Bombas de Infusión Externas

- ¿Medicare da cobertura por las bombas de infusión externas? Las bombas de infusión externas son dispositivos médicos utilizados para administrar fármacos bajo presión directamente a una vena o músculo. Hay varias condiciones y criterios que debe cumplir para obtener cobertura con Medicare. Su médico o proveedor le puede dar información más detallada con respecto a estos requisitos.Si Medicare cubre la bomba de infusión, también cubrirá los medicamentos y los suministros necesarios. Si Medicare no cubre su bomba de infusión, puede ser que sea necesario un seguro de salud suplementario para ayudar a cubrir el costo.

Para asegurarse de que Medicare pague por su bomba de infusión externa, debe seguir los siguientes pasos:

- Sólo su médico le puede prescribir una bomba de infusión externa para usted, así que no compre ningún equipo hasta que haya visitado a su médico, no importa lo que el vendedor le diga.
- El médico debe documentar su necesidad de una bomba de infusión externa en su expediente médico, y darle una orden firmada (prescripción) para ello.
- El proveedor debe recibir la orden antes de que se facture a Medicare y debe ser guardada en el archivo por el proveedor.
- Si recibes Medicare Advantage (como un HMO o PPO) es probable que tenga que seguir los pasos del plan para su aprobación y compra. Llame al número de servicio al cliente de su plan y pregunte sobre sus pasos para la cobertura de una bomba de infusión externa. Su médico debe completar un Certificado de Necesidad Médica.

Medicare Parte B y Bombas de Infusión Externas

Debe tener cobertura de Medicare Parte B y su médico debe haber documentado su necesidad de la bomba de infusión externa y los medicamentos requeridos. El médico también debe escribirle una orden (prescripción) para los suministros que indique claramente por qué lo necesita. Usted debe ser capaz de demostrar que los medicamentos usados con la bomba son así mismos razonables y necesarios para el tratamiento. Esta terapia a menudo se inicia en el hospital y puede continuar en casa después de dar de alta, pero también se puede iniciar en casa. La terapia de infusión a largo plazo, del tipo que se hace en casa, por lo general requiere una parte de acceso en el torso del cuerpo, en lugar de los brazos o las manos. La terapia puede continuar hasta que el paciente ya no necesite la medicación o pueda ir a un ambulatorio de infusión o a la oficina del médico para infusiones continuas.

Algunas de las razones más comunes para necesitar terapias de infusión en el hogar incluyen las siguientes:

- Cancer
- Dolor crónico
- Deshidración
- Problemas gastrointestinales (GI), enfermedad de Crohn, obstrucciones intestinales, síndrome del intestino irritable
- Colapso Cardíaco
- Problemas del sistema inmunológico
- Infecciones serias
- Diabetes

El uso en el hogar requerirá interacción con un equipo de proveedores de atención médica que incluye al médico, un farmacéutico especializado de infusión y una enfermera. Cada uno juega un papel clave:

- El médico ordena la medicación y evalúa su eficacia a través de pruebas de laboratorio y observaciones del farmacéutico y la enfermera.
- El farmacéutico prepara la medicación prescrita y asegura que el medicamento, la bomba de infusión y los suministros se entregan al paciente correcto, en el momento correcto y en la dosis correcta.
- La enfermera enseña al paciente / cuidador cómo usar la bomba y la medicación, para que puedan hacerlo de manera independiente.

Costos de la bomba de infusión externa

Las bombas de infusión externas están en la categoría de «rentados tapados» para equipos médicos duraderos; Lo que significa que usted puede optar por alquilar o comprar una bomba de infusión. La cantidad que usted paga dependerá de si tiene o no la póliza de la Parte B.

Sin embargo, en general, si está inscrito en la Parte B de Medicare:

- Después de haber pagado su deducible anual, pagará el 20% del monto aprobado de Medicare.
- Si tiene un plan complementario de Medigap / Medicare, puede que deba poco o nada de dinero.
- Usted pagará menos si compra de un proveedor que acepta la asignación.
- Si usted recibe su Medicare a través de un Plan Medicare Advantage, usted puede que deba poco o nada dependiendo del plan con el cual usted se haya inscrito y sus beneficios con el plan.

Es importante que haga su tarea. Lea acerca de los factores que afectan la cantidad de cobertura que recibirá. Asegúrese de que todo el papeleo se haya completado correctamente y que compre su equipo a través de un proveedor aprobado que acepte la asignación.

