- 2,152
James, tsk, tsk! Exceptence and excepted? I believe you mean acceptance and accepted.
Okay, you're correct! I promise to do better next time.
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Okay, you're correct! I promise to do better next time.
- 7,066
You are correct, Medicare does not cover Nursing Homes if someone needs to go to a nursing home because the fall under one of the ADL's (Activities of Daily Living). However, a lot of hospitals do not have a "Skilled Nursing Wing" where they can provide therapy for recovery from a broken hip, speech therapy for a stroke etc. In those cases the hospital will contract with a nursing home to provide those services.
You refer to "At Home Recover" as not being covered by Medicare. I believe it is more the term you are using than something that is either covered or not covered. Medicare provides "Home Health Care". This can be physical therapy for recovery from a broken hip. The same as a person would receive in a hospital or if he hospital contracts with a nursing home to provide that service. There are many other instances where Medicare will pay for "Home Health Care". The term "At Home Recovery" is a benefit provided by some Medicare Supplement plans like Plan D and Plan G.
It is a benefit provided by the policy as opposed to a benefit provided by Medicare. The "At Home Recovery" benefit would kick in only after Medicare had stopped "Home Health Care".
I am not familiar with the patient having the right to cancel their plan for the reason you stated or the "Guaranteed Renewability" provision you stated. This is apparently not available in Missouri. It sounds like you are talking about an HMO where the person must use a network facility. Advantage Plans do not have a "network" that people must go to. To the best of my knowledge the person does not have the right to cancel their HMO simply the facility is not in that HMO's network.
When it is stated that Medicare Supplements are guaranteed renewable it means that the policy can not be cancelled by the insurance company for any reason other than failure to make the premium payment or unless the person lied on the application.
HMO's and Advantage plans are not guaranteed renewable. They can cancel the individual if they cancel the coverage for everyone in a certain area. If that is done then Medicare guarantees that the person can take a Med Supp policy as "Guaranteed Issue" for a certain period of time.
One of the biggest causes of confusion when discussing the subject is using general terms to refer to specific benefits instead of using the exact words to describe the benefit being discussed. For example it is very easy to use the term "At home recovery" when one is really talking about "Home Health Care". It can all be very confusing.
Thanks, Frank that did help. The GAP polices add to the Medicare home care coverage. Only when a person signs up for a MA plan is this an issue. Correct?
The Medigap policy Guaranteed Renewability is found in the 2007 Choosing a Medigap Policy page 18 & 19.
If a person owns a GAP policy and then buys a MA plan, the FIRST time, and within that first year decide they do not like it, they have certain rights to be able to go back to a GAP policy, under Federal Law. Some states broaden that right, from what I understand.
This is NOT like a free-look in health care. It is a right to own a GAP policy.
Linda
The Medigap policy Guaranteed Renewability is found in the 2007 Choosing a Medigap Policy page 18 & 19.
If a person owns a GAP policy and then buys a MA plan, the FIRST time, and within that first year decide they do not like it, they have certain rights to be able to go back to a GAP policy, under Federal Law. Some states broaden that right, from what I understand.
This is NOT like a free-look in health care. It is a right to own a GAP policy.
Linda
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Frank, Can you explain the difference between At Home Recovery and Home Health Care?
Wouldn't home health care be the same thing as a nursing home, except you are at home instead of a facility? If thats the case then medicare wouldn't pay that claim, right?
Wouldn't home health care be the same thing as a nursing home, except you are at home instead of a facility? If thats the case then medicare wouldn't pay that claim, right?
I need to clarify something. If GAP's are still available and the person can still medically qualify, and has no pre-existing conditions and it is during the enrollment period. There is no problem.
It is this Guareenteed Renewability that allows it to be re-issued without it being medically underwritten and without any allowances for pre-existing conditions. It also does not have to be during open enrollment.
At anytime, I believe, they can go back to a Medicare A & B. Just not with GAP coverage.
Linda
It is this Guareenteed Renewability that allows it to be re-issued without it being medically underwritten and without any allowances for pre-existing conditions. It also does not have to be during open enrollment.
At anytime, I believe, they can go back to a Medicare A & B. Just not with GAP coverage.
Linda
- 7,066
Thanks, Frank that did help. The GAP polices add to the Medicare home care coverage. Only when a person signs up for a MA plan is this an issue. Correct?
This isn't always an issue with an Advantage Plan's Home Health Care as long as the agent and the prospect understand exactly what is and what is not covered.
The Medigap policy Guaranteed Renewability is found in the 2007 Choosing a Medigap Policy page 18 & 19.
If a person owns a GAP policy and then buys a MA plan, the FIRST time, and within that first year decide they do not like it, they have certain rights to be able to go back to a GAP policy, under Federal Law. Some states broaden that right, from what I understand.
That is correct, however, I am not aware of any states who provide more than 12 months for a person to go back to a Medicare Supplement Policy if they do not like their Advantage Plan. I believe that is a rule set up by CMS and not an option that states can change.
This is NOT like a free-look in health care. It is a right to own a GAP policy.
The "free look" is usually for the first 30 days after the person receives delivery of their Supplement Policy. Not 30 days from the day the app is written. If an agent does not get a delivery slip signed and the client decides they want to cancel the policy 45 days later they still may be able to do it unless the agent or company can provide a delivery slip showing the date the client actually took possession of the actual policy.
For this reason it is important to get a delivery slip dated and signed, at least in Missouri.
If you would like to give me a call I will be happy to discuss all of this with you in more detail.
This isn't always an issue with an Advantage Plan's Home Health Care as long as the agent and the prospect understand exactly what is and what is not covered.
The Medigap policy Guaranteed Renewability is found in the 2007 Choosing a Medigap Policy page 18 & 19.
