Med Supps

[GreenSky]

This discussion seems have gone in different directions. We were talking about the "at home recovery" benefit on plans D and G.

What Newby explained to me and what the client said they had experienced, was this; if you are in the hospital or surgical center and have an operation or procedure done and you are not still to be confined to a hospital, but, you are not ready to be on your own either. An RN or PA comes to your home to check on you and change bandages and such for a short period of time. It's a tempory situation and only related to the procedure or illness that you were just treated for. The benefit is limited in how much is paid per visit and has a cap which limits the duration.

That is not "Home Health Care" or assisted living. It's specifically designed to be temporary.

Yes, we're talking about the at home recovery from Plan D, G, etc.

Your example above would be covered by Medicare wouldn't it. Therefore the coinsurance would be paid by all plans except A. It's not part of an extra benefit. It's medically necessary therefore part of Medicare.

Am I wrong here?

Rick

 

[jdeasy]

Yes, we're talking about the at home recovery from Plan D, G, etc.

Your example above would be covered by Medicare wouldn't it. Therefore the coinsurance would be paid by all plans except A. It's not part of an extra benefit. It's medically necessary therefore part of Medicare.

Am I wrong here?

Rick

I don't know if you are wrong or not. If you're right, there is no extra benefit. If there's not, why is it only on those plans? Is it excluded as a benefit on the other plans? Of course, we are just talking about the 20%.

To include is also to exclude. Why is it there?

 

[Newby]

It just happened that Newby told me that he had a family member that needed the at home recovery and, since that person had it with their med sup, it was an appreciated benefit.

That very day, I met with my client and was going over the differences in the plans. His wife is 6 years older and has been on a med sup for 6 years. She had a need for the at home recovery and her med sup had it as a benefit. He knew what it was because of that and thought it was a great benefit.

I may not run into anyone else that has experience with it, so, I don't know how well an explanation would go to a person that had not experienced a need. It would most likely be like my response was. I didn't see that as an selling point.

I intend to keep telling people what it is and let them decide if it's to their benefit.

I could be wrong here but this is what I think it covered:

Dad was very terminally ill with cancer. He had been in and out of the hospital several times. When he would be released home he was very difficult for mom to handle him. We three local kids took shifts helping her but it was also a great help that home health care nurses came to the house and actually helped with normal activities of daily living.

It may be only $40 per day but if my mom and dad were paying for it, they wouldn't have accepted it. That's how they were. And it was a great help. I was missing 2-days of work a week taking dad to chemo thererpy and doctor's appointments. He was still being treated so he was not a candidate for Hospice. The home recovery was a big help and comfort to mom and to us kids.

Maybe I'm wrong and regular Medicare would have covered it. I'm certainly not a seasoned expert.

 

[senior-advisor-indiana]

Frank,
Here in IN plan F's are not getting the bigger increases, it is the same across the board. I am nt saying that plan F is the best choice though.
Also, I believe that the At Home Recovery benefit and preventative care benefit is as worthless as the Excess benefit.

 

[Frank Stastny]

Yes, we're talking about the at home recovery from Plan D, G, etc.

Your example above would be covered by Medicare wouldn't it. Therefore the coinsurance would be paid by all plans except A. It's not part of an extra benefit. It's medically necessary therefore part of Medicare.

Am I wrong here?

Rick

Nope, you're not wrong except.

As I understand it, At Home Recovery is only used when Medicare terminates paying for Home Health Care. The doctor can decide that the patient still needs assistance at home but Medicare can terminate that benefit for the person if they decide it is no longer necessary. The same way Medicare can cut off Skilled Nursing if the patient isn't showing daily improvement.

If that were to happen, then the At Home Recovery benefit will kick in and pay $40 per day for 40 days or a total of $1,600 per year.

This is not a huge benefit nor one that is used very often but it is an additional benefit not offered by Plan F.

In the example being discussed it is difficult to know if all the cost was paid under Home Health Care or if the individual had used all Medicare would allow for Home Health Care. If Medicare cut them off of Home Health Care then a portion was probably paid by the At Home Recovery benefit.

 

[retread]

Nope, you're not wrong except.

As I understand it, At Home Recovery is only used when Medicare terminates paying for Home Health Care. The doctor can decide that the patient still needs assistance at home but Medicare can terminate that benefit for the person if they decide it is no longer necessary. The same way Medicare can cut off Skilled Nursing if the patient isn't showing daily improvement.

