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Old 06-15-2017, 05:41 PM
 
13,400 posts, read 6,628,465 times
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Quote:
Originally Posted by ocnjgirl View Post
Medicare pays 100% for 20 days IF you are there for skilled rehab after a 3 day (at least) hospital stay. After 20 days, they pay 80% for as long as you are making progress on the skilled unit, up to 100 days. If you have a Medicare supplemental policy, which most do (like AARP, etc) that picks up the 20% Medicare doesn't cover after the first 20 days. I work in rehab and it's only in poor areas that people come into rehab announcing "I have to be out of here in 20 days". A supplemental is a must to get the most out of Medicare, although not cheap (my mom's was over $300/month).

Medicaid is not instant however, the family has to apply and be approved. We get people all the time who we have to discharge home totally unsafe because the family never filled out the Medicaid paperwork.
Hm. My brother's Humana PPO doesn't say anything about 80/20 (that was my understanding too). I called about a bill and they said co-insurance is $160/day. Well, that is the insurance contracted rate. That's 100%. Maybe it was the lack on improvement factor, but elsewhere in this thread someone posted courts have ruled against that.

I guess I have to call them AGAIN. but it's annoying. Whoever answers is just reading from a script. Maybe I am better off with the business office of the actual nursing home.

PS some people can't get plans for seniors. In Texas, people on Medicare because they are disabled can't get many things that seniors can.
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Old 06-15-2017, 06:10 PM
 
13,400 posts, read 6,628,465 times
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Quote:
Originally Posted by Backintheville2 View Post
Yes, 15 states allow it and it allows property to transfer without having to go through probate. In our case, mom was still living in the home and I was her caregiver. But the property will eventually transfer to my sister and me. In fact, both our names are now on the mailing we get from the County Tax Appraiser's office, underneath my mom's name. Our elder care paralegal/attorney office explained it to us and we decided it would be a good thing for us.
Great info. Thank you. I should have known with Texas being SO BIG on homesteads this would be possible.

Lady Bird deeds:

Quote:
They preserve the homeowners ability to immediately qualify for Medicaid benefits. Transfers of assets within a “look-back” period may disqualify applicants from immediately qualifying for benefits. However, executing an enhanced life estate deed is not considered a transfer for Medicaid purposes because the homeowner retains the right to sell the property or revoke the deed.
https://texaswillsandtrustslaw.com/2...ady-bird-deed/
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Old 06-15-2017, 09:27 PM
 
Location: The Triangle
4,465 posts, read 3,458,582 times
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After doing a lot of reading on NC's Medicaid laws/policies, I have discovered that the home is protected from Medicaid lookback/spend down if the spouse lives there and home is jointly owned (certain conditions apply). It is also protected from Medicaid recovery after the nursing home spouse is deceased. I have ordered a booklet that explains Medicaid in detail for my state and look forward to learning more.
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Old 06-16-2017, 05:20 AM
 
20,351 posts, read 16,507,985 times
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Quote:
Originally Posted by jencam View Post
Hm. My brother's Humana PPO doesn't say anything about 80/20 (that was my understanding too). I called about a bill and they said co-insurance is $160/day. Well, that is the insurance contracted rate. That's 100%. Maybe it was the lack on improvement factor, but elsewhere in this thread someone posted courts have ruled against that.

I guess I have to call them AGAIN. but it's annoying. Whoever answers is just reading from a script. Maybe I am better off with the business office of the actual nursing home.

PS some people can't get plans for seniors. In Texas, people on Medicare because they are disabled can't get many things that seniors can.
PPOs and Advantage plans are different, and each one pays differently. I was talking about traditional Medicare. Advantage plans are awful in general once you actually get sick. Anyone who can swing the cost of a supplemental would be much better off switching to traditional Medicare plus a supplemental. It costs more upfront but covers much more. I changed my mom's as soon as I got POA and open enrollment came. She owed $5000 in co-pays after a 3 week rehab stay. Since I switched her she's been back to hospital and rehab 2 or 3 times and owed nothing.

Everyone can get traditional Medicare. It's actually the default when you turn 65, unless you change it. Many seniors change to Advantage plans because they have no or low premiums and you don't have to pay a separate part D premium. The way they are marketed makes them sound like top-notch plans...again, once you get sick it's a different story. They all have gatekeepers, while traditional Medicare does not.

Last edited by ocnjgirl; 06-16-2017 at 06:27 AM..
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Old 06-16-2017, 07:09 AM
 
2,952 posts, read 1,623,898 times
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Quote:
Originally Posted by Sweet*Tea View Post
After doing a lot of reading on NC's Medicaid laws/policies, I have discovered that the home is protected from Medicaid lookback/spend down if the spouse lives there and home is jointly owned (certain conditions apply). It is also protected from Medicaid recovery after the nursing home spouse is deceased. I have ordered a booklet that explains Medicaid in detail for my state and look forward to learning more.
That is what we should all do, each state in different.

