• imgs
    Aging Well Partners
  • Sep 04
  • 3 min

Your Coverage, Your Choice.

Your Coverage, Your Choice.

Kie CopenhaverMA, RHIA, CSA, RCFE, SHSS

One of my passions is advocating for choice with our aging clients. Everyone appreciates having a choice. When it comes to our aging population, I believe they have earned the right to be given the information necessary to make informed choices about their health, healthcare coverage and wellbeing.  So, let’s talk about some often overlooked choices Medicare participants are entitled to under their policies.

Skilled Nursing Facility (SNF)

You, as a Medicare participant, have a choice of which SNF you are discharged to if you find yourself in the hospital and needing additional care and rehabilitation before going home. Medicare has a “Nursing Home Compare” website where anyone can look at the Centers for Medicare and Medicaid (CMS) star rating system for all participating SNFs. Here is a screen shot of a search I did using the zip code 92115.

When you get to this website, you can search the various SNFs by zip, city, state or by specific name. https://www.medicare.gov/nursinghomecompare/search.html

Us the arrows at the top of each column heading to sort the column from most to least stars or least to most stars.  As you can see from the screen shot, you can sort using five different categories:  overall rating of the SNF, health inspections, staffing, quality measures (set by CMS) and distance. Some information will be listed as “Not Available”; if you hold your cursor over the number following “Not Available” (see above the number 2 is listed by Not Available on the second SNF listed in the screen shot), you will get a text box telling you there was insufficient data to compile a rating for this particular facility in this category.  A number of reasons could contribute to insufficient reporting data – if, for instance, you really wanted to go with Boulder Creek Post Acute SNF from the screen shot, it may be worth a call to the facility to understand why there was insufficient data for CMS to assign a star rating on Staffing.

 

Home Health Services

Part A and/or Part B of your Medicare plan covers home health benefits. You will want to read your “Medicare & You 2021” booklet for more specifics on this coverage.

Similar to SNFs, the Medicare beneficiary can go onto the Medicare.gov website to compare various Home Health agencies. If you have Medicare, you have your choice of Home Health agencies to work with.  You may end up needing Home Health after a hospital or SNF stay or if your Primary Care Physician (PCP) writes an order for some kind of therapy to help you maintain your health status/condition (i.e., PT, OT, ST, RT). Ask your PCP or discharge planner about Home Health services.

 

Hospice

As a Medicare participant, you or your loved one has your choice of hospice agencies to work with when/if the time comes. To qualify for hospice care, one must be terminally ill and have a life expectancy of 6 months or less to live. Hospice care and palliative care are not the same thing; palliative care is also known as comfort care, with the goal being to keep someone comfortable and out of pain (often palliative care is done in conjunction with hospice services). There are many other aspects of hospice – clinical services, medications for pain management, durable medical equipment (DME), spiritual and grief counseling, and music therapy – to name a few. You or a family member may visit https://www.medicare.gov/hospiceCompare/ to more closely examine hospice companies that may have been recommended or referred. This CMS database is not set up in the same fashion as the other two comparison sites. If you want additional information on a hospice company and their CMS scores (compared to a national average), give Aging Well Partners a call. We can help you navigate the research and comparison so as to find the agency right for you and your loved one.

 

Not all SNFs, Home Health agencies and Hospice companies are created equal. As a healthcare recipient and more specifically, a Medicare recipient, it is up to you to do your research to ensure you are working with the best and highest rated companies and organizations out there. Let us help you delve into the research, crunch the numbers, and find the service provider(s) that works for you! You have CHOICE. We are here to ensure that our expertise and advocacy is helping you navigate your health and wellbeing path and the choices you have in healthcare services and service providers.

 

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