Why is Medicare So Confusing?
The staff of Visiting Nurse Home Care have recently come face to face with the perplexing and sometimes frustrating world of Medicare. VNHC is not "Medicare Certified", meaning we do not provide Medicare-covered nursing services (like Option Care or St Frances Home Care). But one season a year, we administer flu shots as a public service for our community.
In years past, we have always been able to submit a roster of names to Medicare (sometimes referred to as C.M.S.) and they (slowly but surely) reimbursed us for giving shots as a Medicare benefit. This year, many dozens of claims were denied and we were surprised to learn that the advent of the new Medicare Advantage plans may spell the doom of our influenza immunization program. We find ourselves in a "Catch-22" of not being allowed to bill the Advantage plans because we are not "Medicare Certified" and not being reimbursed by Medicare because clients have enrolled in Medicare Advantage.
The outcome for us has been a significant outlay of cash to buy vaccine, pay clerical and nursing payroll costs, the time spent making multiple submissions of our claims to Medicare - and we are left holding the (empty) bag. This bureaucratic circle has left us wondering about the tail and the dog, and who's wagging whom?
So we sympathize with seniors who try to negotiate their way through the Medicare system and all its differing policies. Do you know the difference between Part A and Part B of Medicare (not to mention Part D)? Do you know the difference between a supplemental and an advantage plan? Do you know how much each of these things cost?
Thankfully, Washington State is a place where people can get help with trying to find, choose and use health coverage. The SHIBA HelpLine, a volunteer-based organization, is a service whose mission is to give free, unbiased information about health care access or insurance. They can help people understand their health coverage, compare health care insurance policies, find a prescription drug plan, and learn their rights and options. They take the time to help people get affordable coverage and understand it. They also advocate for people who suspect fraud.
The SHIBA statewide number is 1-800-562-6900.
Whatcom County: Whatcom Alliance for Healthcare Access (360)715-6533
Skagit County: Skagit County Community Action Agency (360)416-7004
East Skagit County: United General Hospital (360)856-7298
West Skagit County (including San Juan County & North Whidbey): Island Hospital, (360)299-4212.
South Whidbey Island: Senior Services of Island County at (360)321-1600 or toll free at 1-800-673-6981 for Coupeville / Freeland.
And, as always, contact Senior Information and Assistance (in the phone book) across the nation for other resources to unravel the many threads that hold our long-term care system together.
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