A friend of mine daughter had MS, daughter lived in OR. Mom was going to bring her down to NV for care. Mom went looking for medicaid only places, no extra money for more than basic care. There were about 4 here and the only places that would take daughter. Medicaid only. She said they were all not up to her picky standard, smelled etc. except one.
All had a waiting list, best one estimated a year. But of course they don't know. Flu could go through facility and wipe out a few residents.

OR has a lot of state aid not paid in NV. NV also told her she was taking a risk bringing her here. They would have to 'see if she qualified.' No guarantee and that process could take 6 to 9 months. No rebates. I think they didn't wnat her to bring daughter to NV.

Daughter passed a couple years ago.
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Old 06-16-2017, 03:51 PM
 
13,400 posts, read 6,628,465 times
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Quote:
Originally Posted by ocnjgirl View Post
PPOs and Advantage plans are different, and each one pays differently. I was talking about traditional Medicare. Advantage plans are awful in general once you actually get sick. Anyone who can swing the cost of a supplemental would be much better off switching to traditional Medicare plus a supplemental. It costs more upfront but covers much more. I changed my mom's as soon as I got POA and open enrollment came. She owed $5000 in co-pays after a 3 week rehab stay. Since I switched her she's been back to hospital and rehab 2 or 3 times and owed nothing.

Everyone can get traditional Medicare. It's actually the default when you turn 65, unless you change it. Many seniors change to Advantage plans because they have no or low premiums and you don't have to pay a separate part D premium. The way they are marketed makes them sound like top-notch plans...again, once you get sick it's a different story. They all have gatekeepers, while traditional Medicare does not.
OK, so the 80/20 is from the supplemental? I just read the email from the nursing home and she linked me to medicare saying it's $164/day after 20 days.
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Old 06-16-2017, 04:13 PM
 
20,351 posts, read 16,507,985 times
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Quote:
Originally Posted by jencam View Post
OK, so the 80/20 is from the supplemental? I just read the email from the nursing home and she linked me to medicare saying it's $164/day after 20 days.
Again, he has an Advantage Plan. If it's Humana, it's not traditional Medicare. You can't use a supplemental policy with an Advantage Plan. Your dad has to switch to traditional Medicare at the next open enrollment period (it's in the fall I believe), then shop for a supplemental plan. Then Medicare pays 100% for the first 20 days, then 80% up to 100 days, with the supplemental coming in on day 21 and paying the other 20% up to day 100.

With the plan he has, you're restricted to their rules...but they are Humana rules, not Medicare rules. Traditional Medicare is run by the Federal government, not insurance companies. The supplemental policies however ARE sold by private insurers, but they only support traditional Medicare plans.

Advantage Plans never pay enough when you need them. That's why they often have no premium.

My mom owed thousands after her stay (they didn't even pay for the ambulance, we had to pay $500 for her to be taken literally 500 feet across the street from her ALF to the hospital). She thought it was a great plan but it was only good as long as she was healthy. After I switched her, she had to go from zero premium to $311 a month for the supplemental policy and $37 a month for Medicare part D (prescription drug coverage, which is included in Advantage plans) but she saved a ton more than she would have spent in co-pays because she's been in and out of the hospital and rehab multiple times since then.






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Old 06-16-2017, 05:10 PM
 
13,400 posts, read 6,628,465 times
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I undersatnd what you are saying but she is quoting Medicare guidelines. If he had straight medicare it would be the same. A couple dollars higher per day actually. Here is her email:


Good morning,

I have attach directly from Medicare website the breakdown of their coinsurance guidelines which is across the board in every state. Humana gave him a little break off it but normally it is $164.50/day


That can't be 20%.

I can't copy and paste from the pdf showing this, but it specifically says this is the rule for original medicare:
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Old 06-16-2017, 05:13 PM
 
13,400 posts, read 6,628,465 times
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Sorry. Pasting the pdf she sent didn't work so here it is from the website directly:

Your costs in Original Medicare

You pay:

Days 1–20: $0 for each benefit period.
Days 21–100: $164.50 coinsurance per day of each benefit period.
Days 101 and beyond: all costs.


https://www.medicare.gov/coverage/sk...lity-care.html
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Old 06-16-2017, 05:50 PM
 
20,351 posts, read 16,507,985 times
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Quote:
Originally Posted by jencam View Post
I undersatnd what you are saying but she is quoting Medicare guidelines. If he had straight medicare it would be the same. A couple dollars higher per day actually. Here is her email:


Good morning,

I have attach directly from Medicare website the breakdown of their coinsurance guidelines which is across the board in every state. Humana gave him a little break off it but normally it is $164.50/day


That can't be 20%.

I can't copy and paste from the pdf showing this, but it specifically says this is the rule for original medicare:
I don't know what that is, but I have never heard of anything like that, and I get all my Mom's bills. Can you post the link? $820 per day could be accurate as a daily rate on a subacute room, however. All facilities charge different rates though, in some that would be more than 20%, so again I'm not really sure. But in any case, if he had traditional with a supplemental policy, the supplemental would pay that $164.50 a day.
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