I just found several bills for 3 months worth of Mom's prescriptions at the nursing home - this is for her portion of prescription costs after payment by her supplemental insurance. I was told that these would be covered by Medicaide but OHH NOOOOOOO!!! No one told me she MUST be enrolled in Medicare Part D to get this co-pay covered!!!
Generally, if a person is on Medicaide, their Medicare premium is paid the the state (Medicaide) and their premium for Medicare part D is greatly reduced to $1-$5 per month. Long story short, the Social Security Administration which administers Medicare has no communication from Mom's state Dept of Health that she's been approved and receiving medicaide, there fore, she can get Medicare Part D to cover this co-pay but until the SS office gets word from the state - her monthly premiums and deductible are MORE than the co-pays!! I learned all this after four calls this morning. I was especially preturbed that I spoke with a woman at the Medicare-Medicaide service call center - I assume she's paid by the federal government or employed by a contractor of the federal government - who took down all kinds of information then suggested a specific PRIVATE company that would best meet mom's needs for the least amount of money. This choice is based on her prescriptions - it seems that private companies are diving up the pie.
I HATE this confusing BS and it really makes me want to advocate for ONE SOCIALIZED system - as it stands now her expenses are covered by two government programs, one private program and I need to get her enrolled with a 2nd private company to pay what the other 3 (2 public/government and 1 private) will not. It means 4 sets of paper work, 4 sets of billings, 4 mailings, 4 account numbers - IT'S INSANE!!! It's no wonder that Medicare fraud is so easy! I don't want to reduce American jobs but I wonder just how many people are employed to manage this mess? How many people are employed by doctors offices and nursing homes to wade through this mess? If it were in ONE program, might it cost less money to administer? I get especially frustrated when I consider the number of people to manage this bureaucracy and the waste versus the needs of patients and the push to drive down the cost of their care. If it were all under one umbrella plan, perhaps it could cost less and my Mom wouldn't suffer the indignity of the cheap solution!!
Showing posts with label medicare. Show all posts
Showing posts with label medicare. Show all posts
Wednesday, July 28, 2010
Wednesday, June 23, 2010
Medicare versus Medicaide
In the past week I've had three calls from friends about the difference between Medicare and Medicaide. Basically, one is a federal insurance program for the elderly and the other is a state program that helps indigent - or poor - residents.
Disclaimer before you read further: This information is based on my experience and knowledge of Medicaide in two separate states. Each state is different; to find out the specifics of your state, do your research. I suggest that you search "(name of your state) AND medicaide" or contact the your state agency for health and welfare. The Area Agency on Aging within your local area is also a good resource to help you begin to understand Medicare and Mediciade in your state.
The basics: Medicare and Medicaid are BOTH paid for by tax dollars - and you didn't think the USA has socialized medicine....
Medicare is government supported health insurance for the elderly, it DOES NOT PAY for nursing home or long term care. Citizens 65 years and older pay premiums directly from their social security. You may select any doctor who accepts this as payment.
Medicaide is government paid nursing home (long term) care. It may also help pay for Medicare premiums and for prescriptions. Most of the funds for medicaid come from the federal government but the programs are administered by each state. Each state still has to contribute something toward Medicaide.
Medicare is a federal insurance program available to US citizens over 65. To pay for this plan, the federal government takes premiums directly from social security payments. Most of us will be covered by Medicare at some point. Even if you have health coverage as a retiree, those programs usually defer to Medicare once you turn 65 and you're likely to need more medical attention, prescriptions or procedures. In some cases, the primary insurance you had through a pension plan or employer becomes your supplemental plan, meaning that it pays some of what Medicare does no. Medicare does NOT pay for long term care in assisted living or nursing homes. They will not pay for on-going home health care or aides for elderly either. They will pay for up to 120 days in a nursing home provided the patient shows improvement and any therapies administered help the patient improve to return home or return to assisted living. As a citizen, you automatically qualify for Medicare and, near your 65th birthday, you will receive a letter advising you of your status. As of this writing, June 23, 2010, there are many doctors across the country who refuse to accept Medicare payments so use caution when selecting a doctor.
Medicaide is a state program (it may be called something else in your state) generally administered by the State Department of Health and Welfare. Medicaide is not limited to the elderly and may also cover children of poor families, people with physical or mental disabilities or the most poor citizens. It generally does not include dental or vision but in some states eye exams and dentures are covered one time during a set period, like onc every 5 years. Medicaide DOES pay for long term care in assisted living or nursing homes and there are certain criteria to meet before an elderly person may receive Medicaide. Generally these are:
Disclaimer before you read further: This information is based on my experience and knowledge of Medicaide in two separate states. Each state is different; to find out the specifics of your state, do your research. I suggest that you search "(name of your state) AND medicaide" or contact the your state agency for health and welfare. The Area Agency on Aging within your local area is also a good resource to help you begin to understand Medicare and Mediciade in your state.
