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Settlement helps to keep Medicare coverage for chronically ill

A recent settlement in a major case challenging Medicare policies means that now the government run insurance program will cover a variety of treatments for chronic conditions such as Parkinson’s disease and Alzheimer’s disease. The covered treatments will include physical therapy and occupational therapy.

This change will affect Texas residents as they make long term care planning decisions and other types of estate planning decisions. A comprehensive retirement and estate plan includes money set aside to cover medical expenses, and that means figuring out one’s likely needs and making sure that private insurance is available if government programs like Medicare and Medicaid aren’t available for all necessary treatments.

The denials were surprising to many patients, “It was like falling off a cliff in that there was no longer any access to Medicare to help with even small, maintenance types of things, like range of motion,” said the daughter of a man who was suddenly denied care for his chronic condition.

Patient advocates still don’t know exactly how many people will benefit from this settlement and policy decision and it is not clear how quickly the change will take place. The settlement is expected to affect many patients who need in-home care, but first it must be approved by a federal judge.

The original lawsuit was filed over allegations that some Medicare contractors were processing claims in a way that ended coverage for patients who were not improving and needed ongoing care. However, the program is supposed to pay for any reasonable treatment that has been prescribed by a doctor.

Source: New York Times, “What Medicare Will Cover Even if You’re Not Likely to Get Better,” Ron Lieber, Oct. 26, 2012.