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What supplemental products do you mention to seniors to help fill these gaps? Do you bring up the 3 midnight rule and rehab issues with MAPD when first enrolling them in Medicare? The 3 midnight rule seems to be worse with Supps then with a MAPD, as some have an outpatient coverage benefit.
I want to start offering them, as I've had two situatons in the past two weeks and my parents are now hollering for something along with their Med Supps. I was going to put them on Manhattan Life's HHC, but now want something with facily coverage as well. Aetna's nursing home plan covers very little in PA, and ML's Omni Flex isn't here yet. I'm going to look at GTL's Recover Cash next.
Neither has LTC/STC:
1) Case A (age 75/divorced) is a PDP client with Plan F. By the time she reached out to me, her health was already deteriorating so I couldn't move her to G. A few weeks back she had surgery for a bad ankle. I don't have all the details, but once she was moved to a rehab, she was told Medicare wont pay. This was a scheduled surgery and she was hospitalized for a few days as an outpatient. She has some memory issues with daughters living out of state and of very little help.
I called the caseworker at the facility, who was puzzled why the client wasn't aware of this from the doctor's office ahead of time. There is a disconnect. She's expected to be there 4-6 weeks at $400 day.
2) Case B (age 78/widowed) is a friend's mother who was a public school teacher in NJ. She has an Aetna group retiree PPO ESA. Until 2018 the retired teachers had a group Med Supp which got too expensive for the state, so they switched them to the PPO. Two weeks ago she fell and broke her hip and arm. She didn't experience the 3 midnight situation, but now she's in a subacute rehab since last Friday. The insurance company is doing a peer-to-peer review with the facily today as they want to send her home. My friend will ask for an appeal if it's declined. Mom is badly injured with no one to care for her at home full time (grown kids in their 40s and 50s all work).
The facilty suggested dropping the MAPD and switching to OM only. I advised my friend about the SEP when in a facility to suspend the MAPD and she's asking them about adding a PDP. She's also checking with Aetna to see about getting the MAPD back after she's discharged.
I want to start offering them, as I've had two situatons in the past two weeks and my parents are now hollering for something along with their Med Supps. I was going to put them on Manhattan Life's HHC, but now want something with facily coverage as well. Aetna's nursing home plan covers very little in PA, and ML's Omni Flex isn't here yet. I'm going to look at GTL's Recover Cash next.
Neither has LTC/STC:
1) Case A (age 75/divorced) is a PDP client with Plan F. By the time she reached out to me, her health was already deteriorating so I couldn't move her to G. A few weeks back she had surgery for a bad ankle. I don't have all the details, but once she was moved to a rehab, she was told Medicare wont pay. This was a scheduled surgery and she was hospitalized for a few days as an outpatient. She has some memory issues with daughters living out of state and of very little help.
I called the caseworker at the facility, who was puzzled why the client wasn't aware of this from the doctor's office ahead of time. There is a disconnect. She's expected to be there 4-6 weeks at $400 day.
2) Case B (age 78/widowed) is a friend's mother who was a public school teacher in NJ. She has an Aetna group retiree PPO ESA. Until 2018 the retired teachers had a group Med Supp which got too expensive for the state, so they switched them to the PPO. Two weeks ago she fell and broke her hip and arm. She didn't experience the 3 midnight situation, but now she's in a subacute rehab since last Friday. The insurance company is doing a peer-to-peer review with the facily today as they want to send her home. My friend will ask for an appeal if it's declined. Mom is badly injured with no one to care for her at home full time (grown kids in their 40s and 50s all work).
The facilty suggested dropping the MAPD and switching to OM only. I advised my friend about the SEP when in a facility to suspend the MAPD and she's asking them about adding a PDP. She's also checking with Aetna to see about getting the MAPD back after she's discharged.
