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Your Coverage. Your Choice.

Kie Copenhaver MA, RHIA, CSA, RCFE, SHSS

One of my passions is advocating for choice with our aging clients. Everyone appreciates having a choice. When it comes to our aging population, they have earned the right to choose and to be given the information necessary to make informed choices about their health and wellbeing.

Open enrollment for Medicare is fast approaching - when the leaves start changing colors and you are inundated with all things pumpkin spice, you know it is almost time for open enrollment. Talk with your Medicare Enrollment Specialist to ensure the Medicare plan you currently have is working for you. If you are unhappy with the plan you have, open enrollment is the time to change it. Your Enrollment Specialist can help you find the plan that is right for you, your healthcare needs, and your budget. We have a couple of folks who are cracker jacks at this kind of stuff so if you need a referral, let us know.

And while we are on the topic of Medicare and choice, let’s talk about some often overlooked choices Medicare participants are entitled to under their policies.

Skilled Nursing Facility (SNF)

You, as a Medicare participant, have a choice of which SNF you are discharged to if you find yourself in the hospital and needing additional care and rehabilitation before going home. Medicare has a “Nursing Home Compare” website where anyone can look at the Centers for Medicare and Medicaid (CMS) star rating system for all participating SNFs. Here is a screen shot of a search I did using the zip code 92115.


When you get to this website, you can search the various SNFs by zip, city, state or by specific name. https://www.medicare.gov/nursinghomecompare/search.html


You can use the arrows to sort the list from most to least stars or least to most stars. As you can see from the screen shot, you can sort from five different categories: overall rating, health inspections, staffing, quality measures and distance. If you hold your mouse over the “2” in SNF B’s rating on Staffing, you see that a box appears telling you there was insufficient data to compile a rating – this may be a red flag if a SNF is not reporting adequate data to CMS.





Home Health Services

Part A and/or Part B of your Medicare plan covers home health benefits. You will want to read your “Medicare & You 2021” booklet for more specifics on this coverage.

Similarly, with Home Health agencies, you can go onto the Medicare.gov website to compare the various agencies who get reimbursed by CMS. You have your choice of Home Health agencies to work with – this can happen after a hospital or SNF stay or if your Primary Care Physician writes you an order for some sort of therapy to help you maintain your health status/condition (i.e., PT, OT, ST, RT). Ask your PCP or discharge planner about your options for Home Health services.


And finally, Hospice

As a Medicare participant, you or your loved ones have your choice of which hospice agency you want to work with when/if the time comes. To qualify for hospice care, one must be terminally ill and have a life expectancy of 6 months or less to live. Hospice care and palliative care are not the same thing; palliative care is also known as comfort care and the goal is to keep someone comfortable and out of pain (often palliative care is done in conjunction with hospice services). There are many other aspects of hospice – clinical services, medications for pain management, durable medical equipment, spiritual and grief counseling, and music therapy. You or a family member may visit https://www.medicare.gov/hospiceCompare/ to look more closely at hospice companies that have been recommended or referred to you. This CMS database is not set up in the same fashion as the other two comparison sites. If you want additional information on a hospice company and their CMS scores (compared to a national average), give us a call.

Not all SNFs, Home Health agencies and Hospice companies are created equal. As a healthcare recipient and more specifically, a Medicare recipient, it is up to you to do your research to ensure you are working with the best and highest rated companies and organizations out there. Let us help you delve into the research, crunch the numbers, and find the service provider(s) that works for you! You have CHOICE. We are here to ensure that our expertise and advocacy is helping you navigate your health and wellbeing path and the choices you have in healthcare services.

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