According to Emory Health Care, nearly 5 million Americans are currently living with congestive heart failure and approximately 550,000 new cases are diagnosed every year. Congestive heart failure is the most common diagnosis in hospital patients aged 65 and older. Among that age group, one-fifth of all hospitalizations have a primary or secondary diagnosis of heart failure. More than half of those who develop congestive heart failure (CHF) die within 5 years of diagnosis.
Original Medicare Coverage
For Congestive Heart Failure
Original Medicare covers a number of CHF-related medical services.
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care and some home health care. Most people pay a monthly premium for Part A. To fully cover your potential Part A expenses, you have to additionally purchase a Medicare (Medigap) supplement or a Medicare Advantage plan.
Part B covers doctors’ services, outpatient care, medical supplies, and preventive services. Everyone pays a monthly premium for part B. In most cases, that fee is deducted from monthly social security benefit payments. To fully cover your potential Part B expenses, you have to additionally purchase a Medicare (Medigap) supplement, or a Medicare Advantage plan.
Part D covers a portion of prescription drug costs. To get full Part D coverage you have to join a private Medicare approved drug plan or purchase a Medicare Advantage plan that provides Part D coverage.
Logic would suggest that Original Medicare should have a Part C. Well, actually there is a Part C; but Part C is not part of Original Medicare. Rather, Part C is Medicare Advantage.
Read more about Original Medicare.
Medicare Supplement Coverage
For Congestive Heart Failure
A Medicare Supplement policy (often referred to as a Medigap policy) is an optional addition to Original Medicare. Medicare Supplements are sold by private insurance companies. Supplement policies pay for some of the potentially very large health care cost gaps that Original Medicare does not cover.
Read more about Medicare Supplements.
Medicare Advantage Coverage
For Congestive Heart Failure
Medicare Part C is Medicare Advantage. Medicare Advantage plans generally involve HMO or PPO health care organizations. They are provided and operated by private companies (as opposed to the Federal government).
Medicare Advantage Plans provide Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Most plans also include Part D Prescription Drugs and many also provide additional coverage for vision, hearing, dental, wellness programs, transportation to and from doctors and possibly over the counter pharmacy products.
Read more about Medicare Advantage health insurance.
AHCCCS Medicaid Coverage For
Congestive Heart Failure
In Arizona, the state Medicaid department (AHCCCS) provides Chronic Special Needs health insurance plans for low income seniors, and other Medicare eligible individuals, who have been diagnosed with congestive heart failure.
Availability of specific Special Needs Plans varies from county to county and the cost can vary from no cost (for fully eligible AHCCCS members) to low cost (for members who have too much income to qualify for full AHCCCS coverage but are nonetheless living on a limited income).
Congestive heart failure Chronic Special Needs health insurance plans provide all of the services that the federal government requires for Medicare Advantage plans. In addition, many plans coordinate with a Medicare Advantage plan to provide additional benefits. Some AHCCCS Chronic Special Needs plans also provide a care coordinator who helps members get the right care, at the right time, from the right providers.
For seniors who have both Medicare and AHCCCS Medicaid, most of the costs of participating in a congestive heart failure Medicare Chronic Special Needs plan will be covered by federal and state governments.
Read more about AHCCCS Medicaid.
