Medicare recipients can be especially vulnerable to sepsis, which is the body’s extreme response to an infection. People with weakened immune systems due to chronic conditions, such as diabetes, lung disease, cancer, or kidney failure, are commonly at risk of developing sepsis, and seniors make up 65% of all cases. This life-threatening condition can result from an infection anywhere in the body, and can be caused by open surgical wounds, influenza, a bug bite, or skin sores. Left untreated, sepsis can trigger organ failure and can lead to death.

What Are the Symptoms of Sepsis?

The warning signs of sepsis can include a change in body temperature, increased heart rate, fatigue, pain, and confusion. If it is not treated, sepsis can progress quickly to organ failure, difficulty breathing, and a drastic change in blood pressure. When your blood pressure drops to dangerous levels, you may be in danger of going into septic shock.

Your physician can run diagnostic tests to determine if you have developed sepsis. Blood tests, along with a physical examination and related information, can help your physician compile a more comprehensive picture of your health and determine if you are suffering from sepsis. Lab work ordered by your doctor may test blood for levels of white blood cells, lactic acid, C-reactive protein, platelets, Endotoxin, Procalcitonin, and SeptiCyte. Blood culture tests can help a physician determine which bacteria or fungus is causing the infection. When a specific infection is suspected of causing sepsis, an X-ray, MRI, CT scan, a spinal tap, or culture may be ordered to pinpoint the source.

Treating Sepsis

Sepsis can be treated with antibiotics, but many patients also need accompanying IV fluids, oxygen, dialysis, or even surgery to remove damaged and infected tissue. If you are eligible for Medicare because you are 65 years of age or older, or under the age of 65 with certain disabilities, your benefits can help cover the cost of treatment for sepsis.

Can Medicare Help Cover the Cost of Sepsis Treatment?

Medicare Part A (Hospital Insurance) can help cover your care, services and supplies when you are formally admitted into a Medicare-approved hospital or skilled nursing facility. Many patients develop sepsis while they are already in the hospital or a skilled nursing facility for another illness. Your Part A coverage can include the medications you receive in the hospital that are administered by a doctor or nurse.

Part B (Medical Insurance) is optional coverage, but most Medicare recipients enroll when they are first eligible to avoid high out-of-pocket costs for medically necessary services, doctor visits, preventive care. Enrolling in Part B when you qualify for Medicare will also keep you from paying late enrollment penalties if/when you choose to enroll later on. Part B covers clinical diagnostic lab work, including blood tests, urinalysis, tests on tissue samples, and other screenings that may be related to sepsis, when they are ordered by your doctor. Your doctor must be participating in Medicare and accept assignment.

Many people who get benefits through Original Medicare choose to purchase a Medigap policy. Medigap, or Medicare Supplement, policies help cover the out-of-pocket costs that Original Medicare does not, including copayments, coinsurance, and deductibles. Other Medicare recipients choose to get their benefits through a Medicare Advantage (MA) plan, offered by private insurance companies who contract with Medicare to provide your coverage. MA plans are required to provide at least the same Part A and Part B benefits as Original Medicare, but many offer additional coverage, including prescription drug coverage and a yearly out-of-pocket maximum.

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What is Medigap?