If a person owns a GAP policy and then buys a MA plan, the FIRST time, and within that first year decide they do not like it, they have certain rights to be able to go back to a GAP policy, under Federal Law. Some states broaden that right, from what I understand.
That is correct, however, I am not aware of any states who provide more than 12 months for a person to go back to a Medicare Supplement Policy if they do not like their Advantage Plan. I believe that is a rule set up by CMS and not an option that states can change.
This is NOT like a free-look in health care. It is a right to own a GAP policy.
The "free look" is usually for the first 30 days after the person receives delivery of their Supplement Policy. Not 30 days from the day the app is written. If an agent does not get a delivery slip signed and the client decides they want to cancel the policy 45 days later they still may be able to do it unless the agent or company can provide a delivery slip showing the date the client actually took possession of the actual policy.
For this reason it is important to get a delivery slip dated and signed, at least in Missouri.
If you would like to give me a call I will be happy to discuss all of this with you in more detail.
- 7,066
Home Health Care is not the same as nursing home care. An example of Home Health Care would be if a person is released from the hospital but still needs their dressings changed after surgery. Home Health Care is usually only provided for a short time. Nursing Home provides constant care 24/7 for people who can no longer care for themselves.
Medicare will not pay for constant care of an individual if they are at home or if they are in a nursing home.
I have had a lot of prospects tell me that an agent told them that the Skilled Nursing coverage will pay for 100 days of care in a Nursing Home. This is totally untrue. Some agents don't know any better and some are trying to make the policy sound like it has more benefits than it really does.
I have also had people tell me that the agent who talked to them about LTC told them to take the policy with the 100 day elimination period because Medicare will pay for the first 100 days. They tell them that because it makes the LTC policy less expensive. The person taking the policy won't find out that it is untrue until they actually have to go to a nursing home. That's when they find out that they have to pay the first 100 days out of their own pocket.
- 7,066
I need to clarify something. If GAP's are still available and the person can still medically qualify, and has no pre-existing conditions and it is during the enrollment period. There is no problem.
That is correct. However, there is no "enrollment period" for a Medicare Supplement/Gap policy. You can write them 365 days per year.
It is this Guareenteed Renewability that allows it to be re-issued without it being medically underwritten and without any allowances for pre-existing conditions. It also does not have to be during open enrollment.
Actually Medicare Supplement policies are automatically "renewed" each month unless the person cancels the policy. "Guaranteed Renewal" with a Med Supp policy just means that the insurance company can never cancel the policy for the individual. Much the same way a life insurance policy is "guaranteed renewable" unless it has a termination date.
Guaranteed Issue is the provision that allows a person to take a Medicare Supplement Policy without having to answer health questions. The only times a person would have the Guaranteed Issue provision is if they want to go back to a Supp during the first 12 months after taking an Advantage plan for the first time or if their Advantage plan or HMO cancelled their coverage. (Missouri and California are the only states that I am aware of that have an additional provision for Guaranteed Issue.)
At anytime, I believe, they can go back to a Medicare A & B. Just not with GAP coverage.
I'm not sure what you are referring to when you say "without GAP coverage". Medicare Supplement policies are also referred to as Medicare Gap policies. Can you tell me what you are referring to when you say GAP coverage?
A person can take a Medicare Supplement policy at any time. During the first six months they go on Medicare Part B they have a 6 month period where they can't be denied a Med Supp policy because of health reasons. If they are in the hospital at the time you can go to their room and sign them up. This is called "Open Enrollment". Each person only gets one Open Enrollment period.
Once they are beyond the six month Open Enrollment period they can take a Medicare Supplement policy but they will be required to answer health questions. If they can't answer no to them they will be turned down for coverage.
That is correct. However, there is no "enrollment period" for a Medicare Supplement/Gap policy. You can write them 365 days per year.
It is this Guareenteed Renewability that allows it to be re-issued without it being medically underwritten and without any allowances for pre-existing conditions. It also does not have to be during open enrollment.
Actually Medicare Supplement policies are automatically "renewed" each month unless the person cancels the policy. "Guaranteed Renewal" with a Med Supp policy just means that the insurance company can never cancel the policy for the individual. Much the same way a life insurance policy is "guaranteed renewable" unless it has a termination date.
Guaranteed Issue is the provision that allows a person to take a Medicare Supplement Policy without having to answer health questions. The only times a person would have the Guaranteed Issue provision is if they want to go back to a Supp during the first 12 months after taking an Advantage plan for the first time or if their Advantage plan or HMO cancelled their coverage. (Missouri and California are the only states that I am aware of that have an additional provision for Guaranteed Issue.)
At anytime, I believe, they can go back to a Medicare A & B. Just not with GAP coverage.
I'm not sure what you are referring to when you say "without GAP coverage". Medicare Supplement policies are also referred to as Medicare Gap policies. Can you tell me what you are referring to when you say GAP coverage?
A person can take a Medicare Supplement policy at any time. During the first six months they go on Medicare Part B they have a 6 month period where they can't be denied a Med Supp policy because of health reasons. If they are in the hospital at the time you can go to their room and sign them up. This is called "Open Enrollment". Each person only gets one Open Enrollment period.
Once they are beyond the six month Open Enrollment period they can take a Medicare Supplement policy but they will be required to answer health questions. If they can't answer no to them they will be turned down for coverage.
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Frank, I know what you mean, but the terms are very confusing.You would think if someone was recieving care at home for simple things like wound dressings ect.. that it would be at home RECOVERY. I dont even know what I am saying now. I would think home health care would mean long term and at home recovery as short term.
- 2,152
Sure that is the distinction, yet the "Home Health Care Agency" will provide both services since they are basically one of the same except how they are paid.
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