The basics: Medicare and Medicaid are BOTH paid for by tax dollars - and you didn't think the USA has socialized medicine....
Medicare is government supported health insurance for the elderly, it DOES NOT PAY for nursing home or long term care. Citizens 65 years and older pay premiums directly from their social security. You may select any doctor who accepts this as payment.
Medicaide is government paid nursing home (long term) care. It may also help pay for Medicare premiums and for prescriptions. Most of the funds for medicaid come from the federal government but the programs are administered by each state. Each state still has to contribute something toward Medicaide.
Medicare is a federal insurance program available to US citizens over 65. To pay for this plan, the federal government takes premiums directly from social security payments. Most of us will be covered by Medicare at some point. Even if you have health coverage as a retiree, those programs usually defer to Medicare once you turn 65 and you're likely to need more medical attention, prescriptions or procedures. In some cases, the primary insurance you had through a pension plan or employer becomes your supplemental plan, meaning that it pays some of what Medicare does no. Medicare does NOT pay for long term care in assisted living or nursing homes. They will not pay for on-going home health care or aides for elderly either. They will pay for up to 120 days in a nursing home provided the patient shows improvement and any therapies administered help the patient improve to return home or return to assisted living. As a citizen, you automatically qualify for Medicare and, near your 65th birthday, you will receive a letter advising you of your status. As of this writing, June 23, 2010, there are many doctors across the country who refuse to accept Medicare payments so use caution when selecting a doctor.
Medicaide is a state program (it may be called something else in your state) generally administered by the State Department of Health and Welfare. Medicaide is not limited to the elderly and may also cover children of poor families, people with physical or mental disabilities or the most poor citizens. It generally does not include dental or vision but in some states eye exams and dentures are covered one time during a set period, like onc every 5 years. Medicaide DOES pay for long term care in assisted living or nursing homes and there are certain criteria to meet before an elderly person may receive Medicaide. Generally these are:
- Spend down to $2000 or $2500 in assets. This means that the elder MUST use all possible assets before they may receive medicaide. They must consume all cash, CDs, stocks, bonds and savings. Note that if at anytime, an elders assets grow to MORE than $2000 or $2500, they may be disqualified from Medicaide until that money is spent. If you know this will happen, you can plan for it and buy something that they need like depends, lap robes, eye glasses, dentures (medicaide will pay for eye glasses & dentures but only once every few years). Here's a link to an article about the Medicaide spend down on Agingcare.com.
- Look back periods: These can get you in to a lot of trouble. Each state has a defined period where they look back at expenditures to determine whether someone qualifies. This is to prevent transfer of ownership of valueables, gifting of cash, stocks, bonds, etc or deeding of any property before an application for assistance. The object is to ensure that assets are used to provide for someone, that they consume their resources before receiving public resources for their support. Some states have a look back period as long as 7 years!! so be sure to thoroughly understand this before accepting anything from your elders.
- Homes may be exempt: The elder may own a home and the state will not force the sale of it if a spouse, dependent child or other relative lives there. The state may also permit the home to sit - without being sold - if the elder plans to return home.
- Financial recovery: most states seek some kind of financial recovery from an elders estate. First they will put a lien on a home or proprety so that when the elder passes, the state will expect to recoup funds spent on care. If the home/property is occupied by a surviving spouse the state may not use liens. The state may also try to recover funds by forcing the sale of cars or other valuable possessions such as art or antiques.
- Pensions and social security must be spent toward care: Any monthly income received by an elder must be spent on their care, this is often called a co-pay or care contribution. In my mom's case, her social security and pension are deposited directly to her checking accounts and I write a check for her contribution each month. The state pays the rest directly to the nursing home, I don't have anything to do with that.
- Monthly personal allowance: Most states permit each elder to keep between $30-50 a month for their personal use. This isn't a lot at all so I supplement when necessary. I do not give the money directly to her but do pay for her hair cuts, permanents and regular hair appointments.
- Medicare is your PRIMARY insurance after 65 but Medicaide helps: You'll still have to pay a monthly premium if you go on Medicaide but Medicaide will pay the premium for you. So for doctor bills, procedures, tests, etc. Medicare pays first, your supplemental plan (if you have one) pays second and Medicaide pays third. Without a supplemental plan, Medicaide probably covers it all or the doctor may write off some of the charges.
