Home Health & Hospice Week

'Limited open enrollment period' likely to snare some seniors -- and risk home care and HME coverage.

A little-known Medicare open enrollment period that commenced on April Fool's day could prove to be no laughing matter for seniors who need home care services and equipment.

This "limited open enrollment period," allows people in traditional Medicare to opt for Medicare Advantage (MA) plans--plans that may not include adequate coverage for home medical equipment, Vicki Gottlich of the Washington, DC-based Center for Medicare Advocacy tells Eli. The same goes for home health agency services.

Background: The open enrollment period for MA plans was signed into law on Dec. 20, 2006 by President Bush as part of the Tax Relief and Health Care Act of 2006, one of the last pieces of legislation passed in the waning days of the last Congress. The limited open enrollment period runs from April 1 through Dec. 31, 2008.

The concern: Many Medicare beneficiaries will be caught unprepared if they're approached by an MA plan about making a switch during the limited open enrollment period.

"Beneficiaries should look carefully at coverage for durable medical equipment," says Gottlich. "We have seen some Medicare Advantage plans that require more than the 20 percent co-insurance that traditional Medicare charges for durable medical equipment."

Bottom line: Suppliers should strive to help educate consumers about the difference in traditional Medicare and Medicare Advantage. Doing so can help you stave off losses in Medicare revenue.

Beneficiaries, Providers Decry Coverage Problems In Mainstream Press

A recent Associated Press article describes beneficiaries who have been shocked to learn their Medicare MCO doesn't cover much home care, or at least not with the provider they have been using.

Many home care patients are not told or don't know to ask which companies are in their network, said Tina Morgan with Fort Wayne-based A Step Better, which sells diabetes shoes and inserts.

"These plans are ... signing up people who are really not capable of (making) these decisions," Morgan told AP. "I've been there, heard them in senior or apartment complexes saying, 'Throw away all your (Medicare) cards. We'll take care of everything.'"