Medicare Answers
Posted on November 29, 2011 by bob in Medicare
Dear Marci,
I was recently diagnosed with Chronic Obstructive Pulmonary Disease (COPD). Are there any plans that can help with my specific needs?
— Wind
Dear Wind,
Yes, there are Medicare Advantage (MA) plans called Special Needs Plans (SNPs). A SNP is a Medicare Advantage plan (private health plan) that exclusively serves at least one of the following groups:
— People who live in a nursing home or Intermediate Care Facility for the Mentally Retarded (either specific nursing homes or those in a certain area) and people who live in the community but require an institutional level of care;
— People who have both Medicare and Medicaid (dual eligibles);
— People who have a specific chronic, severe or disabling condition defined by the plan (such as diabetes or heart disease).
SNPs provide Medicare-covered health care and services that are designed to meet the special needs of people in the groups they serve. In your case you would choose a SNP that is designed for individuals with COPD. Be sure to call the plan and ask about the additional services they will provide to help you manage your condition. You should also compare the costs of the SNP plan to your Original Medicare costs to see what works best for you.
SNPs must include drug coverage (Medicare Part D) as part of their benefits packages.
Dear Marci,
Will Medicare pay to replace my walker?
—Trudy
Dear Trudy,
Generally, Medicare will replace your walker or any other piece of Durable Medicare Equipment (DME) if the item has been in your possession its whole lifetime and your doctor certifies that you still need it.
The definition of lifetime varies depending on the type of equipment but is never fewer than five years from the date that you began using the equipment. In addition, the item must be so worn down from being used on a day-to-day basis that it can no longer be fixed.
However, if you lose equipment that you rent or own, if it is stolen, or if it suffers irreparable damaged in an accident or a natural disaster, Medicare should cover a new piece of equipment with proof of the damage or theft.
“Replacement” refers to the replacement of one item with an identical or nearly identical item (for example, one manual wheelchair for another, not to switch from a manual wheelchair to an electric wheelchair or a motorized scooter).
Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare. To speak with a counselor, call (800) 333-4114. To subscribe to “Dear Marci,” the Medicare Rights Center’s free educational e-newsletter, simply e-mail dearmarci@medicarerights.org.
To learn more about the services that Medicare will cover and how to change plans, log on to Medicare Interactive Counselor at the Medicare Rights Center’s website at www.medicareinteractive.org.
