Medicare and Cancer Benefits - Prevention, Diagnosis and Treatment

On occasion, this blog allows guest experts to submit a post on a complicated topic.  This week, I am delighted to have a post on how Medicare will cover the prevention, diagnosis and treatment of cancer.  The post also goes into detail on the differences in your coverage if you have a Medigap or Medicare Advantage plan.

This post on Medicare and cancer benefits was written by Danielle Kunkle, the co-founder of Boomer Benefits, an insurance agency specializing in Medicare-related insurance products in 47 states. Her contact information is included at the end of this article.

Medicare and Cancer Benefits

If you have cancer or a family history of cancer, you may have concerns about how Medicare will cover treatment of cancer. Treatment for cancer can be expensive, but Medicare will be an enormous help with diagnosing and treating this health condition.

Medicare provides a wide range of cancer services from preventive care all the way to surgery and chemotherapy. Understanding Medicare’s coverage of cancer treatment starts with first understanding the parts of Medicare.

Original Medicare Parts A and B

Part A is your hospital insurance. It will pay for hospitalization, skilled nursing, blood, home health care and hospice.

Part B is your outpatient insurance. It covers doctor visits, lab-work, durable medical equipment, surgeries, ambulance and many other medical services. In relation to cancer, Part B will also pay for chemotherapy, radiation, second opinions before surgery, drugs administered in a clinical or hospital setting, and physical therapy or rehab care.

Medicare Part B also provides mental health care to deal emotionally with your diagnosis and preventive care screenings, such as mammograms, cervical screenings, prostate exams and colonoscopies.

Medicare Part D Drug Coverage

Part D is for your retail prescription drugs. Although Part D is optional, it is really very important when it comes to cancer care. This is because some cancer medications and anti-nausea medications are now in an oral form which you pick up yourself at a pharmacy. You will want good coverage for these potentially expensive medications.

Your Part D pharmacy card will provide drugs to you at a copay level instead of you paying full price. Most importantly, all Part D plans provide catastrophic coverage. After your spending reaches a certain annual limit, the insurance company then must pay 95% of the cost of your medications for the rest of the year.

Common Questions Regarding Medicare and Cancer

Here are some of the most common cancer questions we receive in relation to Medicare’s coverage of cancer treatment.

Is Immunotherapy covered by Medicare?

Immunotherapy is a form of treatment which helps the body’s immune system fight cancer. Medicare Part B provides coverage for most intravenous medications which are considered reasonable and necessary. Check with your doctor before beginning treatment.

What will be my cost for cancer treatment under Medicare?

You are responsible to pay for your hospital and outpatient deductibles, which are set by Medicare each year. You are also responsible to pay 20% of the cost of your Part B services. There are Medigap plans available which pay after Medicare pays its share. The one with the most comprehensive coverage is Plan F, which will cover 100% of your cost-sharing responsibility.

Medicare beneficiaries can enroll in any Medigap plan without health questions during the first 6 months after their Part B effective date. There are no pre-existing condition exclusions or waiting periods if you apply during this Medigap open enrollment period.

If a Medigap plan is not in your budget, another alternative is Medicare Advantage. Also called Part C, Medicare Advantage plans are private plans which pay instead of Medicare. These plans usually have a network of doctors from whom you will get your care. Some plans require you to choose a primary care doctor who can then refer you to your oncologist and other specialists.

Medicare Advantage plans often have lower premiums than Medigap, but you will pay copays for your various treatments as you go along. As long as you apply during a valid election period and live in the plan’s service area, most people with Original Medicare can get approved for a Medicare Advantage plan. There is only one health question about end-stage renal disease which could prevent you from being covered under a Medicare Advantage plan.

Which cancer doctors can I see while on Medicare?

Medicare has over 800,000 providers. Many cancer treatment centers and specialists participate in Medicare. Visit Medicare’s website to find a list of participating providers.

How Do I Know if a Drug is Covered by Part B or Part D?

Part B typically covers drugs which are offered in intravenous form. However, if your doctor prescribes an oral version of one of these medications or an anti-nausea medication, Part B may cover it. Your doctor must give it to you within 48 hours of your cancer treatment.

If you take a drug which only comes in oral form, your Medicare Part D drug plan will likely cover it. Should you be prescribed a drug that is not on the formulary, your doctor can file an exception with your drug plan to request coverage for it.

Does Medicare cover second opinions?

Sometimes cancer patients want a second opinion before a surgery. Medicare Part B does cover this at 80%. Most Medigap plans will cover the other 20%. If you are enrolled in a Medicare Advantage plan, check your plan’s summary of benefits to determine what your copay will be for this doctor visit.

