Given at the 2014 AOCSN Conference – Medicare Workshop Presentation

1. Peace HavenPeace Haven
Medicare WorkshopMedicare Workshop

2. Medicare has offered a ChristianMedicare has offered a Christian
Science benefit since 1966Science benefit since 1966
 President Lyndon Johnson signedPresident Lyndon Johnson signed
Medicare amendment to SocialMedicare amendment to Social
Security Act on July 30, 1965.Security Act on July 30, 1965.

3. MEDICARE PART AMEDICARE PART A
 Part A – Hospital Insurance –Part A – Hospital Insurance –
covers stay in a Religiouscovers stay in a Religious
Nonmedical Health CareNonmedical Health Care
Institution or Hospital.Institution or Hospital.
 Christian Science NursingChristian Science Nursing
Facilities are called RNHCIs.Facilities are called RNHCIs.

4. MEDICARE PART AMEDICARE PART A
 Most people receive premium-free Part A coverage.Most people receive premium-free Part A coverage.
Part A is available for no cost at the age of 65 if:Part A is available for no cost at the age of 65 if:
– You are eligible for benefits from Social Security orYou are eligible for benefits from Social Security or
the Railroad Retirement Boardthe Railroad Retirement Board
– If you or your spouse worked at least 40 quarters,If you or your spouse worked at least 40 quarters,
oror
– You or your spouse had Medicare-coveredYou or your spouse had Medicare-covered
government employmentgovernment employment
 Those few who will want to purchase Part A, will payThose few who will want to purchase Part A, will pay
up to $426 each month.up to $426 each month.

5. MEDICARE PART AMEDICARE PART A
 If you're under the age of 65, you may beIf you're under the age of 65, you may be
eligible for Part A if you are disabled or haveeligible for Part A if you are disabled or have
other specific healthcare needs.other specific healthcare needs.
 The websiteThe website www.medicare.govwww.medicare.gov explainsexplains
the specific requirements.the specific requirements.
 In most cases, if you choose to purchaseIn most cases, if you choose to purchase
Part A, you must also have Medicare Part BPart A, you must also have Medicare Part B
and pay monthly premiums for both.and pay monthly premiums for both.

6. MEDICARE PART AMEDICARE PART A
 Some individuals will automatically beSome individuals will automatically be
enrolled in Medicare Part A and B.enrolled in Medicare Part A and B.
– If you are automatically enrolled, you willIf you are automatically enrolled, you will
receive your Medicare card in the mail 3receive your Medicare card in the mail 3
months before your 65th birthday.months before your 65th birthday.

7. MEDICARE PART AMEDICARE PART A
 Some individuals are not automaticallySome individuals are not automatically
enrolled in Medicare and will need toenrolled in Medicare and will need to
sign up for Medicare Part A and B.sign up for Medicare Part A and B.
– This includes those who aren’t receivingThis includes those who aren’t receiving
social security benefits yet because theysocial security benefits yet because they
are working.are working.
– If you need to sign up, contact the SocialIf you need to sign up, contact the Social
Security Administration or a SocialSecurity Administration or a Social
Security Office 3 months before your 65Security Office 3 months before your 65thth
birthday.birthday.

8. MEDICARE PART AMEDICARE PART A
 If you were still working at the age ofIf you were still working at the age of
65 and were covered by your65 and were covered by your
employer’s insurance plan, you mayemployer’s insurance plan, you may
want to contact the Medicarewant to contact the Medicare
Coordinator of Benefits and let themCoordinator of Benefits and let them
know that you are no longer workingknow that you are no longer working
so they can record Medicare as yourso they can record Medicare as your
primary payer.primary payer.

