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depends on what kind of patient stay?
I think if you have surgery,you get x number of days,after that,if you want to stay,you have to pay.
also Medicare does not pay for nursing home,Medicaid does
We were discussing nursing home for rehab stay, not long term care. Medicare pays for rehab after a 3-day hospitalization. Medicaid pays for long term care.
Good point, my mom has an Advantage plan and this coming year she may be selling her house and then living out of state, rotating among us kids. Goodness, I wonder if she should/could change to something better. She's almost 85 with cardiac and back issues.
She definitely should. It would have to be traditional Medicare with a supplemental, because all Advantage plans are state-specific. If she's only going to be rotating to different kids in the same state, she can get an Advantage plan for that state though.
ive seen it in relation to rehab after open heart surgery.
You're still not telling me anything. You saw what, exactly? Was this something you were involved in and know details about? Are you sure the person didn't have Advantage plan? Because the only requirement for rehab to be covered is a 3-day hospital stay.
Unless your mom is in a state that doesn’t require her to pass medical underwriting she won’t be able to switch to a medigap plan.
My mom didn't have to go through any kind of underwriting, we just applied, they didn't ask us anything. We used Blue Cross/Blue Shield as her supplemental. I don't know what "letter" plan it was.
I live in Maui, where healthcare providers are limited.
Four years ago, I enrolled in Medicare and chose an Advantage plan from Humana at $40 per month extra. They absolutely sucked. Each time I called about additional charges or denials of service, I would spend hours on hold and often be disconnected.
Just finding routine medical care here is difficult. I joined Maui Medical Group back in 2014 when I had Blue Cross/Blue Shield Insurance but was rarely able to see a doctor, only Physician's Assistants. MMG doesn't even have a Urology Department.
I switched for a year to an individual doctor but then he joined one of the new VIP medical care outfits which required a copay of several hundred dollars per month.
Two years ago, I switched to the Kaiser Permanente Senior Advantage Plan. It costs an extra $185 per month in Maui, and I finally feel like I have excellent medical care. I can't say enough good about them and recommend them to my family and friends. (In most places, there isn't an extra fee per month.) I have never had to call them about unpaid bills. If I need treatment that is unavailable on Maui, they fly me to Honolulu at their expense.
Meanwhile I continue to receive bills from medical providers that Humana still hasn't yet paid after years.
If I had chosen original Medicare plus a Medigap policy, I can't see how I would be better off. Kaiser is the most complete medical provider here and operates the only hospital on the island.
I live in Maui, where healthcare providers are limited.
Two years ago, I switched to the Kaiser Permanente Senior Advantage Plan. It costs an extra $185 per month in Maui, and I finally feel like I have excellent medical care. I can't say enough good about them and recommend them to my family and friends. (In most places, there isn't an extra fee per month.) I have never had to call them about unpaid bills. If I need treatment that is unavailable on Maui, they fly me to Honolulu at their expense.
Meanwhile I continue to receive bills from medical providers that Humana still hasn't yet paid after years.
If I had chosen original Medicare plus a Medigap policy, I can't see how I would be better off. Kaiser is the most complete medical provider here and operates the only hospital on the island.
In your case, Kaiser is a great plan. Kaiser can perform very well, depending on location. We've had very good reports from some CA people on Kaiser, other parts of the country sometimes not. The fact they are a medical provider, not just an insurer, is a good thing. I would consider an Advantage offered by a local medical provider who is answerable to the community it serves. I would not consider a national behemoth insurer whose only interest is profit. In WI, our medical provider Advantage plans are given high marks, especially in the rural areas.
Most people choose Advantage because Medigap premiums + Part D coverage is either unaffordable or just because it's cheaper. Yours is an expensive Advantage plan. $185/mo. is Medigap premium territory even with drug coverage. But you get your money's worth - and Kaiser keeps its commitments. Not all MAs do, as you've learned.
Last edited by Ariadne22; 11-11-2022 at 12:33 PM..
You're still not telling me anything. You saw what, exactly? Was this something you were involved in and know details about? Are you sure the person didn't have Advantage plan? Because the only requirement for rehab to be covered is a 3-day hospital stay.
good lord. only you know or have experience with medicare? Do you work for medicare cause you sound like it! Yeah I was involved, personally involved, and the hospital stay was 2 weeks after emergency open heart surgery where the patient almost died! Good enough for you? and Original medicare would only approve 10days of rehab! Its crap!
good lord. only you know or have experience with medicare? Do you work for medicare cause you sound like it! Yeah I was involved, personally involved, and the hospital stay was 2 weeks after emergency open heart surgery where the patient almost died! Good enough for you? and Original medicare would only approve 10days of rehab! Its crap!
I'm sorry, I just don't believe that. Medicare doesn't work that way, it doesn't pre-approve rehab stays. There are no gatekeepers. I think we should just agree to disagree.
In your case, Kaiser is a great plan. Kaiser can perform very well, depending on location. We've had very good reports from some CA people on Kaiser, other parts of the country sometimes not. The fact they are a medical provider, not just an insurer, is a good thing. I would consider an Advantage offered by a local medical provider who is answerable to the community it serves. I would not consider a national behemoth insurer whose only interest is profit. In WI, our medical provider Advantage plans are given high marks, especially in the rural areas.
Most people choose Advantage because Medigap premiums + Part D coverage is either unaffordable or just because it's cheaper. Yours is an expensive Advantage plan. $185/mo. is Medigap premium territory even with drug coverage. But you get your money's worth - and Kaiser keeps its commitments. Not all MAs do, as you've learned.
I used to believe that I would eventually be forced to move back to the mainland as I get older and require more medical care.
Example: A few years ago, I needed to see a dermatologist about hives, caused by an allergy. The first available appointment was 10 months in the future!
Since I joined Kaiser, I have come to realize that I will be able to "age in place" while receiving appropriate care right here. It has been a profound and happy realization for me! They are the only Advantage plan offered here with a 5-star rating.
Love me some Maui!
Last edited by Futuremauian; 11-12-2022 at 11:03 AM..
I'm sorry, I just don't believe that. Medicare doesn't work that way, it doesn't pre-approve rehab stays. There are no gatekeepers. I think we should just agree to disagree.
sorry to disillusion you but medicare is def a gate keeper. if it doesnt approve of any test, any treatment etc etc it doesnt pay! been there and done that and I have the symptoms that may kill me thanks to that crappy govt ins.
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