- Medicaide can start and stop payment so WATCH THEIR BANK ACCOUNTS!!: If an elder is hospitalized, their care may be paid my Medicare for that period and for a time (sometimes as long as 120 days, 3 months) AFTER they return to a nursing home. BE CAREFUL and watch their funds during this period. If their monthly income is NOT used for a nursing home while Medicare is paying, it can build up over the $2000 or $2500 in maximum assets. This nearly happened to my Mom so I bought some personal items for her to ensure that she did not accumulate more than $2500. I also started a burial fund - allowed by her states' Medicaide program) and plan to contribute to it if/when she begins to accumulate more than $2000. On a personal note: I don't feel like I'm ripping off the state or being dishonest in this case, she would have been only $250-300 over the $2500 but that relatively small amount would cause all kinds of headaches and I'd have to redo her medicaide application all over.
Saturday, June 19, 2010
Medicare takes a while to "buy" wheelchair -
Mom's "free" wheelchair wasn't so free after all and no one knew it - apparently, she had to pay for some of it even though deductibles and co-payments on her part had been met. The whole situation has me frustrated and demonstrates that people just don't know all the rules and regulations about payments when dealing with Medicare and Medicaide. I believe there may be some confusion over billing and with the three parties involved but I'm so frustrated with the matter, that I'll end up paying the $58 myself.
When Mom got her wheelchair we were told "Medicare will buy it.." "Outright, completely, 100% paid for by Medicare?", I asked the assisted living facility? "ABSOLUTELY", the staff at the ALF assured me several times... Well, that's absolutely WRONG! Medicare pays for the rental of a wheelchair for 16 months or so. If the patient still needs the wheelchair by then it's considered paid for, so it's a rent to own program. When Mom transferred from assisted living to the nursing home, we didn't know the wheelchair had to go back to the medical equipment rental company so it went into storage. After two months they reached me and I took the chair back immediately. At that time, I was disgusted with the whole process and asked for some kind of receipt; they were reluctant to provide it but I insisted. Good thing I listened to my gut, because 2 days later I got a call asking when I planned to return the wheelchair!!! At that time, I asked about outstanding bills, payments, co-pays ANYTHING and was told it was paid in full....
They're FULL OF IT alright..... yesterday an angry accounts receivable clerk from the rental company called wanting the $58. It seems she's been sending invoices to Mom at the assisted living center. The ALF gave a forwarding address at the nursing home but they've received no money. The nursing home finally told her to call me as the Power of Attorney (PoA). Medicare has taken back two months worth of rent from the medical rental company because Mom was in a nursing home where wheelchairs are provided. Medicare wouldn't pay for the two months that the chair was in storage. Thinking the chair was Mom's property, we put it in storage and that will cost us $58. It's not a HUGE amount of money but it's money I'll have to take from her savings. It's inconvenient. It's frustrating to talk to people who assume you're trying to run-out on a bill. It's frustrating that the "experts" don't know the process yet speak with certainty. I've found this same situation over and over, things are so complex with billing Medicare, Medicaide, supplemental insurance, Medicare for health care, Medicare for prescriptions, Part B, Part D - never mind what happened to Part A and C!!- payments made, payments rescinded... It's all just too complicated. I wish they'd put people to work figuring out how to make it easier, or put in some regional offices with case workers. UGH!!
Will medicare buy mom dad a wheel chair? How can I get medicare to buy mom dad a wheelchair? Wheelchair rental for the elderly.
When Mom got her wheelchair we were told "Medicare will buy it.." "Outright, completely, 100% paid for by Medicare?", I asked the assisted living facility? "ABSOLUTELY", the staff at the ALF assured me several times... Well, that's absolutely WRONG! Medicare pays for the rental of a wheelchair for 16 months or so. If the patient still needs the wheelchair by then it's considered paid for, so it's a rent to own program. When Mom transferred from assisted living to the nursing home, we didn't know the wheelchair had to go back to the medical equipment rental company so it went into storage. After two months they reached me and I took the chair back immediately. At that time, I was disgusted with the whole process and asked for some kind of receipt; they were reluctant to provide it but I insisted. Good thing I listened to my gut, because 2 days later I got a call asking when I planned to return the wheelchair!!! At that time, I asked about outstanding bills, payments, co-pays ANYTHING and was told it was paid in full....
