Increase Medicare Home, Nursing and Lab Services???

Medicare does not charge a copay for patients whose doctors prescribe home health care for the first 20 days in a skilled nursing facility.  Several proposals would require a copay for home health care, including one that would require a payment of $100 for home health episodes with 5 or more home health visits and add copays for the 1st 20 days of care in a skilled nursing facility (nursing home).  Medicare does not currently require a copay for laboratory services (such as blood and diagnostic tests).  A number of proposals would require beneficiaries to pay 20% of the cost of laboratory services

Pro:  Imposing a copayment for home health, skilled nursing facility and laboratory services will discourage unnecessary use of these services.  Shifting more of the cost for these services to Medicare beneficiaries will also reduce Medicare costs and help to improve the long-term stability of the program.  Most Medicare supplemental insurance plans would cover at least a portion of the cost-sharing, which would lessen the financial burden of these proposals on the majority of beneficiaries who have supplemental coverage.  (Avalere Health)

Con:  Many Medicare beneficiaries — particularly those who are low-income and do not qualify for any additional assistance — will have trouble affording new copayments for home health, skilled nursing facility and laboratory services.  These individuals may end up not receiving needed care or services.  Even Medicare beneficiaries with supplemental policies could face higher out-of-pocket costs, as premiums would likely rise to offset the higher copays.  State governments would also pay more, as Medicaid would be responsible for the copayments of low-income Medicare beneficiaries who receive assistance from Medicaid.  (Avalere Health)

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About alonegwen

Retired educator interested in living life fully. Will write about aging wisely, good reads, food, travel, dance reviews, and other items as they interest me.
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2 Responses to Increase Medicare Home, Nursing and Lab Services???

  1. Blonduxo says:

    Speaking as a home health nursing professional I would venture to say that in the milieu I work in I have never seen an instance where home health, skilled nursing facility and laboratory services have been prescribed, are agreed to, but are unnecessary. In today’s post-hospitalization health care market the trend is to prescribe services only when they are absolutely necessary. Cost shifting to the patient in my experience often forces people to make difficult choices sometimes to forgo recommended therapies or tests which can have a negative impact on their future well being.
    Keep in mind that the high costs of hospitalization, i.e. performing every test under the sun to definitively diagnose an illness-which is done to prevent litigation-is where cost savings could potentially occur. Another would be for everyone regardless of age to consider and determine in writing their advance directives which would guide decision making should the individual not be in a state where they could be their own decision maker and their preferences could be honored relieving the family of often heart-wrenching and not always 100% agreed upon courses of action.
    Another point to consider is that hospitals and skilled nursing facilities have an obligation to discharge patients to a safe environment for their particular circumstance therefore those medicare beneficiaries who are low-income and may not qualify for any additional assistance in a future co-pay situation would likely remain in the acute or sub-acute setting until they met that standard.

    • alonegwen says:

      Thank you for your excellent response! I am attempting to inform about proposals that are out there for the future of Medicare. is an AARP site. AARP is trying to gather information and opinions from members and non members about the future of Medicare and Social Security. Thanks again for reading…

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