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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.

 

 

 

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.

 

What Would You Do?

This is a question I hear fairly frequently. Family caregivers come to me looking for solutions to their caregiving challenges, and often this question surfaces. “If this were you, what would you do?”

Recently, I was reminded of this question after attending a one day conference with Teepa Snow, a national expert in communicating with those with dementia and Alzheimer’s. It was a day I will not soon forget. She was engaging, interesting, entertaining, and so very informative. I could not get over how many notes I took, as she showed the large audience many techniques in having a successful communication with their dementia and Alzheimer’s patients or family members.

So, if someone came to me looking to understand how to communicate with their loved one who has Alzheimer’s, I would share what I know, and I would also recommend they look online for Teepa Snow. She is the most informative expert I know of in this area of Alzheimer’s.

Here is a link to her website. Be sure to check it out.