9. MEDICARE PART AMEDICARE PART A
 How to Sign Up for Part A and BHow to Sign Up for Part A and B
– Apply online at Social SecurityApply online at Social Security
– Visit your local Social Security officeVisit your local Social Security office
– Call Social Security at 1-800-772-1213Call Social Security at 1-800-772-1213
– If you worked for a railroad, call 1-877-If you worked for a railroad, call 1-877-
772-5772772-5772
 You don’t need to sign up for MedicareYou don’t need to sign up for Medicare
annually. However, each year you canannually. However, each year you can
review and change your benefits.review and change your benefits.

10. MEDICARE PART BMEDICARE PART B
 Part B – Medical Insurance which includes medicalPart B – Medical Insurance which includes medical
procedures, doctors, equipment, ambulanceprocedures, doctors, equipment, ambulance
services, etc…services, etc…
 Most people pay a monthly premium currentlyMost people pay a monthly premium currently
between $104.90 to $335.70 per month, based onbetween $104.90 to $335.70 per month, based on
income.income.
 Automatically enrolled in Part B, unless youAutomatically enrolled in Part B, unless you
specifically decline.specifically decline.
 Part B cannot be used in a Christian SciencePart B cannot be used in a Christian Science
Nursing Facility.Nursing Facility.
 Medigap or Medicare Supplement Insurance policyMedigap or Medicare Supplement Insurance policy
may require that you have Part B coverage.may require that you have Part B coverage.

11. MEDICARE PART BMEDICARE PART B
 How to Drop Part BHow to Drop Part B
– If your Medicare coverage hasn’t startedIf your Medicare coverage hasn’t started
yet:yet:
 And you were automatically enrolled in bothAnd you were automatically enrolled in both
Part A and Part B and sent a Medicare card,Part A and Part B and sent a Medicare card,
follow the instructions that come with thefollow the instructions that come with the
card, and send the card back. If you keep thecard, and send the card back. If you keep the
card, you keep Part B and will pay Part Bcard, you keep Part B and will pay Part B
premiums.premiums.
 Or if you signed up for Medicare versus beingOr if you signed up for Medicare versus being
automatically enrolled, contact Social Securityautomatically enrolled, contact Social Security
to drop Part B. to drop Part B.

12. MEDICARE PART BMEDICARE PART B
– If your Medicare coverage has alreadyIf your Medicare coverage has already
started:started:
 Contact Social Security for instructions onContact Social Security for instructions on
how to submit a signed request to drop Parthow to submit a signed request to drop Part
B. Your coverage will end the first of theB. Your coverage will end the first of the
month after Social Security gets your request.month after Social Security gets your request.
– You generally won’t be able to re-enroll inYou generally won’t be able to re-enroll in
Part B until the next enrollment periodPart B until the next enrollment period
(January 1 – March 31st) and you will(January 1 – March 31st) and you will
have to pay a late enrollment penalty,have to pay a late enrollment penalty,
which can be substantial. which can be substantial.

13. MEDICARE PART CMEDICARE PART C
 Part C – includes Managed CarePart C – includes Managed Care
Organizations, also known as HMOsOrganizations, also known as HMOs
(health maintenance organizations)(health maintenance organizations)
and PPOs (preferred providerand PPOs (preferred provider
organizations)organizations)
– Require prior written authorization forRequire prior written authorization for
coverage in a Christian Science Nursingcoverage in a Christian Science Nursing
Facility which can be difficult to obtain.Facility which can be difficult to obtain.
– Authorization must happen beforeAuthorization must happen before
admission or immediately upon arrival.admission or immediately upon arrival.

14. MEDICARE PART DMEDICARE PART D
 Part D – Prescription Drug Service –Part D – Prescription Drug Service –
most people pay a monthly premium.most people pay a monthly premium.
Insurance provided by privateInsurance provided by private
companies.companies.
 Part D cannot be used in a ChristianPart D cannot be used in a Christian
Science Nursing Facility.Science Nursing Facility.

