Medicare Question!?!

[bassadict69]

I am hoping someone can explain this a little better. The social worker seems to be having trouble explaining it & the Medicare website is pretty much useless.

My dad was told the other day that his Medicare is about to run out. They said something about having a 60 day something or other to spend at home for it to kick back in.

I have no idea what they are talking about, but we were hoping to get his venous stasis ulcers healed up enough before then so he can go ahead with his Mitral Valve replacement & triple bypass. This is the last thing we need on top of all the delays! With the fluid retention problems he has, there is no way he will last 60 days without needing further treatment to remove another fluid buildup. There was about 30 days between the time he went home after removing the fluid last time & his most recent admission to remove fluid after putting on another 30 to 40 pounds.

Can someone please explain how this medicare works? Seems to me they are saying he is not spending enough time between admissions &/or treatments...

 

[Ross]

There are too many things unsaid to be able to tell you what's going on or what to do. Pretty much need you to post the entire deal that your dad is on, whether traditional medicare or medicare advantage HMO or is this hospice care?????

 

[csutherland]

Not sure, but won't it start over Jan 1?

 

[dick0236]

Like Ross said, you haven't provided enough info. I suggest you contact Medicare or his medicare supplement directly for an explanation. If you do not have a "medical power of attorney" for him, it would be a good idea to have him give you POA(power of attorney). That would allow you access to his medical info.

 

[bassadict69]

I will get more details...

 

[Nancy]

Maybe it has something to do with the medicare deductible.

"What Are Medicare Deductible and Copayment Charges?
The Medicare "deductible'' is the amount that must be paid by a Medicare beneficiary before Medicare will pay for any items or services for that individual. Currently, the Medicare Part B deductible is $100 per year."

What I have found is that I have to pay the deductible amount out of pocket around the first of each year, then after that Medicare takes over all payments until the next first of the year.

It's a yearly deductible thing. Maybe that is what was meant by it "running out", that at the first of the year, the small deductible will kick in again.

 

[kfay]

Is your father in the hospital or a rehab/nursing facility? I know that when my mom was in the rehab place after her back surgery, she only had so many days before she had to have so many days out. I don't even pretend to understand all of the medicare stuff. I can't imagine if they send him home and he needs to go back in for fluid removal, they wouldn't allow that.
Good luck figuring all that out.

Kim

 

[Blanche]

We have Original Medicare

We have Original Medicare

Albert's been hospitalized more than a few times while covered by original Medicare and I must say that I have found it very hard to understand Medicare's manuel and written information. But, I do think that this article from AARP might help.

you.http://www.aarp.org/health/insurance/articles/original_care_hospital.html

Check out the section titled "Care in a Hospital." It's on the second or third page.

Please note that this document seems to deal only with those who have Original Medicare. If your father has coverage under anything other than Original Medicare, you need to contact that vendor.

This is how I interrupt the Medicare documents. The first 60 days of hospitalization are covered with a copay of $1024 in 2008. If, at the end of the 60 days that are covered, hospitalization is still required, you must pay $267 per day for the days 61-90.

When the patient has been out of the hospital for 60 days, you begin again all over with the above.

This Medicare Hospital Stay benefit continuous. That is, it does not begin again yearly. Albert had his strokes and hospitalizations from mid-December to the end of January. All of the hospitalized days counted for the first 60 days.

This is really difficult to understand...(and I took many insurance courses and worked full time for an insurance broker for 5 years in the early 1960's.)

Hope this helps some. The info I used here is from the article from AARP and from my Centers for Medicare & Medicaid, "Medicare & You," 2009 edition, p.125.

If you think I might be of some assistance, please contact me.

Wishing you, your dad, and your family all the best,
Blanche

 

[bassadict69]

Is your father in the hospital or a rehab/nursing facility? I know that when my mom was in the rehab place after her back surgery, she only had so many days before she had to have so many days out. I don't even pretend to understand all of the medicare stuff. I can't imagine if they send him home and he needs to go back in for fluid removal, they wouldn't allow that.
Good luck figuring all that out.

Kim

Dad is in Promise Hospital which is a long term care hospital.

 

[bassadict69]

Blanche, thanks for that explanation! That pretty well sounds like what is going on.

A few months ago, he was admitted in the hospital with excess fluid, they kept him there a couple of days to start the treatment, then transfered him into Promise Hospital (LTC) for I think 21 days then he was sent home. About a month later, the fluid happened again & the same scenario took place again. Then about a month later, it all happened again. So, I think you are right on the money about him needing to be out for 60 days for everything to kick in again.

Thanks for the link, I should have time later to carefully read it!

 

[ALCapshaw2]

Before answering your Question, we would need to know what kind of Insurance he has.

There is Standard (Original) Medicare which can have "Medicare Supplement Insurance" also called "Medigap" insurance plus a separate Part D Prescription Drug Plan.

These kinds of plans allow patients to see ANY Doctor, ANYwhere, Without Referal, as long as they are a Medicare "Accepting" or Medicare "Participating Provider. Be sure to ASK which and what that means as far as coverage is concerned.

There are also "Advantage Plans" under which you give up your "Original Medicare" coverage and everything is specified by the Private Insurance Company. This insurance typically has separate CoPays and Deductibles for Every Admission to a Hospital.

You would need to know the Insurance Carrier and contact them for the details of their specific plan (or read your dad's copy of the plan coverage).

Advantage Plans usually require that patients see Doctors and Providers which are "In Network" and may require referals for specialists or Doctors / Providers who are "Out of Network".

It really is understandable (usually) once you learn how to navigate through the system.

Good Reference materials are:

Medicare and You (obtainable from medicare or on their website www.medicare.gov or 1-800-633-4227)

2008 Choosing a Medigap Policy:
A Guide to Health Insurance for People with Medicare
(from Centers for Medicare & Medicaid Services through the above website or telephone number)

Every State should also have a
"State Health Insurance Assistance Program (SHIP)"
See the Medicare Website for contact information for your state or call Medicare. They can provide counciling on all medicare issues but are EXTREMELY Busy and Overworked during the Annual "Open Enrollment Period" - Nov. 15 thru Dec. 31 (whoever decided to create a 6 week open enrollment period that encompasses Thanksgiving, Christmas, and New Years? !)

Good Luck!

 

[escargome]

I just want to chime in with, "Get a durable power of attorney" from your dad so that you can discuss his personal medical status with the insurance, the doctor, the hospital, etc. Now with this new HIPPA privacy unless the social worker or the hospital are kind, they will discuss NOTHING with you. I ran into this roadblock with my mom and my husband, so if you can it only takes a little time (you can actually find forms on-line) and a notary. I know your mom is still living, but sometimes all those words and explanations can be somewhat of a large load for the mature spouse. God Bless You All. I will keep you all in my prayers..