Medicare Appeals: How Older Adults Can Succeed in Getting the Coverage They’re Entitled to

On average, seniors are each taking 15 – 18 different prescribed medications, so Medicare coverage of these medicines is often extremely important. And with a typical price tag of greater than $11,000 annually for the most typical medicines prescribed for the elderly, it could be debilitating when Medicare suddenly denies coverage. Nevertheless, that’s taking place ever more frequently as Medicare plans are progressively establishing coverage limits on seniors – generally outside of affirmation from the Centers for Medicare & Medicaid Services.

Because the Medicare appeals process for denied coverage can be so intimidating, unfortunately, a great many aging adults just accept the denial – at frequently an outrageously high financial impact, and also at potential risk to their health when necessary medicines are discontinued because of lack of Medicare insurance coverage. As stated by David Lipschutz, senior policy attorney at the Center for Medicare Advocacy, “A lot of people fall through the cracks. They simply don’t know what to do. Or they try to go through the process, and it’s complicated and time-consuming and they just give up.”

Even though several medications must be covered by Medicare across the board (those for HIV/AIDS, depression, cancer, and seizures, to name a few), there’s a gray area by which medications are covered for other conditions – and preapproval is oftentimes required, or patients are given the criteria that lower cost methods need to be used first (also known as step therapy). Denials usually come as a result of neglecting to satisfy these requirements.

So, exactly what can a senior try to receive the drug insurance coverage to which they’re entitled? There are particular important steps:

  • First, obtain a formal coverage determination from the senior’s Medicare drug plan. Details on submitting this specific request can be found by clicking here.
  • When coverage is determined, there are five levels in the Medicare appeals process, detailed here.
  • Keep detailed documentation throughout every step of the process. To get more guidance, the Medicare Rights Center can help. You can reach them at 800-333-4114.

Keep in mind that it’s important to be persistent. Frequently, higher levels of Medicare appeals are approved even though initial steps result in disheartening results. Contact Endeavor Home Care, the number one San Diego home care team, for additional tips and hands-on assistance for seniors. We are able to provide resources that will help seniors in addition to their family members advocate for themselves, as well as specialized in-home care services to ensure that medications are taken just as prescribed, that prescription medication refills are taken care of, and much more. Call us at (480) 535-6800 and learn how to keep your senior loved one safe and flourishing!

Endeavor Home Care’s Top Elderly Travel Tips

Summer vacations are something everyone looks forward to! Exploring new destinations, leaving the worries of our everyday world behind, checking items off our bucket lists. And helping a senior loved one enjoy such a thrill makes it all the better. You will find, however, certain factors to keep in mind that can help pave the way to successful elderly travel:

  • Schedule a pre-trip physician visit. To be certain your senior family member is physically able to comfortably cope with the rigors of a lengthy car trip or air travel, and all that your intended destination has to offer, a check-up with the senior’s doctor is essential. You can use this opportunity to determine what prescription medications he or she must take along, any kind of dietary restrictions to adhere to, and any other concerns or tips to keep in mind.
  • Keep your plans senior-friendly. You’ll want to plan plenty of time for rest, and figure out the top points of interest that you want to make a goal to see, with a few other backup choices which might be added in if your elderly loved one’s tolerance allows. It’s also useful to research available amenities provided to senior citizens – motorized scooter and wheelchair rentals, accessible entrances and walkways, preferential seating and also early admission times, and so on.
  • Plan for the unexpected. Keep a directory of emergency contact numbers in your phone, and take a printed list as well. It’s also useful to verify the location of the closest hospital to where you’ll be staying, together with other possibly necessary amenities such as restrooms and areas to stop for meals, refreshments, or additional supplies. Also be sure your family member has an identification card with your name and cell phone number listed, in the event that he/she happens to become separated from you.
  • Take it easy and enjoy yourself! It’s natural to fall into a pattern of protection with our aging loved ones, and certainly we would like to keep them safe; but take care not to let the pendulum swing too far as to become restrictive or patronizing. Allow sufficient opportunities for your elderly loved one to express himself and explore to his heart’s content with openings such as, “What do you want to look at next?” or “Let’s give this a try!”

Did you realize that Endeavor Home Care offers patient, caring San Diego caregivers to provide accompaniment services that make elderly travel as safe and enjoyable as possible for families, allowing them to focus on simply taking pleasure in quality time together and making lasting memories? Call us today at (480) 535-6800 for more information!

Alzheimer's Memory Loss

How to Cope with Alzheimer’s Memory Loss and a Desire to “Go Home”

“Home sweet home,” the saying goes; but if you are caring for a loved one with Alzheimer’s who is experiencing memory loss and insists home is somewhere other than where he or she is currently living, what do you do? When you are providing care for a loved one with dementia, unfortunately this discussion can be a common occurrence. And the bewilderment and sorrowful yearning being conveyed are nothing less than heartbreaking – and, if we’re truthful, annoying.

At Endeavor Home Care, our professionally instructed San Diego dementia care team helps families control difficult events such as this, and we recommend trying the following to help restore peace to an upset loved one with dementia:

  • Instead of rationalizing, help the senior feel validated. Reasoning or arguing with a senior with dementia can actually increase frustration and unrest. Even if the older person is in the same home she’s resided in for the past 20 years, within her thoughts, “home” could represent the enjoyment she felt in her childhood home together with her parents. Her sentiments of loss are quite real, and should be acknowledged.
  • Provide reassurance. Maintain a calm, soothing tone of voice and body language and take a seat next to the person, providing consolation through a hug, hand-holding, or maybe lightly touching the person’s arm, if these kinds of actions are accepted.
  • Next, redirect. Once you’ve provided a soothing presence and affirmed the person’s views, redirection to some pleasurable, entertaining activity will be helpful. Taking a walk outdoors or in a different part of the house, playing favorite music, or checking out photograph collections are just a couple of suggestions; consider the particular person and incorporate the things that work best for her.

For further suggestions about helping restore peace to a troubled loved one with memory loss resulting from Alzheimer’s or another type of dementia, contact Endeavor Home Care at (480) 535-6800. We can help keep seniors safe, enrich socialization, and present them with opportunities to strengthen both cognitive and physical wellbeing through services such as:

  • Patient, sensitive assistance with personal care responsibilities such as bathing and dressing
  • Participating in conversations and reminiscing about the past
  • Helping the senior to participate in physician-approved exercises
  • Playing board games, cards or games on a tablet device with the senior
  • Planning and making nutritious meals
  • Running errands such as picking up groceries and medications
  • Providing transport to health care appointments and other outings
  • And so much more

Whether just a few hours each week of respite care for primary family caregivers are necessary, or full-time, seamless, around-the-clock caregiving is wanted, we’re always ready to partner with you to deliver the highest quality dementia care. Contact Endeavor’s San Diego dementia care experts to find out more and to arrange for a free in-home assessment.