15. REQUIREMENTS FORREQUIREMENTS FOR
MEDICARE COVERAGEMEDICARE COVERAGE
 For Medicare to cover ChristianFor Medicare to cover Christian
Science Nursing Care at a ChristianScience Nursing Care at a Christian
Science Nursing Facility, theScience Nursing Facility, the
beneficiary (patient) must:beneficiary (patient) must:
– sign an election formsign an election form
– have a condition that would qualify him orhave a condition that would qualify him or
her forher for inpatient care in a hospital or ainpatient care in a hospital or a
skilled nursing facilityskilled nursing facility
 A skilled nursing facility is not the same as aA skilled nursing facility is not the same as a
nursing homenursing home

17. MEDICARE ELECTIONSMEDICARE ELECTIONS
 When a patient is admitted, the patient willWhen a patient is admitted, the patient will
sign an election upon admission so it issign an election upon admission so it is
available for Medicare.available for Medicare.
 The election form is only sent to Medicare ifThe election form is only sent to Medicare if
the patient’s care level qualifies forthe patient’s care level qualifies for
Medicare.Medicare.
 Once an election is sent to Medicare it is inOnce an election is sent to Medicare it is in
effect until it is revoked by the patient.effect until it is revoked by the patient.

18. MEDICARE ELECTIONSMEDICARE ELECTIONS
 Prior to the filing of an election form, aPrior to the filing of an election form, a
Christian Scientist can use MedicareChristian Scientist can use Medicare
for medical services or supplies and itfor medical services or supplies and it
won’t impact the use of Medicare in awon’t impact the use of Medicare in a
Christian Science Nursing Facility.Christian Science Nursing Facility.
 After an election is filed, there areAfter an election is filed, there are
consequences associated with usingconsequences associated with using
Medicare for medical services andMedicare for medical services and
supplies.supplies.

19. MEDICARE ELECTIONSMEDICARE ELECTIONS
 Receiving medical care after anReceiving medical care after an
election is establishedelection is established
– Once – no waiting period.Once – no waiting period.
– Twice – 1 year waiting period.Twice – 1 year waiting period.
– Three Times – 5 year waiting period.Three Times – 5 year waiting period.
 A revocation doesn’t occur again untilA revocation doesn’t occur again until
a new election is filed.a new election is filed.

20. MEDICARE ELECTIONSMEDICARE ELECTIONS
 Example: a patient receives ChristianExample: a patient receives Christian
Science Nursing Care and signs anScience Nursing Care and signs an
election form. The patient thenelection form. The patient then
receives medical care.receives medical care.
– This creates one revocation.This creates one revocation.
– After the revocation occurs the patientAfter the revocation occurs the patient
can receive as much medical care ascan receive as much medical care as
they need or want.they need or want.

21. MEDICARE ELECTIONSMEDICARE ELECTIONS
– Then the patient returns to a ChristianThen the patient returns to a Christian
Science Nursing Facility. AfterScience Nursing Facility. After
discharging the facility the patientdischarging the facility the patient
purchases a wheelchair and usespurchases a wheelchair and uses
Medicare to pay for the purchase. TheMedicare to pay for the purchase. The
patient has just created a secondpatient has just created a second
revocation. Now the patient must wait onerevocation. Now the patient must wait one
year to re-enter a Christian Scienceyear to re-enter a Christian Science
Nursing Facility under Medicare.Nursing Facility under Medicare.

22. DETERMININGDETERMINING
COVERAGECOVERAGE
 Medicare does not require a medicalMedicare does not require a medical
diagnosis for Christian Scientistsdiagnosis for Christian Scientists
receiving care in a Christian Sciencereceiving care in a Christian Science
Nursing Facility.Nursing Facility.
 Using guidelines from Medicare, aUsing guidelines from Medicare, a
Christian Science Facility Nurse willChristian Science Facility Nurse will
determine if a patient’s care needsdetermine if a patient’s care needs
qualify for Medicare.qualify for Medicare.

