Trying to navigate through the murky waters of Medicare coverage can be a daunting task.
By Tim Mitchell, Senior Care Partners P.A.C.E.
Did you know there are ten Medicare Supplement plans available? They are simply labeled A, B, C, D, F, G, K, L, M and N. Each supplement covers something that is not covered under basic Medicare coverage. If this is confusing to you, don’t feel like you are alone in your confusion. Hundreds of thousands of seniors are just as confused as they wade through the insurance-jargon-filled explanation of these benefits.
Medicare Supplement plans generally charge premiums, which is a monthly amount you pay to be covered, whether or not you use the covered services. The amount of the monthly premium can vary widely. Some plans, for example, might charge $70 per month while others charge $270 per month.
Another option, while less known, is the opportunity offered by PACE (Program of All-Inclusive Care for the Elderly) programs, now in thirty-one states across the country. Fortunately, Michigan is one of those states where PACE is available as an option. While PACE is not a Medicare Supplement plan, the PACE benefit includes all Medicare covered items and services. However, most people participating in the program do not have any out of pocket expense.
Senior Care Partners P.A.C.E. is the PACE organization in this region of Michigan offering PACE services as an alternative to the traditional Medicare model. PACE programs throughout the country have become a desirable alternative to the standard healthcare options for seniors. The question is often asked, “What makes Senior Care Partners P.A.C.E. and other PACE organizations different than traditional care services for the elderly?”
Most people don’t realize that the Center for Medicare and Medicaid Services (CMS) looks very favorably on PACE programs because the outcomes for seniors have been proven to be much better than traditional healthcare. A historical perspective of the PACE program may be beneficial to understanding how PACE organizations have come to experience this positive reputation.
The PACE model of care can be traced back to the early 1970’s when, in response to community concerns for the older adults of San Francisco’s Chinatown, North Beach, and Polk Gulch neighborhoods, a committee was formed, headed by Dr. William L. Gee, a public dentist, to address the issue. The committee then hired Marie-Louise Ansak in 1971 to investigate potential solutions. This group, along with other community leaders, formed On Lok Senior Services to create a community based system of care. On Lok means “peaceful, happy abode” in Cantonese. It was a place where frail older adults could gather in a peaceful, happy place and receive hot meals, health and social services, and supervision during the daytime, while returning to their homes in the evening.
Simultaneously, in the 1970’s the federal and state governments became increasingly interested in the development of community-based services. As a result, waivers of federal Medicaid requirements allowed state governments to experiment with fee-for-service programs for frail elderly and disabled beneficiaries. It was during this time that On Lok Senior Health Services became the first Program of All-Inclusive Care for the Elderly (PACE) recognized by CMS.
Recognizing the great benefits of the PACE model, in the mid-1980’s Congress authorized waivers for ten replication sites and The Robert Wood Johnson Foundation provided start-up grants for these new ventures as well as funds enabling On Lok to provide technical assistance for the project. By 1994 there were ten new sites open using the PACE model of care. This demonstration proved to be so successful that PACE was eventually established as a permanent Medicare program by the Balanced Budget Act of 1997.
While PACE has continued to grow and evolve, the same basic principles that demonstrated to be a highly sought aftercare model are the same principles that guide 263 PACE centers in 31 states today. At a 2015 event in Washington, DC, commemorating the 50th anniversary of Medicare and Medicaid, Andy Slavitt, then acting administrator of CMS, called PACE a “glimpse into our future.” In other words, he believed the PACE model was the correct model for caring for our nation’s aging population. Additionally, in a study of PACE programs in multiple states, Dr. Victor Hirth concluded, “PACE has become the epitome of quality care for the elderly throughout the nation.”
Senior Care Partners P.A.C.E., with locations in Battle Creek, Kalamazoo, and Portage, serving Calhoun, Kalamazoo, eastern Van Buren, southeastern Allegan, and southern Barry counties, offers this same innovative model of care for the elderly. At these centers, they provide acute and post-acute care, home care, and community based services coordinated by an interdisciplinary team of health care professionals in a collaborative fashion at one single location to enable each participant to receive the most personalized level of care while still living at home. Their staff is on call 24 hours a day and 7 days a week for the care of the participants. All these services are provided at no out-of-pocket expense for most of the seniors involved in the program.
If you are a senior seeking an alternative to the traditional complexities of the Medicare system, you may want to investigate the services of Senior Care Partners P.A.C.E. Your world may just become much less complicated by simply making a phone call to Senior Care Partners P.A.C.E. at (269) 441- 9319. They will be glad to explain to you the “Senior Care Partners P.A.C.E. difference.” You can also visit online at www.seniorcarepartnersmi.org.