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Hospitalization, Skilled Nursing and Medicare

Recently, in one 48-hour period, I received similar questions from caregivers. These caregivers were not related, and they did not know one another. Each was the adult child whose parent was about to be discharged from a skilled nursing facility. Though they were very informed and had been through the hospital to skilled nursing to home process before, they were each a little unsure about their options, and wanted to be sure they did right by their parent. Their questions had to do with skilled nursing facilities, Medicare, covered days, and finally home health care options. It led me to lay out some of the information so that others could benefit. Below are the 2017 Medicare hospital and skilled nursing facility benefits. This information does not cover every aspect of the subject, but it is a start.

Medicare Part A Hospital Expenses*

Member Deductibles:

Members will have a $1316 deductible per benefit period. A benefit period starts the day you are admitted to a hospital or skilled nursing facility, and ends after you have not been in the hospital or SNF for 60 consecutive days.

Member Co-payments:

  • $0/day for days 1-60
  • $329/day for days 61-90 in hospital per benefit period.
  • $658/day for days 91-150 in hospital per benefit period (Lifetime Reserve Days).
  • No coverage after day 150 in hospital (or day 90 if Lifetime Reserve Days previously used).

Skilled Nursing Facility Expenses*

  • Full coverage of expenses in skilled nursing facility for days 1-20 when this follows a 3-day hospitalization during each benefit period.
  • $164.50/day for days 21-100 in a skilled nursing facility during each benefit period.
  • No coverage after day 100 in skilled nursing facility during each benefit period.

*Hospital and Skilled Nursing Facility daily co-pays may be covered by your Medigap policy or other commercial secondary insurance coverage.

 

 

 

Visiting Mom During the Holidays and Something is Not Right

The holiday season is here, and you may have visited, or will be visiting an elderly loved one. Are things different than the last visit? Are you seeing things that don’t seem right?  How do you know if something is wrong?  Below are some areas to consider (note feminine emphasis for ease of writing, but also applicable to elder males):

Personal Hygiene – Does she shower less frequently, wear dirty clothes, or have neglected teeth? Are there any injuries that you can see? Is there a urine smell? Was she always fastidious about her wardrobe, and now is dressing in a less put together way?

Forgetfulness  – Have you seen stacks of unopened mail or newspapers, unpaid bills, unfilled prescriptions or missed appointment slips? Letters from credit card companies with reminders to pay or late payment charges can be a sign.

Behavior – Does she repeat questions? Can she carry on an extended conversation? Does she refuse any suggestion or does she just agree with everything said? Does she retain what was said? Are there any apparent mood swings? Is she unusually loud or quiet? Is she angry?

Relationships – Do friends call? Have relationships changed in such a way that friends and neighbors have expressed concerns? Has she quit socializing or participating?

Medication and Health Management – Can she take medications without supervision? What are the medications? Who goes to the doctor with her? Is she going to the doctor at all?  Does she refuse to go?

Eating Habits – Does the refrigerator contain adequate food? Is there any spoiled food present? Have her eating habits changed? Any unexplained weight loss? Has she missed meals or have a lack of appetite?

Shopping or buying things – Do you see evidence of excessive shopping or ordering? Is the mail full of charitable letters, a sign that she is giving money to anyone who asks?  Is she having difficulty making change or writing checks?

Home Maintenance – Is it in disrepair? Is dust accumulating where (at one time) she was a great housekeeper? Is trash accumulating?

Kathleen S. Allen, LCSW, C-ASWCM, is a Geriatric Care Manager and Elder Care Consultant in Northern Virginia. She works with seniors and their families to help guide them through the challenges of aging and caregiving.

 

This article was first published in December 2011, and has been revised for this posting.

Enrolling in Medicare with an Employer Health Plan – Who Pays First?

Recently, I received the following question from a reader:

“I have health insurance through my employer, my husband is self-employed. Will my insurance still be the primary insurance when my husband turns 65 and applies for Medicare?”

Suspecting this could be a complicated question, I went to the medicare.gov website to research the answer. Not too much longer I believe I found the answer in their publication CMS #02179, dated August 2015, “Your Guide to Who Pays First.”

In both the chart that starts on page 6, and in the text on page 12, they refer to such a scenario, answering that when one is 65 or older and covered by a group health plan of either oneself or one’s spouse, and the employer has 20 or more employees, the group health plan pays first, and Medicare second. When the employer has less than 20 employees, then Medicare would be the first payor.

This publication is worth a look because there are many more scenarios to consider. It is available for download on the medicare.gov website here. If you prefer to someone directly, call 1-855-798-2627.