Senior Life Mattters
Drug Coverage During Medicare Sanctioned StaysBy Janell Sluga
As individuals retire or age into Medicare, their insurance situation can change dramatically. There are a multitude of options open to those with Medicare. The terms, prices and products offered are dramatically different each year.
The purpose of this column is to give those who are eligible for Medicare, or soon to be eligible for Medicare, some understanding of their insurance options and how it could impact their health and finances.
These questions and answers are meant as a guide to help you understand the complex questions you are now thinking about. Each individual's specific situation may create a different solution. You shouldn't necessarily do what your friends, family and neighbors do.
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Question: My wife is having surgery and will need to be in a skilled nursing facility during her rehab stay. How does our insurance (drug coverage) cover us during this time?
Answer: When you are admitted to a skilled nursing facility after a three-day hospital stay or longer, your stay may be covered by Medicare Part A. (I have covered how your health insurance will cover you in previous articles, and if you need that explained, call me and I will send those copies to you.)
Medicare Part A will cover those medications you need during that Medicare Part A covered stay at the SNF; much like it covered your medications during your hospital stay. This means the SNF pharmacy should not be billing your medications to your other prescription drug coverage while Part A is covering your stay. Once your Medicare Coverage ends at the SNF or you leave the SNF, you go back to your previous prescription drug coverage situation.
You may have VA coverage, retiree coverage, employee coverage, EPIC, Medicare Part D or many others. These types of coverage begin to be billed for your medications once your Medicare coverage ends.
Leaving this SNF or your Medicare Coverage ends but you stay in the SNF, you now have a special enrollment period to use to change your coverage. This period lasts for 60 days after you leave the facility or your Medicare coverage ends (or both). For those individuals who already have a Medicare Part D plan, they can use this time to join a different plan.
This SEP also applies to those in a Medicare Advantage plan. Let me explain that a little further. If you are in a Medicare Advantage plan (HMO, PPO or PFFS), you also have this same SEP. This is an opportunity to switch to an alternative company, plan, and even type of plan. You can switch from an HMO without drug coverage to an HMO with drug coverage; from an HMO to a PPO; from an HMO with drug coverage to a Medicare Supplement plan with a stand alone drug plan.
If you already have Medicare Supplement insurance with stand alone drug coverage, you can now switch to another company's drug plan. You can also switch to a Medicare Advantage plan with drug coverage.
The options go on and on for the changes you can make. These special enrollment periods are like a ''get out of jail free card'' in Monopoly. They gives you an extra opportunity to change your drug coverage to a more beneficial situation to you. If you aren't sure if this SEP applies to you, call 1-800-MEDICARE, visit www.medicare.gov, contact your local OFA office or call me with questions.
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Janell Sluga is a geriatric care manager certified and works for Senior Life Matters, a program of Lutheran Senior Housing. She has worked in Chautauqua County with Seniors for more than 16 years. She is HIICAP - Health Insurance Information, Counseling and Assistance Program - counselor trained by Office For the Aging.
She does not sell insurance, or represent any insurance company. She is an unbiased source of insurance and education to help seniors choose the best option for them.
You may submit questions to be answered in later columns to Janell Sluga, at Senior Life Matters 737 Falconer St. Jamestown, NY 14701 or by e-mail at janells@lutheran-jamestown.org. Please remember that not all questions can be answered in this format, but as many as can be, will be.
