We address Medicare 2025 in this video...
Here's the LINK in case you missed it...https://youtu.be/jNYAngM2EdE
Medicare's open enrollment period for 2025 will be from October 15 to December 7. Changes made during this time will take effect on January 1, 2025.
How can I find a GUIDE-approved program so Medicare will pay for my respite care, home care, or a care navigator?
Well MEDICARE is putting together a list and here is what I am finding so far…
GO to this website: https://www.cms.gov/priorities/innovation/guide/faqs#bgrnd
And scroll down about a quarter of the page and and look for the
GUIDE Participant List (XLSX). (It’s #5 under Partner Organizations)
Click on it. You will see that there are only about 391 facilities that are MEDICARE-approved at this time. I'm sure others are trying to get approval.
Now to read more about this program, go here: https://www.cms.gov/priorities/innovation/guide/faqs#pay-meth
WARNING! So if anyone tries to sell your senior a MEDICARE plan stating that they have the GUIDE program, make sure there is one in your area!!
Quick points about the Medicare 2025 GUIDE program
For a person with Medicare to receive services under the model, they must meet certain eligibility requirements. The senor has to show proof that they have been diagnosed with dementia, at any stage.
To do this they will need to find a healthcare provider that is participating in the GUIDE Model in their community. A person with Medicare or their caregiver could then visit a GUIDE Participant, and after consenting to receive services from the GUIDE Participant, CMS will confirm whether the individual meets the model eligibility requirements before aligning them to the GUIDE Participant.
How is “caregiver” defined in the GUIDE Model?
For the Medicare 2025 GUIDE Model, a caregiver is defined as a relative, or unpaid nonrelative, who assists the beneficiary with activities of daily living and/or instrumental activities of daily living. Depending on the beneficiary’s need, the assistance may be episodic, daily, or occasional.
What are the approved screening tools for dementia staging?
Basically, your senior must be diagnosed with dementia and then YOU will need to take this test. Just click on this link, the Zarit Burden Interview (ZBI). I’ve already made the test available for all of you and how often most caregivers use it.
How do I learn more about the MEDICARE 2025 changes?
Go to this guy…
Medicare School.com https://youtu.be/0D8KdnaQReo?si=asyEZxOrskKAvhDa.This guy will give you a video on the changes in more detail.
or call my guy if you want personal help:
Mine is Randy Spencer. Great guy. Been doing this for years. Used to teach this stuff so will explain everything to you. He knows exactly what I need and why. He lives and breathes this stuff and to be honest, “The devil is in the details” and I don’t want to spend so much time trying to figure this all out so I let him mess with it.
And here’s a few more changes you need to know:
- Medicare Part D Changes:
- Out-of-pocket maximum: For those with Part D drug coverage, there will be a new out-of-pocket maximum of $2,000 per year. After you reach this limit, Medicare will cover 100% of your medication costs for the rest of the year. This is a significant reduction from the current cap of around $8,000.
- Elimination of the coverage gap (donut hole): Currently, beneficiaries pay more once they reach a certain limit in drug costs, but this gap will be eliminated, helping to streamline prescription drug expenses. Finally!!!
- Drug deductible: The deductible for most prescription drug plans will increase, but it will be capped at $590.
- Medicare Advantage Plan Changes:
- Reduced supplemental benefits: Many Medicare Advantage plans are expected to scale back supplemental benefits such as dental, vision, and over-the-counter allowances due to budget cuts. Some plans may even be discontinued altogether, potentially affecting millions of beneficiaries. If your plan is impacted, you'll be notified in the fall of 2024 and will need to select a new plan during the Annual Enrollment Period(GoHealth).
- Provider network adjustments: Some Medicare Advantage plans may see changes to their provider networks, meaning some enrollees may lose access to their preferred doctors or hospitals(AMAC Medicare).
- Mid-year benefit notices: Starting in 2025, enrollees will receive mid-year notifications detailing any unused supplemental benefits, allowing them to make better use of their plans(GoHealth).
- Additional Care Benefits: GUIDE program
- Expansion of dementia care: Medicare Advantage plans will further prioritize dementia care through the GUIDE program, which offers resources for caregivers and enhanced services for people living with dementia, such as respite care and 24/7 access to care navigators (if you’re a member of the Caregiver Freedom Club, see my webinar on care navigators. I used to be one and I tell you all about what I used to do for my clients.)
- Mental health improvements: Plans are required to provide better access to mental health professionals like therapists and opioid treatment providers, ensuring beneficiaries receive the support they need. Another finally!!!
