I took mom to an eye doctor appointment because she was complaining of not seeing and having scratchy eyes. Doc put her on antibiotic and asked her to use a warm compress. But it seems Medicare and Wellmark are not paying since this service isn't covered.
My mother's Medicare plan and supplement paid for no eye doctors. My plan, which is Kaiser, pays for both Optometrist and Opthamologist services within the Kaiser organization. You should check your supplemental plan to see what they do and do not cover.
1. Does your mom’s original Medicare policies cover the eye treatments she requires?
https://www.medicare.gov/coverage/eyeglasses-contact-lenses
The above link may help you better understand what is covered. Many factors are involved including does the doctor she is going to accept Medicare insurance?
Doctors offices usually know right away if your insurance will pay for the treatment you are requesting or they are recommending. But if you are unsure, call Medicare or look on the Medicare.gov website.
There is a search available on the above link that allows you to input your test and see if it’s covered.
2. Does her supplement cover the eye treatments your mom requires?
The supplement only pays if Medicare pays. The purpose of the supplement is to pay all or part of the 20% that Medicare doesn’t pay. There is no need to call the supplement to see if it pays. They will tell you only if Medicare has paid on the bill. Some treatments are completely covered by Medicare and then the supplement doesn’t pay because there is nothing left owing. But of course you can call them and they will explain to you how they pay.
3. Many of the medications for the eyes are very expensive.
Part D pays for medications and that depends on the plan that is chosen. We are reminded to be sure to compare our Part D this fall to make sure the meds we need are covered by the plan we choose.
4. Does your mom’s original Medicare Part A, part B and part D and supplement still pay when mom is on hospice?
It will continue to pay as it would have before going on hospice if used for something it covers.
It isn’t clear if mom is on hospice at this time. If she goes on hospice it will be for a specific reason.
Let’s use as an example cancer as the reason one might go on hospice.
If a person is told they have an incurable cancer and no more curative treatment will be given, then the patient has the option of going on hospice for additional care, supplies, equipment and stronger meds to control pain or to keep her comfortable.
One can keep their existing health insurance and use it for other issues that might occur that have nothing to do with the reason they are on hospice.
So if your mom is on hospice, you need to understand what hospice used as the reason she qualified at this time.
This is a choice of whether or not to keep the insurance she already has in place. It is not required to keep in order to have hospice but it is still useful if curative treatment is sought for other issues that the person chooses to treat. Not everyone who is on hospice is actively dying.
All of the comments I have made are for Original Medicare. There are many different Advantage plans. If a person has one of those, they need to call the number on their insurance card and ask their questions.
Your headline question was “Will mom’s Medicare and Supplement policy benefits end when she goes into hospice?”
No, they won’t end unless you cancel her policies. Even then Part A will stay in effect. The caveat is you can’t use hospice and Medicare plans to treat the same issue. One is for end of life care (hospice) and the other is health insurance for curative care. A supplement never pays unless Medicare pays first.
The supplement is to “supplement” what Medicare DOES pay for. If Medicare (original Medicare) does not pay on the doctors bill, then neither will the supplement.
Hospice does not allow Doctor or Hospital visits. Its end of life care. Some life saving measures are discontinued. Like chemo and dialysis. Its comfort care.
Medicare covers hospice services under Medicare Part A. If your mother is enrolled in hospice, Medicare will continue to cover hospice services, such as pain relief, symptom management, medical and nursing services, and support for both the patient and family. Medicare coverage may shift to focus on comfort care rather than curative treatments once hospice begins. It’s important you speak with the hospice provider to understand exactly what will be covered.
In addition, contact Medi-care and ask them.
Generally, once in Hospice, they handle / direct all medical care - which is for COMFORT CARE only.
These services mentioned may not be paid by Medicare or Wellmark in any case. You need to ask them why they didn't / aren't paying.
Gena / Touch Matters
I myself would take a hard and fast list of assets and income and go to an elder law attorney. I think they are best at guiding you how to proceed and how to arrange the assets to be paid directly for her care, with the rest of the care picked up by Medicaid once she qualifies for needing care.
See All Answers