Living Smart for Seniors

Lake County, Florida

Finding insight as we go

This Blog was created out of a need that I saw when working with the senior population as a Speech Therapist over 10 years. Many issues would come up and repeat themselves, such as a family not understanding Medicare or how to deal with a loved one whose Dementia was turning them to be combative. Over time I felt I was getting so many lessons on how to prepare for my future and even prevent much of what I saw that I felt the need to share it so that maybe it helps at least one other person. Over time, I hope to collaborate with other professionals to make this a more thourough as well as enjoyable place to get informed. 

3 Tips When Using Medicare For Therapy

1. Medicare A or Medicare B?

Medicare A is used after having a qualifying hospital stay for your home health services. This includes nurse visits, as well as Physical Therapy, Occupational Therapy, and Speech Therapy. This is best for when the person still needs more nursing services and less therapy due to medical complications. Medicare A restricts how often a person can receive therapy services. Medicare B is best used when you no longer need the skills of a nurse to visit and really need more intensive therapy care as there are no restrictions on how often you can be seen as long as it is medically necessary.


2. How Do I switch from Medicare A to Medicare B?

If you are receiving home health services after a qualifying hospital stay and no longer need the services of the nurse, but are ready for more intensive or ongoing therapy you should request a discharge from your home health agency from your Medicare A benefits. Many home health agencies are not providers for Medicare B benefits, so you would either have to go to an outpatient center or find a mobile therapy company that comes to you. Private therapy services are another option as more and more therapists are starting their own practice and becoming Medicare B Providers.


3. Never pay more than your 20% co-pay

 Under Medicare B benefits you will have a 20% co-pay (unless you have supplemental insurance). But how do you know if you are paying your therapist too much? One way is to visit The Fair Health Consumer and look up the codes provided on your superbill. This is much easier than trying to understand the Medicare Fee Schedule. Most agencies will have rates that are much higher than what Medicare allows. However when providing therapy services to anyone with Medicare benefits, they must lower their rates to the Medicare Fee Schedule or lower.