Read your/your parents Medicare supplement health insurance coverage NOW!

Parent Cafe
1

<p>My mom has gone into skilled nursing after a brief hospital stay, unable to return to her assisted living facility. Though Medicare pays Days 1 through 20, we will have a copay for Day 21 through 100 of $141.50, or thereabouts.</p>

<p>If I had only researched her policy and added another $40 or so a month premium, I’d have NO COPAY for Days 21 through 100.</p>

<p>So, giving you guys a heads up, check this out NOW!</p>

<p>So far, Mom has never had to pay any copays for anything: doctor visits, physical therapy, orthotics, and the like, so we assumed she was covered for EVERYTHING! Not so!</p>

<p>Working with her Medicare supplement provider right now to get her covered as soon as she is released, so we won’t have to face this again.</p>

<p>Good luck all!</p>

2

<p>good advice. I always make sure to point that out to my customers whenever they look at those plans because that can really add up and it’s usually very unexpected.</p>

3

<p>Can either one of you educate me further? What am I looking for? I know my mother has a supplement with a letter (“C,” I think), and was unaware of other or better options. Thanks!</p>

4

<p>Go to your plan’s website. There should be a chart with the different options and what it covers. My Mom has Part B, Blue Cross. It DOES NOT cover the skilled nursing copay for Day 21-100, so we have to pay a copay of about $150/day. I am hoping to get her on Plan F, which covers all of Day 21-100. Cost difference is less than $30 a month. There is also a Select option, which is cheaper, and was suggested should my mother move into the area. You have to use a certain hospital to be on that plan, though, but the premiums would be $40 less than what they are for her B coverage. </p>

<p>Be careful to not assume that skilled nursing will only last for 20 days, which Medicare covers 100 percent of. We were led to believe she would be in skilled nursing for a very short time, which I guess is relative to different people. My mother is not even having a Care Plan meeting until a few days after her Medicare full coverage runs out, so we are forced to pay the copay for at least a few days. </p>

<p>I find it odd at how quickly things moved in the hospital, where my Mom would have liked to have stayed a few more days to rehab there, rather than move to a skilled nursing facility. Now that she’s in a skilled nursing facility, things have slowed down quite a bit, which was not a problem as long as we weren’t paying, but I’m worried that now that we are paying, things will continue to run at a snail’s pace as the cash register rings up each day.</p>

<p>To Fred’ Mom, if you can’t find the information on the website, call the sales office. The agent will be more than happy to educate you on the different plans. My initial information call was rather abrupt and rude, but once I got to an agent, she was more than happy to help me. I will, after all, be paying more than I used to, so she sees a bigger commission coming her way. (I know, I’m a cynic).</p>

5

<p>Yes, “things” have changed a lot once health care started costing so much. </p>

<p>**Hospitals are strictly designed for medical care, not for rehab. If the patient is able to proceed to a rehab facility, that’s where they go. (Back in the day, my mom was in the hospital for a week after giving birth, now it’s barely a day.)</p>

<p>**Insurance carriers need to recoup costs, so in theory, it’s like you pay $30-40 over time, or you pay that co-pay as needed. If I had only researched her policy and added another $40 or so a month premium, I’d have NO COPAY for Days 21 through 100. Don’t assume, BTW, that “no one pays”. We all pay, through our taxes and our deficits.</p>

<p>**Be mindful of what insurance really needs to cover: medical care in the last years of life is extremely costly. You should also have insurance, not for the occasional ear infection or annual check-up, but for the catastrophic events in your life.</p>

6

<p>So true, don’t just look at your parents’. Look at your own.</p>

<p>One reason I’m so sensitive to this is that I was surprised by an almost one thousand dollar bill for son’s recent visit to a pediatric specialist. The doctor ordered every test under the sun, and unfortunately, I have a high deductible, so it’s all coming out of my pocket.</p>

<p>Had I known this was going to cost me upfront, in addition to the premiums I still pay, I may have either questioned the necessity for the tests, or God forbid, forewent the specialist.</p>

<p>Husband is aggravated that we got the bill, yet have no idea what the results of the tests are. No correspondence, no phone call, nothing. </p>

<p>I have a friend who is a physician’s assistant, and she has a heart defect. She went to the same clinic we have the big bill from, and found that her insurance didn’t cover this very expensive procedure she needed. She left with an $18,000 bill. She pays 100 to 300 every month towards it, to keep in good faith.</p>

7

<p>Fred’s mom, if she has plan C that is very good. Plan C is one of the best plans there is and it does have the SNF coverage in it. The only plan “better” is F and even that is just one extra benefit which to be honest with you most people don’t use. You could call her company and see if she’d be better off on that one but C is very good. </p>

<p>Mont, Make sure your local hospital is on their select plan F listing if she goes with that one, because if she goes there and it’s not that will be very expensive.</p>

