<p>As many of you know, my mom had a recent hospitalization that resulted in a brief stay in a skilled nursing facility. Medicare took care of Day 1 through 20, but we were going to have to be out of pocket any days after that.</p>
<p>She has Blue Cross Medicare Supplement Part B only, and I called Blue Cross to get her on a different plan, I believe F, where she would be covered for SNF from Day 21 through 100.</p>
<p>I just received a letter saying they denied her coverage because of her recent hospital stay with cellulitis, diabetic retinopathy (which I don’t believe she has), and chronic pulmonary disorder (which she does have, although doesn’t require oxygen, just albuterol).</p>
<p>Is there any option or another company I can look into that will give us coverage for skilled nursing care? I know it may be expensive, but she’s probably not going to qualify for Medicaid anytime soon, as her monthly SS income is higher than the threshold amount I was quoted when I inquired recently about qualifying her.</p>
<p>I am hoping to qualify her for Veterans Benefits, but haven’t heard anything from that, but that would at least help pay for any additional premiums she would incur for an additional SNF policy.</p>
<p>Although I don’t know the specifics of your situation, I would say don’t get your hopes up about veterans benefits. My dad is back home from the hospital after a debilitating stroke and is paying out of pocket for a 24 hour caregiver. He is a veteran and we had hoped he would qualify for the VA Aid & Attendance program, which is a subset of their pension program. However, the maximum annual income that a veteran is allowed to have and still qualify for Aid & Attendance benefits is $19,736 per year (or $23,396 if there is one dependent). </p>
<p>Have you ever checked into having your Mom change to a Medicare HMO rather than having Medicare and a supplement?</p>
<p>I work with billing for a clinic and also have experience with my own mother’s health insurance issues. We found that the Medicare HMO plan worked out much better for her.</p>
<p>Here is a link to the Medicare website where you can input her information (including any RX drugs) to see what plans are available in the area. I haven’t played aound on the website in a while but you used to be able to compare plans side by side.</p>
<p>My FIL qualified for benefits to help with the cost of assisted living. His income was SS only and after selling his house (only netted about 36K) was put in a non-revocable trust, he and my MIL qualified. here are attorneys who specialize in helping with veteran’s benefits. It would be worth your time to check in out.</p>
<p>proudwismom - I suspect you mother is healthy and has not required skilled nursing. The medicare HMO worked great for my MIL until she required a significant amount of skilled nursing when it was a disaster. Some person in an office decides how long to cover a person in skilled nursing and/or rehab rather than the health care providers.</p>
<p>While my mother has never required a nursing home she does have significant health issues. The Medicare HMO she is on covers SNF in full for days 21-100. Many Medicare HMO’s have better coverage than just having Medicare and a supplement. </p>
<p>The Medicare replacement policies available in each area of the country varies as does the coverage each provides. The OP’s mother may not have an option that would be better than what she has now. However, it never hurts to see what is available. From my experience few people know about the website to compare coverages.</p>
<p>On paper, the SNF coverage looks fabulous. But, read the fine print. It discusses qualified coverage. For example, my MIL was admitted to the hospital for “sepsis.” Her physician recommended 2-3 weeks in a SNF before going back to assisted living. However, her HMO did not approve any time in a SNF as her sepsis was “cured.” Never mind that she was left physically and mentally debilitated after her episode of sepsis. I have multiple examples over the last 6 months in which the HMO decided how long was appropriate for hospitalizations and a SNF. After a certain period as determined by them, they will simply not pay, despite recommendations of the physician.</p>
<p>Again, it looks like a good deal on paper, but try to have an elderly family member in the hospital and/or SNF and you’ll find that straight Medicare gives the care providers much more decision making power.</p>
<p>Medicare Advantage plans very rarely give better coverage then a medicare supplement plan (especially plan F that the OP is looking into). The plan F she is looking into has no deductibles for anything, no copays, and the freedom to go wherever she wants throughout the US with no network & automatically pays whatever is left over after medicare as long as they approved and paid on their portion. Actually that plan covers her out of the country also. Yes, the supplements do tend to cost more premium wise… but for someone who has many medical issues, all those co pays under the advantage plans can add up pretty quickly. I’ve seen advantage plans where if you go in the hospital you have a 175 dollar co pay for each of the first 20 days. ouch. Plus, they only have certain times each year that you can enroll into and dis-enroll out of an advantage plan, and this is not one of them. Next time you can enroll in one (unless you are new to medicare or fall under certain circumstances) is between Oct 15 and Dec 7 and that’s for coverage starting Jan 1 of 2012.</p>
<p>I’m sorry you have had a bad experience. Ours has been good.</p>
<p>I work with Medicare billing at a clinic. Many of our patients have Medicare replacement plans. Are they all 100% satisfied? I’m sure not. Niether are all the patients with Medicare B plus a supplement. Some supplement policies are also better than others. Personally, I would never have a BCBS policy. I’ve dealt directly with them as a provider office rep and their business practices scare me. </p>
<p>I also have many relatives who are older (10 kids in the family and my mother is youngest) so I am familair with the arbitrary decisions that insurance companies can make in regard to coverage.</p>
<p>Again, I just gave the information as an alternative. We are lucky to live in an area with some of the best healthcare in the country and one of the best Medicare HMO’s in the country. I realize not everyone does.</p>