Medicare can be perplexing, all the more so when you combine complex health issues and the need for medical aids such as oxygen or hospital beds. While the insurance maze can be difficult to traverse, an estimated 47.5 million people received this program in 2010, which is more than a sixth of the nation’s population.

Here is a brief overview and some answers to some commonly asked questions regarding Medicare and home health care.

1. Who qualifies?

Medicare is a national health insurance program provided by the U.S. government for those who are:

– 65 and older

– Under 65 with certain disabilities

– Diagnosed with End Stage Renal Disease (ESRD), a form of permanent kidney failure requiring dialysis or a kidney transplant

2. What types of services does Medicare cover?

Medicare has four different coverage sections: Part A, B, C, and D. “Original Medicare” consists of Part A & B, while Part C is known as “Medicare Advantage Plan”. These four parts are summarized briefly:

– Medicare Part A: Hospital Insurance

* Part A covers care while in hospital as well as health care in skilled nursing facilities, home health care, and hospice.

– Medicare Part B: Medical Insurance

* Part B covers doctor’s visits as well as visits to other health care providers. Additionally, Part B covers hospital outpatient care, durable medical equipment (like intravenous infusion devices), and home health care services. Part B also covers specific types of preventative services, such as getting certain vaccinations.

– Medicare Part C: Medicare Advantage

* Part C combines health plan options you purchase from other private insurance companies approved by Medicare. Part C also integrates Medicare Prescription drug coverage (Part D) and can be tailored to include extra benefits at an extra cost.

– Medicare Part D: Medicare Prescription Drug Coverage

* Part D covers the prescription of Medicare-approved prescription drugs and can lower the cost of other medications. Similar to Part C, Medicare-approved private insurance companies also run Part D.

3. Why do I need to choose between Medicare plans?

The choice of “Original Medicare” (Parts A & B) entails payment of monthly premiums for part B and may necessitate additional coverage to pay deductibles and coinsurance to see physicians, hospitals, and other providers who accept Medicare. If you require Prescription drug coverage, you must pay a monthly premium to join the Medicare Prescription Drug Plan (Part D).

The “Medicare Advantage Plan” (Part C, which covers Part A & B), also requires the payment of monthly premiums in addition to the Part B premium & a copayment for in-plan doctors, hospitals. If prescription medications are not covered by your supplemental coverage, you have the option of joining the Medicare Prescription Drug Plan (Part D).

As with prescription medications, you can purchase supplemental coverage to cover services not covered by Medicare. The “Original Medicare” plan allows for the option of buying Medicare Supplement Insurance (Medigap), while the “Medicare Advantage Plan” does not.

It is prudent to always check if you can take advantage of other additional coverage through your employer or union, military, or Veteran’s benefits.

4. Is home health care covered by Medicare?

The Medicare website states, “Medicare only covers home health care on a limited basis as ordered by your doctor”. As reviewed earlier, Parts A & B are the Medicare options which cover the home health care services specified by Medicare.

Coverage of home health care by Medicare in New Mexico stipulates you must meet the following criteria:

– You are currently receiving regular services from a physician. This physician must also maintain a care plan unique to you, which is reviewed regularly.

– Your physician must certify a “need” for specific medical services such as requirements for intravenous medication therapy, physical therapy, occupational therapy, respiratory therapy, or speech-language pathology services.

– The home health care agency providing you services must be Medicare-certified (for more details see below).

– Your physician must certify your health status as homebound, which is indicated by the following:

* Your health condition limits you from leaving the house.

* You are unable travel from home without help (i.e. transportation assistance such as aids or individuals).

* Leaving your home takes considerable effort and may be detrimental to your health condition.

5. My home health company does not take Medicare, why is this?

The Medicare-approval process is lengthy and costly, so while it may appear that many companies may not take Medicare, they may actually be in the process of becoming Medicare certified.

Furthermore, the Medicare criteria for individual qualifying to receive home health care are very strict; the reality is that many people who may apply for coverage by Medicare for their approved home health company services will not actually receive coverage. Currently, Medicare pays only about half of all health care costs to seniors. Medicare very often denies payment due to not meeting criteria, so it is essential to be aware if you meet these criteria prior to restricting yourself exclusively to Medicare-approved home health care companies.

Now is the time to enroll in a no monthly premium Medical Advantage Plan (MAP) to upgrade your Medical benefits.

