Senior Health Services

Seniors have a multitude of through programs such as Medicare and the Program of All-Inclusive Care for the Elderly (PACE). Each program caters to individuals who meet specific age criteria or disability status.

When a senior elects Medicare coverage, they may choose from one of five plans depending on their needs. The plans cover services such as inpatient hospital care, outpatient care, preventive medicine and prescription drugs. While the basic plan is free to most seniors, the remaining plans require monthly premiums, deductibles and coinsurance.

Seniors who desire a more comprehensive level of care may opt for the PACE program. PACE provides all an individual’s Medicaid and in a consolidated care plan. Specifically, each person receives all their care through a dedicated team of specialists and a case manager who coordinates all the senior’s care. Keep reading for more information on senior health services such as Medicare and PACE.

What is Medicare?

As a federal program, Medicare provides medical benefits to qualified seniors. The program consists of five separate plans from which an individual may select for their coverage. Each policy covers a specific set of services and enrollees may elect one or more of the plans. The Medicare plans are:

  • Medicare Part A
  • Medicare Part B
  • Medicare Part C
  • Medicare Part D
  • Medigap – Gap insurance

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For most individuals, basic Medicare Part A is free. Anyone who wants to purchase additional Medicare coverage must pay monthly premiums, deductibles and coinsurance for each plan selected. There are two ways to enroll in the program. First, anyone 65 years of age and older receive free Medicare Part A and are automatically enrolled in the program when they turn 65 years of age. Also, individuals who have end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS) are automatically enrolled in Part A effective the date of their diagnosis. Those who do not qualify for automatic enrollment in Medicare must enroll in a plan manually.

Services Offered with Medicare Insurance

The benefits offered through Medicare vary and depend on the plan selected. Each Medicare plan only covers a specific set of health care services. As such, individuals may need to purchase several plans to ensure they have ample coverage to meet their needs. Services provided through each plan are:

  • Medicare Part A – Coverage includes inpatient hospital stays, skilled nursing care and some in-home services
  • Medicare Part B – The medical services plan provides routine medical services through a primary care provider and specialty practitioners, as required.
  • Medicare Part C – Represents a comprehensive health plan that incorporates both Plan A and Plan B in one policy.
  • Medicare Part D – Costs for an enrollee’s prescription drugs are covered by Part D
  • Medigap gap insurance – When an individual has out-of-pocket expenses related to healthcare, the Medigap plan helps cover some of the costs to minimize the financial burden to the beneficiary

How much does Medicare cost?

Medicare Part A is offered at no cost to most Medicare beneficiaries. To receive free Part A Medicare coverage, the individual must have earned enough work credits. If not, they must pay a monthly premium of $422 for coverage. The remaining plans require enrollees to pay a variety of out-of-pocket  . Individuals who elect Part B must pay a monthly premium of $134. Costs for Plan B may be higher depending on the individual’s income.

In addition to premiums, beneficiaries must pay a Medicare deductible. The deductible is the amount a covered individual must pay before Medicare pays the cost of services. Although the plan covers most of the fees for each service, most times, there is a balance. Beneficiaries must pay the remaining balance in the form of coinsurance.

The Medicare fee schedule for Plans C, D and Medigap vary as each plan is administered by different insurance companies contracted with Medicare. As such, enrollees must contact each insurance company to get a quote on the desired plans.

Medicare Eligibility Criteria

Medicare coverage applies to seniors and as such, enrollees must be 65 years of age or older to meet  . Those younger than 65 years of age may qualify for Medicare coverage if they are receiving Social Security Benefits or Railroad Retirement Board benefits. They may also be eligible if they have ESRD or ALS.

What is the Program of All-Inclusive Care for the Elderly (PACE)?

Although Medicare targets healthcare for seniors, the   (PACE) targets the frail elderly members of the community. The PACE program is a comprehensive health care plan that incorporates all of individuals health services in one plan. The program aims to minimize reliance on nursing facilities and enable seniors to remain in their homes if it is safe for them to do so. PACE services are administered as an adult day health care program.

Through the program, a case manager and a dedicated care team coordinate all the senior’s care. As most participants are dually eligible for Medicaid and Medicare, they receive health care from both programs through PACE healthcare.

To qualify, individuals must be at least 55 years of age and meet the criteria for requiring nursing home care. They must also demonstrate an acceptable level of independent living skills and they must reside within a PACE service area.

What does the PACE program for elder care provide?

The comprehensive PACE healthcare plan includes a variety of services aimed at meeting all health, social and recreational needs of each enrollee. Upon enrollment in PACE healthcare, seniors work with a case manager to develop a care plan. The plan outlines the level of care required, services provided and other services depending on the program participant’s needs. In general, PACE services include:

  • Primary Care – Visits with a primary care physician assigned to the participants care team
  • Restorative Therapy – Therapies aimed at improving the range of motion or enhancing the ability to perform activities of independent living such as dressing or laundry
  • Nutritional Counseling – Counseling and advice on a meal plan based on the enrollee’s healthcare needs
  • Meals – Daily meals provided to enrolled adult day health care participants
  • Recreational Therapy – Activities such as games or puzzles designed to keep the PACE elder care participants healthy.

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