Author Bio

Danielle Kunkle is the co-founder of Boomer Benefits, an insurance agency specializing in Medicare-related insurance products. They help baby boomers new to Medicare learn about their benefits and coverage options across 47 states.  You can reach her at dkunklebb@gmail.com or 1-855-732-9055.

If you are interested in more information on common medical issues as you age, retirement planning, Social Security, Medicare, and more, please use the tabs or pull-down menu at the top of the page to find links to hundreds of additional helpful articles.

Watch for my book, Retirement Awareness: 10 Steps to a Comfortable Retirement, which will be released by Griffin Publishing in 2017.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit:  Google images

Safety Rules for Grandchildren

Many of today's grandparents are very involved in the lives of their grandchildren.  Three million grandparents are currently raising their grandchildren; millions more regularly babysit them. However, at the 2017 Pediatric Academics meeting, the attendees discussed the fact that many safety rules have changed over the past few decades and grandparents could be unintentionally putting their young grandchildren at risk.  Whether you are actively raising your grandchildren or occasionally babysitting them, it is important to learn the new rules for keeping them as safe as possible.

Why Grandparents Are Not Aware of Safety Recommendations

Grandparents are often confused by the changing recommendations. Young parents are constantly bombarded by new recommendations on how to keep their children safe.  Grandparents, however, are only rarely included in the visits to pediatricians and they are even less likely to have conversations with their peers about the best way to feed, transport and care for an infant.  As a result, they are frequently left out of the loop when new suggestions are released by experts.  In addition, some grandparents are resistant to the idea that things have changed since they raised their kids and they need to change their child-rearing ideas, too.

Modern Safety Recommendations for Infants and Young Children

1.  Today's pediatricians recommend that babies be put to sleep on their back, not on their sides or stomach as they were in the past.  Caregivers should not put blankets, toys or pillows in the crib with an infant. Making these changes can reduce the risk of SIDS (Sudden Infant Death Syndrome), which is the leading cause of death for infants between the ages of one month and one year.

2.  If a child is burned, butter is not the proper treatment for it.  If the burn is severe, call the child's pediatrician or take the baby to the emergency care or urgent care center nearest your home.

3.  Injuries should be cleaned and covered with a bandage to reduce the risk of infection.

4.  When a child has a fever, they should NOT be put in an ice bath, although this treatment was common 30 or 40 years ago.  Today's experts point out that this treatment can drop the body temperature too much and cause hypothermia.

5.  Infants should be transported in a rear-facing car seat as long as possible.  Toddlers should ride in a forward facing car seat with a five point restraint system. Older children can use booster seats after they outgrow their car seat.  The exact age and size of the children in each type of seat varies from state to state, so make sure you know the requirements for your state.  Before you offer to car pool with another parent or grandparent, make sure your vehicle can accommodate all the necessary car seats and booster seats.  Many cars can only accommodate a maximum of two car seats in the back seat. Children cannot ride in the cargo area of an SUV or station wagon, which was common a few decades ago.  Below are the laws in the State of California, according to the California Highway Patrol website in 2017.  The laws may vary slightly in the state where you live:

2017 California Child Safety Seat Laws

• Children under 2 years of age shall ride in a rear-facing car seat unless the child weighs 40 or more pounds OR is 40 or more inches tall. The child shall be secured in a manner which complies with the height and weight limits specified by the manufacturer of the car seat.
• ​Children under the age of 8 must be secured in a car seat or booster seat in the back seat.
• Children who are 8 years of age OR have reached 4’9” in height must be secured by a safety belt.
• Passengers who are 16 years of age and over are also subject to California's Mandatory Seat Belt law.

How Grandparents Can Stay Up-to-Date on Childcare Recommendations

The rules above are just the tip of the iceberg, and new suggestions for proper child and infant care are released frequently, including when to begin feeding solid foods to an infant, the types of food they should eat, and the products which are safe to use on an infant. As a result, if you are raising a grandchild or occasionally babysit one, it is important you stay current.  Go to well-baby checkups at the pediatrician's office, if possible.  In addition, attend parenting meetings and read current books and magazines on child rearing.

Below are a few sites where you can learn the latest childcare recommendations:

American Academy of Pediatrics Healthy Children Website

Parents.com

Parenting.com

For Car Seat Laws, check your state Highway Department website

If you are interested in additional information for grandparents, or tips for senior citizens, including where to retire, financial planning, Social Security, Medicare, common medical issues and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.

