As a Medicare sales agent, it is important to stay informed about all of the benefits Medicare provides to ensure that you are delivering the best possible service to your clients. While many beneficiaries may be aware of the basic benefits provided by Medicare, some of the lesser-known benefits are often overlooked.
These lesser-known benefits can provide valuable coverage and support for your client's healthcare needs. Additionally, discussing these lesser known benefits can help you build trust and rapport - leading to stronger, longer-lasting relationships.
Although there are certainly more, here are a few examples of the lesser known benefits that we'll cover today:
• Durable Medical Equipment (DME)
• Mental Health Services
• Diabetes Management
• Home Health Services
Durable Medical Equipment (DME)
To qualify for Durable Medical Equipment (DME) under Original Medicare. a beneficiary must have a medical need for the equipment and a doctor's prescription. The DME must also be considered medically necessary and reasonable for the treatment of a specific medical condition. Some examples of DME covered by Medicare include wheelchairs, oxygen equipment, walkers. and hospital beds. This benefit helps reduce out-of-pocket expenses for beneficiaries who would otherwise have to pay for DME on their own.
Mental Health Services
To qualify for Mental Health Care under Original Medicare, a beneficiary must have a mental health condition that requires treatment and a doctor's referral for the services. Medicare covers a range of mental health services, including individual and group therapy, psychiatric evaluations and medication management. Beneficiaries can receive these services in a variety of settings, including outpatient clinics, hospitals and community mental health centers.
The Diabetes Prevention Program (DPP) and Diabetes Self-Management Training (DSMT) are two distinct programs under Original Medicare that address different aspects of diabetes care.
- The DPP is a lifestyle change program designed for individuals who are at high risk for developing type 2 diabetes. It focuses on healthy eating, physical activity. and other lifestyle changes to prevent or delay the onset of diabetes. To qualify for the Diabetes Prevention Program (DPP) under Original Medicare. a beneficiary must be at high risk for developing diabetes. have a body mass index (BMI) of 25 or higher. and receive a referral from their doctor for the program.
- On the other hand, DSMT is a program designed for individuals who have already been diagnosed with diabetes. It focuses on educating patients on how to manage their diabetes. including monitoring blood sugar levels. taking medications. and making lifestyle changes. DSMT also provides patients with individualized support and guidance on how to manage their condition effectively. To qualify for DSMT under Original Medicare. a beneficiary must have diabetes and a referral from their doctor for the training.
Home Health Services
To qualify for home health services under Original Medicare. a beneficiary must meet the homebound status requirements set by Medicare. They must also have a plan of care established and their doctor will need to re-evaluate and recertify their plan of care every 60 days.
To be considered homebound, your client must:
- Require the assistance of medical equipment or another person to leave their home. This could include using crutches. a walker. or a wheelchair. Additionally, their doctor may determine that their health could worsen if they leave their home.
- Secondly. it must be difficult for your client to leave their home, and they must typically not be able to do so without assistance.
By staying informed about these and other lesser known benefits. you can ensure you are providing the best possible service for your clients' healthcare needs all while building trust and rapport leading to stronger. longer-lasting relationships.