If that were to happen, then the At Home Recovery benefit will kick in and pay $40 per day for 40 days or a total of $1,600 per year.

This is not a huge benefit nor one that is used very often but it is an additional benefit not offered by Plan F.

In the example being discussed it is difficult to know if all the cost was paid under Home Health Care or if the individual had used all Medicare would allow for Home Health Care. If Medicare cut them off of Home Health Care then a portion was probably paid by the At Home Recovery benefit.

Thanks for drawing attention to the fact that "At home recovery" is not the same as "Home Health Care". Others have mentioned it, also.

I know many agents have dismissed At Home Recovery as worthless, and some never noticed the difference between that and Home Health Care.

The chances of needing At Home Recovery are slim, and can not be justified on a risk basis, but if comparing plans and not an economical penalty, my position is then it is OK.

I understand that Home Health Care is coming under tighter scrutiny by CMS because some abuses by Home Heath Aid agencies, particularly when it comes to housekeeping chores. Others may want to chip in with their comments here.

 

[Newby]

Frank,
Here in IN plan F's are not getting the bigger increases, it is the same across the board. I am nt saying that plan F is the best choice though.
Also, I believe that the At Home Recovery benefit and preventative care benefit is as worthless as the Excess benefit.

Continental Life of Brentwood recently increased Plan F by 16.5% and all other plans by 8% in Indiana.

 

[Newby]

Nope, you're not wrong except.

As I understand it, At Home Recovery is only used when Medicare terminates paying for Home Health Care. The doctor can decide that the patient still needs assistance at home but Medicare can terminate that benefit for the person if they decide it is no longer necessary. The same way Medicare can cut off Skilled Nursing if the patient isn't showing daily improvement.

If that were to happen, then the At Home Recovery benefit will kick in and pay $40 per day for 40 days or a total of $1,600 per year.

This is not a huge benefit nor one that is used very often but it is an additional benefit not offered by Plan F.

In the example being discussed it is difficult to know if all the cost was paid under Home Health Care or if the individual had used all Medicare would allow for Home Health Care. If Medicare cut them off of Home Health Care then a portion was probably paid by the At Home Recovery benefit.

I could be way off here but...isn't the at-home recovery benefit to help you with the ADLs (using the restroom, bathing, mobility, getting in and out of a wheelchair, eating, getting dressed etc.)

And home health care is actually medical care to help you recover from your illness? I thought that was the difference.

 

[GreenSky]

I could be way off here but...isn't the at-home recovery benefit to help you with the ADLs (using the restroom, bathing, mobility, getting in and out of a wheelchair, eating, getting dressed etc.)

And home health care is actually medical care to help you recover from your illness? I thought that was the difference.

Here's what I believe is the correct explanation.

If someone is on a Medicare approved home care plan, the at home recovery will provide $40 a day for custodial care such as (as you correctly stated) help with ADLs.

You must be on the plan written by the doctor for this benefit to kick in.

I received the information from Craig Ritter at www.ritterim.com. If it's wrong, yell at him! (But he's rarely wrong).

Rick

 

[Frank Stastny]

I could be way off here but...isn't the at-home recovery benefit to help you with the ADLs (using the restroom, bathing, mobility, getting in and out of a wheelchair, eating, getting dressed etc.)

And home health care is actually medical care to help you recover from your illness? I thought that was the difference.

The short answer would be NO.

Medicare Home Health care will help with things like ADL's when they were associated with recovery from an illness or injury. I have even had client's who were having someone from a home health agency come in a clean for them. This was several years ago when I believe things were a lot "more relaxed" regarding Medicare enforcement.

Stop and think about it. Medicare is not going to pay to have a home health person at the home all day to help with going to the bathroom. A couple of times a week for bathing maybe but only if associated with an illness or recovery from surgery, speech therapy for a stroke etc.

These benefits will be provided when requested by a physician and approved by Medicare whether or not the person has At Home Recovery.

At Home Recovery to the very best of my knowledge is exactly what I said it is earlier. It has nothing to do with ADL's. In fact neither does Medicare Home Health care. ADL's may be a part of Home Health Care but I can guarantee you that a doctor is not going to request Medicare Home Health care, not will Medicare approve it just to help someone take a leak.