They're FULL OF IT alright..... yesterday an angry accounts receivable clerk from the rental company called wanting the $58. It seems she's been sending invoices to Mom at the assisted living center. The ALF gave a forwarding address at the nursing home but they've received no money. The nursing home finally told her to call me as the Power of Attorney (PoA). Medicare has taken back two months worth of rent from the medical rental company because Mom was in a nursing home where wheelchairs are provided. Medicare wouldn't pay for the two months that the chair was in storage. Thinking the chair was Mom's property, we put it in storage and that will cost us $58. It's not a HUGE amount of money but it's money I'll have to take from her savings. It's inconvenient. It's frustrating to talk to people who assume you're trying to run-out on a bill. It's frustrating that the "experts" don't know the process yet speak with certainty. I've found this same situation over and over, things are so complex with billing Medicare, Medicaide, supplemental insurance, Medicare for health care, Medicare for prescriptions, Part B, Part D - never mind what happened to Part A and C!!- payments made, payments rescinded... It's all just too complicated. I wish they'd put people to work figuring out how to make it easier, or put in some regional offices with case workers. UGH!!
Will medicare buy mom dad a wheel chair? How can I get medicare to buy mom dad a wheelchair? Wheelchair rental for the elderly.
Wednesday, April 21, 2010
Medicaide should help but for a few months will put Mom's accounts in the hole!!
Mom just began getting Medicaide to supplement her rent for a nursing home and for a few months she won't have enough to cover all of her expenses. I'll have to chip in about $100 a month. Mom must pay nearly all of her income (social security and pension) to the nursing home. She gets $30 for her personal needs and $200 for her supplemental insurance premium. The deficit happens because Medicaide considers ALL of her social security - the grose amount BEFORE deduction of premiums for Medicare part B. Medicaide is supposed to pay the premiums now but it takes a while for the Federal government to get the message and stop the withdrawals. So for a few months Mom is required to pay out what she doesn't get. I spoke with Medicaide and they said she will get reimbursed for the Medicare part B premiums but it could take 3-5 months until it's all said and done. So, I'll make regular deposits in Mom's account and continue to make calls if it doesn't happen by July.
Medicaide wants more than Mom dad gets Medicare premiums are still withdrawn medicare premiums put mom dad in the hole medicare premiums cause over drafts over drawn
Medicaide wants more than Mom dad gets Medicare premiums are still withdrawn medicare premiums put mom dad in the hole medicare premiums cause over drafts over drawn
Tuesday, June 23, 2009
Friends pride and denial risks Mom's safey
An old friend called a couple of days ago looking to find some way to help her mother after she returned home from a back surgery. It was an odd call full of questions from her and sound answers from me (or so I thought...) but I don't think she got the answers she wanted from me. Long story short, my friend can't realize that her mother probably needs the professional care of LPNs, RNs or CNAs after surgery. She wants to keep her mother in her own home rather than use the available resources to ensure that her Mom is safe and well tended during her recouperation. She seems too proud to admit that her mother needs the additional assistance of professional care givers.
Here's the scenario:
Friend's Mom is 84 and has severe osteoporosis; so bad that she broke three ribs trying to lift a 10 pound chicken from the freezer and thus the need for surgery. She lives alone, goes to mass each morning and walks 2 miles a day. In the past year she has been hospitalized and recouperated at home after a severe bladder infection and again after surgery to repair cracked vertebrae. The vertebrae surgery required a brace that was nearly impossible for her to get off and on by herself and limited her movement and increased her risks of falls. Friends Mom had bad experiences with pain medication; she was either allergic or took too much but because she was home recouperating alone, no one knows for sure. She woke up on a soaked kitchen floor with buckets, cups and plates all around her and no memory of what happened. There have also been some instances when Friends Mom got lost when she travelled to an unfamiliar part of town; it's small enough that she should have been able to find her way to familar territory.
My friend hoped to work out a schedule with her siblings (think no cost to Mom) but they all have commitments to jobs, kids in school and in-laws that need support during chemo and surgeries as well. Her dependable and responsible siblings used their available vacation time for Mom's previous recouperation so had none left to use.
My first response was : Let Medicare pay for time in a rehab center (nursing home). (They pay for 100 days, 3+ months of rehab care after surgery or hospitalization).
I thought my friend would have a herd of cows right then and there! You'd think I suggested throwing her Mom out the car door at high speed. It went something like this: (Explicative)...Mom can't go to a nursing home! She's not one of those old ladies! How could you even SAY that?!! My second suggestion was to contact a home health care provider to go by 3 to 4 times a day but at nearly $16 per hour that was out of the question as well.