23. MEDICARE COVERSMEDICARE COVERS
 Part A Includes: Christian SciencePart A Includes: Christian Science
Nursing ServicesNursing Services
 Room and mealsRoom and meals
 Most nursing suppliesMost nursing supplies

24. MEDICARE DOES NOTMEDICARE DOES NOT
COVERCOVER
 Christian Science Nursing Care thatChristian Science Nursing Care that
does not require adoes not require a JournalJournal-listed-listed
Christian Science NurseChristian Science Nurse
 Christian Science PractitionersChristian Science Practitioners
 Personal items such as telephone andPersonal items such as telephone and
hairdresser chargeshairdresser charges
 Rest and studyRest and study
 Private duty or home nursingPrivate duty or home nursing

25. PART A: WHAT YOUPART A: WHAT YOU
PAY (2014 Rates)PAY (2014 Rates)
Initial Period
60 days
Lifetime
Reserve
60 days
Co-insurance
Period 30 days
$1,216
Deductible
$304 per day
$608 per day

26. PART APART A
COVERAGECOVERAGE
 Medicare is designed for short term staysMedicare is designed for short term stays
and ends when the patient no longer has aand ends when the patient no longer has a
condition that would qualify for Medicarecondition that would qualify for Medicare
coverage in a hospital or a skilled nursingcoverage in a hospital or a skilled nursing
facility.facility.
 Christian Science nurses expect quickChristian Science nurses expect quick
healing. This progress may result inhealing. This progress may result in
nursing determining that the patient’snursing determining that the patient’s
condition no longer warrants Medicarecondition no longer warrants Medicare
coverage.coverage.

27. EXAMPLE OFEXAMPLE OF
COVERAGECOVERAGE
 Days 1 to 60 - all inclusive flat rate -Days 1 to 60 - all inclusive flat rate -
$420/day$420/day
--------------------------------------------------------------------------------------------------
Month 1 (30 days) x $420 = $12,600Month 1 (30 days) x $420 = $12,600
Month 2 (30 days) x $420Month 2 (30 days) x $420 = $12,600= $12,600
Total ChargesTotal Charges ==
$25,200$25,200
You Pay $1,216You Pay $1,216

28. USING MEDICAREUSING MEDICARE
AGAINAGAIN
 Although Medicare is a short-term program, itAlthough Medicare is a short-term program, it
may be used more than once.may be used more than once.
 If 60 days has passed between stays in aIf 60 days has passed between stays in a
Christian Science Nursing Facility, anotherChristian Science Nursing Facility, another
deductible must be paid by the patient.deductible must be paid by the patient.
 If less than 60 days has passed betweenIf less than 60 days has passed between
stays in a Christian Science Nursing Facilitystays in a Christian Science Nursing Facility
and the patient has Medicare days remaining,and the patient has Medicare days remaining,
then Medicare picks up where it left off whenthen Medicare picks up where it left off when
the patient discharged.the patient discharged.

29. USING MEDICAREUSING MEDICARE
AGAINAGAIN
 Medicare may be used again at aMedicare may be used again at a
Christian Science Nursing Facility if:Christian Science Nursing Facility if:
– The patient is out of the facility for 60The patient is out of the facility for 60
days and does not use Medicaredays and does not use Medicare
anywhere.anywhere.
– Or, the patient remains in a ChristianOr, the patient remains in a Christian
Science Nursing Facility but at a lowerScience Nursing Facility but at a lower
level of care for 60 consecutive days.level of care for 60 consecutive days.

