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Medicaid/Medicare May Offer Some Benefits that Might Help ...Check Your Options

 
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Depending on your state and your plan, you may have benefits that might help.  You will usually be given an Enrollment Guide or a Summary of Coverage. These outline your coverage and tell you what your options are.




For Medicaid:  List of Medicaid Benefits

https://www.medicaid.gov/medicaid/benefits/list-of-benefits/index.htm


List of Medicaid Benefits

The list below outlines mandatory Medicaid benefits, which states are required to provide under federal law, and optional benefits that states may cover if they choose.

Mandatory Benefits:

   Inpatient hospital services
   Outpatient hospital services
   EPSDT: Early and Periodic Screening, Diagnostic, and Treatment Services
   Nursing Facility Services
   Home health services
   Physician services
   Rural health clinic services
   Federally qualified health center services
   Laboratory and X-ray services
   Family planning services
   Nurse Midwife services
   Certified Pediatric and Family Nurse Practitioner services
   Freestanding Birth Center services (when licensed or otherwise recognized by the state)
   Transportation to medical care
   Tobacco cessation counseling for pregnant women

This is the Index for States:

https://www.medicaid.gov/state-overviews/index.html


Optional Benefits that your state may offer:


   Prescription Drugs
   Clinic services
   Physical therapy
   Occupational therapy
   Speech, hearing and language disorder services
   Respiratory care services
   Other diagnostic, screening, preventive and rehabilitative services
   Podiatry services
   Optometry services
   Dental Services
   Dentures
   Prosthetics
   Eyeglasses
   Chiropractic services
   Other practitioner services
   Private duty nursing services
   Personal Care
   Hospice
   Case management
   Services for Individuals Age 65 or Older in an Institution for Mental Disease (IMD)
   Services in an intermediate care facility for Individuals with Intellectual Disability
   State Plan Home and Community Based Services- 1915(i)
   Self-Directed Personal Assistance Services- 1915(j)
   Community First Choice Option- 1915(k)
   TB Related Services
   Inpatient psychiatric services for individuals under age 21
   Other services approved by the Secretary*
   Health Homes for Enrollees with Chronic Conditions – Section 1945





What Medicare Covers


https://www.medicare.gov/what-medicare-covers


Medicare offers this booklet: "Medicare & You"


Your Medicare coverage choices

Learn about the 2 main ways to get your Medicare coverage — Original Medicare (Part A + B) or a Medicare Advantage Plan (Part C).


For Medicare Advantage see this topic: https://permies.com/t/92560/Medicare-Medicare-Advantage-Medicare-Supplement


This link may help:


https://www.consumerreports.org/cro/2012/09/managing-medicare/index.htm


Where to get free Medicare advice:


https://www.consumerreports.org/cro/2014/10/where-to-get-free-medicare-advice/index.htm





Wikihow article on "How to get a Physician's Referral for a Massage"


https://www.wikihow.com/Get-a-Physician-Medical-Massage-Referral


1 - Identify a condition or injury that can benefit from medical massage. In order to prove medical necessity for a massage, you must have a recognizable health condition that may respond to massage in a positive way.

2 - Check insurance rules. Before proceeding with a request for a physician referral for a massage, check to see what the actual rules are for your insurance policy.

Consider whether or not a referral will result in coverage. Often, even if you have a referral, other coverage limitations may apply. Read the policy document thoroughly to make sure that this is not the case.

Understand any exclusions or limitations specifically mentioned in the policy. Another stumbling block for getting medical massage covered is when it is included in exclusions, along with chiropractor visits and other specific types of treatment.

3 - Talk to your primary care provider. In many HMOs and other health plans, this doctor is the one who must authorize the referral.

Discuss medical necessity with the doctor. Figure out how that medical professional will diagnose a condition that can formally necessitate medical massage.

Ask the doctor about what kinds of other treatments go along with medical massage. One way to get a better chance of successful coverage is to combine medical massage with other types of treatments. Ask about how a holistic treatment plan can help provide better rehabilitation or recovery while legitimizing the use of medical massage within a greater context.


 
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