Bomba de infusión externa a través de distribuidores certificados

Usted ahorrará dinero si ordena de un proveedor aprobado por Medicare. Los proveedores deben cumplir con normas estrictas para calificar como proveedores de Medicare y tendrán un número de proveedor de Medicare. También puede comprar su bomba de cualquier tienda que lo venda. Sin embargo, si el proveedor del cual solicita su bomba de infusión externa no está inscrito en Medicare, Medicare no pagará por el equipo.

Cosas que usted debe pensar antes de elegir un proveedor:

Hay dos tipos de proveedores de Medicare: los proveedores participantes y los que están inscritos, pero han decidido no participar.
Los proveedores participantes no cobrarán más que la cantidad permitida por Medicare.
Un proveedor aprobado por Medicare que no quiera participar puede cobrar más que la cantidad aprobada por Medicare. Sin embargo, no pueden cobrar más del 15% por encima del monto aprobado por Medicare. También pueden pedirle que pague la factura completa cuando recoja el equipo. En esta situación, Medicare le enviará el reembolso directamente a usted. Sin embargo, prepárate para esperar; Esto puede tomar un par de meses para recibir el pago.
Si recibe su cobertura de Medicare a través de un Plan Medicare Advantage (como un HMO o PPO), es probable que el plan tenga sus propios pasos para la compra del equipo. Además, el plan puede tener restricciones sobre el proveedor desde el que pueda comprar. Es importante saber que su plan de salud debe proporcionar por lo menos lo que cubre Medicare, ellos no pueden suministrar menos. Dependiendo de su plan, en realidad puede recibir más cobertura de la que obtendría con Medicare solo. Es aconsejable llamar al servicio de atención al cliente del plan Medicare Advantage y preguntar acerca de su cobertura antes de solicitar una bomba de infusión externa y suministros.

Medicare Supplement Plan A

Medicare Supplement Plan A is also referred to as Medigap Plan A. This plan is sometimes overlooked because it has fewer benefits than other Medigap insurance plans.

What does Medicare Plan A cover though? It still covers the most important benefit, which is the 20% of outpatient medical care that Medicare doesn’t cover.

Make no mistake. Medicare Plan A pays this, so it is still a very good plan.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	❌
Medicare Part A deductible	❌
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan B

Medicare Supplement Plan B, also called Medigap Plan B, offers the same benefits as Plan A. In addition, it will also pay your Part A hospital deductible for you. This is a significant benefit as the deductible in 2017 is $1,316, and tends to go up slightly each year. Having Medigap Plan B means that you will never have to worry about that deductible going up.

Your hospital deductible is a per-incident deductible, not an annual one, so this is an important benefit. Medicare Plan B will pay the deductible even if you incur it more than once in the same year.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	❌
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan C

Medicare Supplement Plan C is a policy which covers nearly all of the Medicare gaps that you would usually be required to pay. The only exception is the Part B excess charges.

Excess charges are surcharges that your doctor can charge above and beyond what Medicare will reimburse. They are limited to 15% beyond what Medicare pays. Many doctors do not charge excess charges, but occasionally they do. If this concerns you, the Medigap Plan F or G might be a better choice for you than Medicare Plan C. Those two plans cover excess charges, so you won’t have to worry about asking.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	✔
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan D

Medicare Supplement Plan D is one of the ten Medigap options you can purchase to supplement your Original Medicare benefits. (It is not to be confused with PART D, which is for prescription drugs. You can read about Part D drug policies here.)

A Medigap Plan D policy covers most of the gaps in Medicare for you, with the exception of the Part B deductible and also any excess charges. An excess charge is an additional amount you will pay if a provider charges more than the Medicare allowed amount. You will pay out of pocket for these two minor items if you purchase a Medicare Plan D. However, the policy does cover all of the most important things, like the 20% of outpatient services that you would otherwise owe.

It’s important to compare pricing between Medigap Plan D and Plans F or G, which have richer benefits. This will help you determine if the savings is worth the additional financial exposure to you. Some people would rather pay more for their supplement if they know that all the gaps will be covered. Others don’t mind a little cost-sharing to get lower premiums.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan F

Medicare Supplement Plan F has also been the #1 seller with The Benefit Link for many years. According to a report from America’s Health Insurance professionals, about 57% of all Medigap policies in force were a premium Medicare Plan F policy. (In recent years, Plan G has been the second most popular Medicare supplement plan, and you can read more on that below.)