8

<p>Montegut … sorry your parents are in this situation!</p>

<p>One global comment as I’ve become involved with my Mom’s care … I’m a pretty bright guy and 50 years old and I find the health insurance, social security, medicaid, etc stuff INCREDIBLY confusing … I can not imagine what disaster this is for elderly folks who are on their own trying to work this the maze of programs, organizations, rules, etc. I think if we set a group off to make a system totally confusing and illogical for elders to understand that group could not come up with something more of a mess than what we have now.</p>

9

<p>Thanks, fender. Agent advised not to go with Select because of the hospital choice restriction. F is the way to go since she is OOS and who knows what hospital she’ll end up if she changes facilities. I wonder, is there any coverage for long term, when you’re beyond Day 100? As it stands, we’ll have coverage until Day 100. But what if she requires long term care? Is there a coverage I should be looking at now?</p>

10

<p>Montegut – if she requires long term custodial care, that wont be covered unless she has a long term care plan already. (That’s different than any of the Medicare supplements.) Given her current condition, it is unlikely that she would be able to buy such a plan at this point. </p>

<p>Unfortunately, I don’t think she’ll even have Medicare-paid coverage through day 100 – that’s only if she needs skilled nursing care, which is different than long-term custodial care. While she’s still benefitting and showing significant progress from therapy (Speech, physical, or occupational) or is getting IV infusions or other specialized care it will probably count, but if she gets to the point where the therapy isn’t making much improvement, that will stop, and if she no longer needs medical support that must be supplied by an RN, I think that becomes the point at which she’s discharged from Medicare-paid skilled nursing, even if she still needs to be in a nursing home for her own safety and care.</p>

11

<p>Thank you all for your advice. I will make the calls on Monday. 3togo – I’m a 50 year old lawyer who well understands most things, but have had the hardest time navigating the “old age” bureaucracies, for my mother and her contemporaries, all who believe I have some sort of magical understanding. Unfortunately, the ways the laws are written (which I can understand), and they way they are applied (which I can’t figure out), cause me to spin my wheels. The elderly, even those not terribly old or ill, if left to their own devices, are constantly impeded in their efforts to obtain the benefits to which they are entitled. Again, thanks all.</p>

12

<p>You should also check any Long Term Care policies before you parents sign them. My mother purchased her Long Term Care supplement when she was 70–still healthy, not on any medication, without any signs of dimentia and still living in a four-bedroom house with a yard. At that time, she had to choose whether she wanted her plan to include home health care visits. She opted for “no.” She couldn’t imagine allowing anyone into her home to help her do anything.</p>

<p>Now, she is 85 and really needs someone to check on her every day to be sure she is taking her medicine properly, but she refuses to let us arrange for that because it would be too costly. After her skin cancer/grafts this year and her ministrokes two summers ago, Medicare paid for the home care visits for 21 days after she was released from the hospital or the skilled nursing facility, but once she did not need wound care or OT, Medicare stopped paying.</p>

<p>The only way now to assure that she is taking her medicine (short of my brother visiting her every day to give them to her), is to have her move from her independent living apartment into assisted living, but she doesn’t qualify for it because she can still do the “Activities of Daily Living” on her own.</p>

<p>It would give her four children huge peace of mind if someone checked in our her every day and she can afford it, but she thinks paying for it is “ridiculous.” It’s her favorite word. If she had opted for it, the long-term care would pay for it.</p>

<p>If she didn’t check every line item of her bank statement on a yellow legal pad every month, we’d hire someone and tell her Medicare was paying for it. But she’s the type who calls the phone company if her phone bill is 5 cents more than last month and asks why.</p>

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<p>Montegut - That is EXACTLY what we found at the first skilled nursing facility where my dad was sent after his hospitalization. (By the way, it is my understanding they must have a care conference in 14 days - but I could be wrong).</p>

<p>When dad was being discharged there was some debate as to whether he should go to skilled nursing “for a short time” or return to his independent living apartment. The doc was pushing for home, the social worker to skilled nursing. The skilled nursing facility was very loving, caring, accommodating - but there was no effort whatsoever (except during actual PT/OT) that dad was encouraged to rehab and get home. He had abdominal surgery and I came in one day and they were shaving him in bed. At that point he could get up with a walker - there was a wheelchair available to use - but they were shaving him in bed. I (being the B**** that I can be) asked what was going on. I pointed out that nothing had happened to his arms and that he could surely shave himself seated in chair in the bathroom. The nurse’s aide turned to him and asked him so sweetly, “Well, do you think you would like to do that?”</p>

<p>When I went to the first care conference I asked what were the benchmarks for discharge. They looked at me gravely and said it was waaaaaaay too soon to even think about that. </p>

<p>I will stop before I get my blood pressure up again.</p>

<p>Anyway, long story, but when an opening came at the skilled nursing facility associated with his continuing care retirement community, we moved him there (it was filled at time of discharge from hospital) and the change was mind blowing. They got his too easily pampered butt out of bed and home in 8 days. </p>