30. MEDICAID VSMEDICAID VS
MEDICAREMEDICARE
 MedicareMedicare
– Age 65 or older or disabledAge 65 or older or disabled
– Short termShort term
– Skilled careSkilled care
– No financial requirementsNo financial requirements
 MedicaidMedicaid
– Age 65 or older or disabledAge 65 or older or disabled
– Short or long termShort or long term
– Includes skilled and non-skilled careIncludes skilled and non-skilled care
– Less than $1,500 in financial assets (Ohio)Less than $1,500 in financial assets (Ohio)

31. MEDICAIDMEDICAID
 Two states with Christian ScienceTwo states with Christian Science
Nursing Facilities ther offer MedicaidNursing Facilities ther offer Medicaid
coverage to Christian Scientistscoverage to Christian Scientists
– OhioOhio
– California (MediCal)California (MediCal)

32. PHONE NUMBERS &PHONE NUMBERS &
WEBSITESWEBSITES
 MedicareMedicare
1-800-633-42271-800-633-4227
www.medicare.govwww.medicare.gov
 Social Security AdministrationSocial Security Administration
1-800-772-12131-800-772-1213
www.socialsecurity.govwww.socialsecurity.gov
 Peace HavenPeace Haven
1-314-965-38331-314-965-3833
www.peacehavenassociation.orgwww.peacehavenassociation.org

33. FACILITY PAYMENTSFACILITY PAYMENTS
 It is important to understand thatIt is important to understand that
neither Medicare or Medicaid coverneither Medicare or Medicaid cover
100% of the facility’s costs to operate100% of the facility’s costs to operate
and provide care.and provide care.
 An inherent amount of benevolence isAn inherent amount of benevolence is
given to all those who have Medicaregiven to all those who have Medicare
or Medicaid as their payer.or Medicaid as their payer.

34. INSURANCE FOR CSINSURANCE FOR CS
Three major types of insurance:Three major types of insurance:
 Medigap (Medicare Supplement)Medigap (Medicare Supplement)
 General Health Insurance PoliciesGeneral Health Insurance Policies
 Long Term Care (LTC)Long Term Care (LTC)

35. MEDIGAPMEDIGAP
Medicare Supplement InsuranceMedicare Supplement Insurance
 This covers the Medicare deductibleThis covers the Medicare deductible
and coinsurance. It may also coverand coinsurance. It may also cover
care after exhaustion of Medicarecare after exhaustion of Medicare
benefits.benefits.

36. HEALTH INSURANCEHEALTH INSURANCE
POLICIESPOLICIES
 Can be challenging to bill for coverage.Can be challenging to bill for coverage.
 Make sure Christian Science care isMake sure Christian Science care is
specificallyspecifically mentioned in the policy.mentioned in the policy.
 Don’t just accept that the policy will payDon’t just accept that the policy will pay
because the insurance agent says so.because the insurance agent says so.

37. LONG TERM CARELONG TERM CARE
(LTC)(LTC)
 Long Term Care InsuranceLong Term Care Insurance
– No diagnosis is usually requiredNo diagnosis is usually required
– Patient must need assistance with at least 2Patient must need assistance with at least 2
Activities of Daily Living (ADLs)Activities of Daily Living (ADLs)
 Examples of ADLs are mobility, eating,Examples of ADLs are mobility, eating,
dressing, etc…dressing, etc…
– Insurance companies generally only ask forInsurance companies generally only ask for
proof that care is being providedproof that care is being provided
– Benefits are usually significantly less than otherBenefits are usually significantly less than other
Health Insurance coverage ($100 - $200 a day)Health Insurance coverage ($100 - $200 a day)

38. INSURANCEINSURANCE
COMPANIESCOMPANIES
 Peace Haven does not recommendPeace Haven does not recommend
insurance, but the following companiesinsurance, but the following companies
have paid in the past:have paid in the past:
– United Health Care (Medicare Supplement)United Health Care (Medicare Supplement)
– AARP (Medicare Supplement)AARP (Medicare Supplement)
– UNUM (LTC)UNUM (LTC)
– SCS/Monumental (LTC)SCS/Monumental (LTC)

39. CONCLUSIONCONCLUSION
 Questions & AnswersQuestions & Answers
 Followed by a quick AffordableFollowed by a quick Affordable
Care Act UpdateCare Act Update