A Medigap plan, or Medicare Supplement, pays after Medicare to help cover your deductibles, copays, and coinsurance that you would otherwise be responsible for. Medigap plans do not replace your Medicare Part B. You must be enrolled in both Part A and Part B first, then you are eligible to enroll in Medicare supplement Plan F.

When you add a Medicare Supplement Plan F or G to your Original Medicare benefits, your coverage will be quite comprehensive. By definition, Medigap Plan F is the Medicare supplement with the most benefits.

Medicare – Plan F

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	✔
Medicare Part B excess charges	✔
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan G

Did you know that Medicare Supplement Plan G is the second most popular Medicare supplement (next to Plan F) with our Baby Boomer clients? Today we’re going to tell you why. Everyone has heard of Plan F, but what is Medicare Supplement Plan G? What does Plan G cover?

Medicare Plan G coverage is very similar to Plan F. It offers great value for beneficiaries who are willing to pay a small annual deductible. After that, Plan G provides full coverage for all of the gaps in Medicare. It pays for your hospital deductible, copays and coinsurance. It also covers the 20% that Part B does’t cover.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	✔
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan K

Medicare Supplement Plan K offers you the same basic benefits as other supplements, but with lower premiums. For example, this plan will still cover preventive care services and give you an extra year in the hospital. However, you split the cost-sharing with the insurance carrier on certain items like the Part A deductible. You also agree to pay the Part B deductible and any excess charges.

Medicare Plan K also includes a cap on your spending called an out-of-pocket maximum. For instance, let’s say you have a year with a lot of medical treatments. If your out-of-pocket spending reaches the maximum limit, then your Medigap K policy will kick in to pay all of the rest for that year.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	50%
Blood (first three pints)	50%
Hospice Care coinsurance or copayment	50%
Skilled Nursing Facility Care coinsurance	50%
Medicare Part A deductible	50%
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan L

Medicare Supplement Plan L policy also includes a cap on your expenses. This is referred to as your out-of-pocket limit or maximum. Medicare sets this limit annually, and in 2018, the limit for Plan L is $2,620. This means that if in any one calendar year your spending reaches $2,480 in Medicare-approved covered expenses, then the Medigap insurance carrier pays the rest. The cap makes it much easier to agree to share in 25% of the costs on the items listed because you know that even if a year of bad health occurs, you won’t have more exposure than the maximum cap figure.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	75%
Blood (first three pints)	75%
Hospice Care coinsurance or copayment	75%
Skilled Nursing Facility Care coinsurance	75%
Medicare Part A deductible	75%
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	❌

Medicare Supplement Plan M

Medicare Supplement Plan M is one of the new supplements created by the Medicare Modernization Act. It first hit the Medicare insurance market in the summer of 2010. (Sometimes we hear people call it Medicare Part M or Medigap Part M, but the correct term is Plan M.)

Medicare Plan M provides the same basic benefits as other supplements. However, it has a slightly reduced monthly premium in exchange for your willingness to pay half of your hospital deductible and all of your annual outpatient deductible. By sharing in these deductibles as well as excess charges, you get the benefit of reduced premiums.

Plan M could be a good fit for someone who doesn’t expect to visit the hospital often and feels he can afford the occasional cost-sharing. However, it’s important to have a licensed agent who specializes in Medicare supplements to help you. He or she will evaluate the differences in premiums and make sure that the savings are worth the risk of some expenses.

Medicare Part A coinsurance and coverage for hospital benefits	✔
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	50%
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

Medicare Supplement Plan N

Medicare Supplement Plan N has been popular since it was first introduced in 2010. Also called Medigap Plan N, this option was created for consumers who like the idea of paying a lower premium in exchange for taking on a small annual deductible and some copays.

All Medicare supplement Plan N policies are the same, no matter which insurance company you choose. You can find Plan N available in many states from various well-know insurance companies.

In 2015, AHIP reported that Plan N enrollment grew by 33% between 2013 – 2014.

(You will find that sometimes people refer to Plan N as Part N, but the proper term is Plan N. Medicare itself has Parts, but when you are referring to supplemental insurance, use the word Plans.)

Medicare Part A coinsurance and coverage for hospital benefits	$20 copay for office visits; $50 copay for ER
Medicare Part B coinsurance or copayment	✔
Blood (first three pints)	✔
Hospice Care coinsurance or copayment	✔
Skilled Nursing Facility Care coinsurance	✔
Medicare Part A deductible	✔
Medicare Part B deductible	❌
Medicare Part B excess charges	❌
Foreign Travel Emergency (up to plan limits)	✔

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