<p>Based on what I saw with my dad, in some facilities, people become less independent and self-reliant. The first place would have been great if dad had been dying. They just loved him (as they told me one day - I said try loving him a little less).</p>

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<p>Oh, my heavens. Your mom must be my dad’s long lost twin! At his independent living apartment, the pharmacy on site will come to his apartment & put his prescriptions each
week in the pill tender for $10/month. But I had a terrible time convincing him to do it. </p>

<p>And I shouldn’t get started on his refusal to use disposable colostomy bags, which after medicare and his health plan from his long ago employer cost him 10 cents. Oh, yeah. I would be cleaning out a bag each day rather than spend 10 cents. </p>

<p>And I wonder why I am now on BP meds.</p>

14

<p>Is it a generational thing wherein our parents check every penny on every bill…sweating the small stuff whilst ‘wasting’ large sums of money on other things?</p>

15

<p>Oh, my gosh, I am loving the above posts.</p>

<p>My brother just emailed me frantically, as Mom is still waiting on her evaluation and wondering what’s going on.</p>

<p>I told him I am as much in the dark as they are.</p>

<p>Mom’s doctor sweetly told her last week, Oh, you can stay here as long as you want! Sure, wouldn’t she like that. She’s not paying for it!</p>

<p>I can just see Mom now, cursing up a storm, how we’ve railroaded her into “a place”! Katrina was beyond her control, but by golly, she’s going to get her ombudsman on the phone right now and have us arrested! </p>

<p>Poor thing can’t see, so she makes empty threats.</p>

<p>As for taking good care of them, oh, yes, indeed, these facilities do do that. They know where their bread is buttered. In the “old days”, when your parent went into “a home”, they were dead in six months or less. I hate to be so candid, but we had no idea that Mom would live this long in “one of those places”.</p>

<p>This activities of daily living thing is so frustrating. They’re too well to go to a nursing home, but too bad off to live on their own.</p>

<p>As for medication, we’re in the same boat. Mom is on Depakote, and if left to her own devices, she would just not take it. Even though she may have been physically able at times to require a lower level of care, we’ve always paid for the highest plan, because it entailed a nurse giving her her meds and making sure she took them. She was once on Seroquel as well after a psychiatric hospital stay, but she refused to continue taking it, as it made her sleep, so the doctor took her off it. She really would benefit from it, as she only sleeps two hours a night, and it would give both her children and her facility’s staff a lot more peace of mind.</p>

<p>Also true about the Day 14 care plan. On admission, I was told there would be a 14 day care plan. When one wasn’t called, I assumed Mom was on track to be released by Day 20, and since I live out of state, I didn’t rush over there asking for one. I’m figuring we’re getting our Day 14 care plan a little late, by about 10 days by the time it rolls around.</p>

<p>As stated above also, there is the matter of them no longer benefitting from therapy, or plateauing. I guess that is similar to the term “maximum medical cure” that I hear in my legal work. So, mom can just continue on a status quo, but not be qualified for medicare paid skilled nursing, but also not able to do activities of daily living to qualify for assisted living. Where does she go then? What type of facility? Is this where residential care comes in?</p>

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<p>In many parts of the country, insurance salespersons are pushing hard the newer Medical Advantage plans. BEWARE. They seem great on paper. But Medicare no longer administers the reimbursements, a private insurance company is paid to do so. They are really HMO’s but are quick to say they are not HMO’s. Medicare dollars go to the insurance company who then makes all the rules. </p>

<p>Medicare PART C IS NOT MEDICARE PART B. </p>

<p>And Medicare supplement plan C (which is Medicare Part B PLUS a secondary plan C IS NOT THE SAME IS MEDICARE PART C. </p>

<p>You only want to go on Medicare Advantage is you have little ability to pay. You pay less but you will ultimately give up much of the control over your choices.</p>

17

<p>Sunny, I’m in insurance and not a fan of the advantage plans at all (unless you can’t afford a premium, in which case it’s usually better then nothing). I don’t know anyone at my company that does particularly like them. Medicare supplement plan C is a great option all around, so is plan F. The new plan N is very nice also. It has co pays like the advantage plans which give it a cheaper premium but it gives you the freedom to keep regular medicare and go wherever.</p>

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<p>My parents tried the Advantage program and then couldn’t find any doctors who would take them - so they switched back. Lesson learned.</p>

19

<p>For those of you with concerns about elderly parents and medication, Philips makes a medication dispensing system that might be helpful. You can load a month’s worth of medication and an alert goes off to remind them to take their pills. If they don’t take the pills out a phone call goes out. It also doesn’t let them take out doses they shouldn’t be taking yet.</p>

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<p>^^^Thanks, electronblue. I’ll look into that. One of my concerns about moving Mom closer to home is that my state’s facilities do not offer medication assistance. As this is a big issue with Mom, it has been a major obstacle to bringing her back home. If she goes off her meds, she gets, well, to be frank, crazy, and we spent years doing damage control from her behavior before she finally got on meds.</p>