All policies are regulated by the federal and state governments. Residents of Massachusetts, Minnesota and Wisconsin have specialized plans. Plans K and L...Read the rest of this article »

Senior Care Reimbursement Overview

by Gilbert Guide

Planning for long-term care is complicated. Each person's needs are unique; therefore, the cost of long-term care varies greatly. Some social and physical assistance is available for free or at a low cost, while very expensive nursing home or home health services can cost upwards of $200 per day. There are many different ways to finance long-term care. You will probably need to use a combination of payment sources, which may include Medicare, Medicaid, long-term care insurance and other programs,...Read the rest of this article »

Medicare Advantage Plans: Buyers Beware!

by Jill Gilbert

On Monday, the New York Times ran a great story about Medicare Advantage Plans. Medicare Advantage Plans are a type of health plan sold by private insurance companies. The plans are associated with Medicare. It seems that seniors across the country have been duped into signing away their Medicare benefits by enrolling in a Medicare Advantage Plan. In some cases, the seniors didn’t understand how the Medicare Advantage Plans worked, and in others, they didn’t even know that the...Read the rest of this article »