Watch for my book, Retirement Awareness: 10 Steps to a Comfortable Retirement, which is being published by Griffin Publishing in 2018.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit:  morguefile.com

How to Hire a Home Care Agency

At some point, nearly everyone who lives long enough is going to need a little extra help.  If you or your loved one does not need to live in a skilled nursing or memory care facility, a home caregiver may be able to provide all the assistance you or your family member needs.  Whether you are hiring the person for yourself, a spouse or a parent, what are some of the issues you need to consider in choosing the right caregiver and agency?

Choose a Licensed Caregiver Agency

Although it may be tempting to hire a private individual as a caregiver, it can be a risky move.  Most district attorneys and law enforcement officials have dealt with cases in which valuables or money were stolen by unlicensed, private caregivers.  In addition, an unlicensed caregiver is more likely to ask for "loans" or not be qualified to provide proper care, especially in an emergency.  They may have had little or no training or experience in dealing with medications, lifting people who have fallen, knowing when to call 911 or handling other situations.  A better solution is to deal directly with an agency which is bonded and responsible for training and assisting you in choosing the appropriate employee for your situation.

What to Look for in a Licensed Caregiver Agency

The State of California has a Home Care Services Consumer Protection Act which requires agencies to meet certain requirements.  Even if you live in another state, these are guidelines you should look for in any agency you may choose to employ:

*  They should conduct background checks on their employees
*  They should provide an employee dishonesty bond
*  They should provide training (although in California only 5 hours are required)
*  They should carry liability insurance
*  They should keep records on any reports of suspected abuse
*  They should provide workers compensation coverage for their employees

What to Look for in the Caregiver Who Comes to Your Home

Whether you are hiring the caregiver for yourself or a family member, you want to make sure they will be a good fit and able to handle the job.  You should insist on meeting the caregiver before they begin working alone with you or your family member.  There are certain issues to consider:

*  You need to recognize that a caregiver is NOT there to provide medical care.  The caregiver is employed to provide needed assistance with activities of daily living such as grocery shopping, cooking, feeding, bathing, dressing, dispensing medication at the appropriate times, or moving the client from the bed to a wheelchair or making similar transitions.  They may also drive them to medical appointments and social engagements.

*  The caregiver should be a self-starter, recognize when something needs to be done, and be willing and energetic enough to do it.

*  The ideal caregiver should have a caring personality.  They should smile often, be willing to give a hug occasionally, listen to repetitive stories, and laugh at the funny ones.  Since they may be the only person their client sees regularly, they need to be able to fill of the role of both caregiver and friend.

*  They should be willing and able to keep their client as active as possible, helping with their physical therapy exercises and enabling them attend their favorite social events or fitness classes.

*  The caregiver should be observant and intuitive, able to recognize when "something doesn't feel right."  They should be comfortable letting other family members or medical personnel know if they suspect there is a problem and be ready to call 911 in an emergency.  They should also be good communicators and able to explain any changes they see. 

*  They should be diplomatic and discrete in dealing with other family members, especially if their client is dying, goes on hospice or becomes stressed when certain relatives are around.

What You Can Do to Help the Caregiver

Whether you hire a caregiver for yourself or a family member, there are steps you can take to make their job easier and more beneficial for the client.

* Give the patient the opportunity to have input in choosing the caregiver.  They are the one who will spend their days with this person and you want to hire someone they will enjoy being with.  The patient also needs to be involved in compiling the instructions which will be given to the caregiver, so they feel they still have ultimate control over how they will spend the final months or years of their life.
*  Provide the caregiver with a detailed list of medications and when each one should be taken.
*  Provide a list of the patient's favorite foods and recipes, as well as any mealtime preferences and food allergies.
*  Explain sleeping, television, music and other preferences to the caregiver.
*  Make sure the caregiver knows who is and is not allowed in the home with the client.
*  Have the physical therapist or other medical personnel show the caregiver any exercises the client should be doing, the proper way to move the person and other important details of their care.
*  Give the caregiver a list of emergency numbers ... family members, doctors, therapists, etc.
*  Put all this information and anything else which you think will be important in a binder which the  caregiver can refer to if they have any questions.  This is especially important because occasionally the caregiver may become ill and a substitute caregiver will take their place. 

You should also make arrangements to have bills paid, taxes done and other business matters handled by someone other than the caregiver.  The caregiver should not be expected to take care of these things, so another family member, conservator, or public guardian will need to handle these matters if you or your family member becomes unable to handle their financial affairs.

If you need more information about retirement planning, common medical issues, where to retire, Social Security, Medicare, changing family relationships and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.

Watch for my book, Retirement Awareness: 10 Steps to a Comfortable Retirement, which will be released by Griffin Publishing in 2018.

You are reading from the blog:  http://www.baby-boomer-retirement.com

Photo credit:  morguefile.com