In all honesty, Friends Mom IS one of those old ladies. She is quite frail, needs someone to ensure she eats and taked meds regularily. She also needs companionship and, most important of all, she needs some skilled nursing care (think professionally trained) and rehabilitation to get back on her feet after this surgery. She will ONLY get that at a nursing home or from home health care aides. If you can afford the care at home, by all means, do it, other wise take advantage of the Medicare policy and let your elder get the care s/he needs. 100 days is a long time to recoupe from a surgery and she would probably would not be there long but she's likely to recoupe faster with the care they can provide. Rehab centers or nursing homes are well prepared to deliver 3 meals a day, medications, physical therapy, bathing and toileting assistance. These are things that we just can't do well at home if we're helping out as our busy schedules permit. Our Elders deserve the full attention of professionals if we aren't able to do it.
To be sensitive to my friend - She has deep love and respect for her Mom. She wants to be supportive, she feels guilty and knows her Mom will feel best emotionally at home. Yet,she expects too much of local relatives who can't be there and she is unable to travel to help due to her own job. I can say, based on my own failure to act, denial is really easy but can cost Mom a lot in the end. There comes a time when our elders need our help in spite of our own preferences, pride and aversions. Let go of the stigma that nursing homes are terrible. Most of these facilities realize that the payments they get from Medicare are important and reliable revenue; they won't screw it up. Their employees also enjoy knowing that they can help elders get back on their feet and WANT to see them go home because it means they did their job well and had a success. They are proud of the kind care they can provide; we just need to swallow ours and let them do their jobs for our elders.
Here's the scenario:
Friend's Mom is 84 and has severe osteoporosis; so bad that she broke three ribs trying to lift a 10 pound chicken from the freezer and thus the need for surgery. She lives alone, goes to mass each morning and walks 2 miles a day. In the past year she has been hospitalized and recouperated at home after a severe bladder infection and again after surgery to repair cracked vertebrae. The vertebrae surgery required a brace that was nearly impossible for her to get off and on by herself and limited her movement and increased her risks of falls. Friends Mom had bad experiences with pain medication; she was either allergic or took too much but because she was home recouperating alone, no one knows for sure. She woke up on a soaked kitchen floor with buckets, cups and plates all around her and no memory of what happened. There have also been some instances when Friends Mom got lost when she travelled to an unfamiliar part of town; it's small enough that she should have been able to find her way to familar territory.
My friend hoped to work out a schedule with her siblings (think no cost to Mom) but they all have commitments to jobs, kids in school and in-laws that need support during chemo and surgeries as well. Her dependable and responsible siblings used their available vacation time for Mom's previous recouperation so had none left to use.
My first response was : Let Medicare pay for time in a rehab center (nursing home). (They pay for 100 days, 3+ months of rehab care after surgery or hospitalization).
I thought my friend would have a herd of cows right then and there! You'd think I suggested throwing her Mom out the car door at high speed. It went something like this: (Explicative)...Mom can't go to a nursing home! She's not one of those old ladies! How could you even SAY that?!! My second suggestion was to contact a home health care provider to go by 3 to 4 times a day but at nearly $16 per hour that was out of the question as well.
In all honesty, Friends Mom IS one of those old ladies. She is quite frail, needs someone to ensure she eats and taked meds regularily. She also needs companionship and, most important of all, she needs some skilled nursing care (think professionally trained) and rehabilitation to get back on her feet after this surgery. She will ONLY get that at a nursing home or from home health care aides. If you can afford the care at home, by all means, do it, other wise take advantage of the Medicare policy and let your elder get the care s/he needs. 100 days is a long time to recoupe from a surgery and she would probably would not be there long but she's likely to recoupe faster with the care they can provide. Rehab centers or nursing homes are well prepared to deliver 3 meals a day, medications, physical therapy, bathing and toileting assistance. These are things that we just can't do well at home if we're helping out as our busy schedules permit. Our Elders deserve the full attention of professionals if we aren't able to do it.
To be sensitive to my friend - She has deep love and respect for her Mom. She wants to be supportive, she feels guilty and knows her Mom will feel best emotionally at home. Yet,she expects too much of local relatives who can't be there and she is unable to travel to help due to her own job. I can say, based on my own failure to act, denial is really easy but can cost Mom a lot in the end. There comes a time when our elders need our help in spite of our own preferences, pride and aversions. Let go of the stigma that nursing homes are terrible. Most of these facilities realize that the payments they get from Medicare are important and reliable revenue; they won't screw it up. Their employees also enjoy knowing that they can help elders get back on their feet and WANT to see them go home because it means they did their job well and had a success. They are proud of the kind care they can provide; we just need to swallow ours and let them do their jobs for our elders.
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