While some MAPs have a monthly premium, there are enough of them to choose from whereby you don’t need to pay a monthly premium.

Medicare Advantage Plan, Part C, came into existence in 2003 and has been growing ever since. Now nearly 27 million Medicare beneficiaries get their Parts A and B benefits delivered through MAPs which are offered by private insurers and typically include Part D prescription drug coverage.

In addition to delivering your Part A and Part B benefits, many MAPD Plans offers benefits not available through Original Medicare which may include dental, hearing, fitness programs, telemedicine, money for healthy food, personal household help, over-the-counter drugs, transportation to doctor visits, and other extras. Plans can also tailor their benefit packages to certain chronically-ill conditions such as diabetes or kidney disease.

MAPD Plans must cover all the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even when you’re in a Medicare Advantage Plan. In all types of Medicare Advantage Plans you’re always covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage of the plan’s service areas (but not outside of the U.S.)

In most Medicare Advantage HMO (Health Maintenance Organization) Plans, you can only go to doctors, other health care providers, or hospitals in the plan’s network, except in an urgent or emergency situation. In an HMO-POS(Point of Service) Plan, you may be able to get some services out-of-network for a higher copayment or coinsurance.

You just need to make sure that your favorite providers and hospitals are in the network and that your medications are on the plan’s formulary.

The Medicare Annual Enrollment Period (AEP) allows you to leave a plan, sign up for a plan, or switch plans.The AEP lasts from October 15th to December 7th each year. However, if you are just turning 65, the AEP is unimportant. Your Initial Enrollment Period (IEP) starts 3 months before the month you turn 65 and ends 3 months after the month you turn 65. Finally, if you enrolled in a MAPD Plan between Oct. 15th and Dec 7th, you can switch to another Advantage Plan or drop it in favor of Original Medicare and pick up a standalone Part D prescription plan between Jan.1st and March 31st.

Health and fitness is one of the most important things in our lives. Here are some essential health tips you can consider that will help you not only lose weight but improve your quality of life.Make more movements Take it as your day to day challenge to figure out ways for moving your body. As for instance, you can climb stairs when you have been given a choice between the stairs, lifts, escalators or elevators.Or consider walking your dog, chasing the kids, tossing balls with your friends, mowing the lawn and things like that. Anything which moves your major limbs serve two basic purposes – they are your fitness tool, and also your stress buster. Change the way you used to view things.Think ‘move’ within even smaller increments of time. Trust me on this! It’s not always about spending over an hour inside the local gym. And do not think that staying fit is just about 45-minute aerobic dancing class.And there’s no reason to think that those tai chi professionals or the kickboxing gigs are the only fit guys in the nation. If you can do any of those that’s good! But until you can, keep moving more.Try to cut fat Avoid too fatty things. Good examples are fried foods, heavy cheese burgers or other forms of fatty meats (like pork, delicious bacon, ham, juicy salami, ribs or even sausage). Moreover, dairy products like normal/cottage cheese, milk or cream must be taken with caution. You get best results with the lower fat versions.Nuts, sandwich meats or mayonnaise should be cut substantially. Likewise, you should curb the consumption of margarine, butter or even ketchup or sauces. They should not be avoided fully. They should be taken in fixed/limited amounts. Fortunately, you can find lower fat versions of these things, since they are used as the substitute of butter. There are fat free yet delicious cheeses or mayonnaise. You should try to make yourself a lean and mean, fat-burning guy!Give up smoking Did you ever pay attention to the jury? They definitely came on to a negative verdict on smoking. Since the 1960 as the US Surgeon General made an announcement confirming the harmful effects of smoking, there has been substantial improvement in the tendency of Americans for cutting back from tobacco products which kill. Whatsoever, stay away from smoking as much as possible. If you can’t quit in a single day, reduce it gradually.Leave out your stress This is easier said than done. The truth is that, you got to live a stress-free life no matter what your current condition of health and fitness is. Today, you can find different types of stress busters. While a number of techniques are physical, most others are like mental therapies. For instance, some experts recommend that you learn and practice to think positively.You have to make sure that you’re spending at least half an hour per day on something that gives food to your mind. Good examples are soaking yourself into a hot tub; walking on or around the beach or talking a walk in a quiet park; reading a book that matches your taste and so on.