Medicare Help!!! For Skilled Nursing/Rehab - Has Plan B BCBS Anthem Ret Fed Employee

[PaperHanger]

My grandfather recently had heart valve replacement, and now he needs to come out of the hospital and into a Skilled Nursing Rehab facility.

I specialize in FE, so I don't know anything about senior health and really need some help here during christmas.

Seems that each of the Skilled Nursing facilities is saying he won't be covered because he's on Plan B, some say he needs to switch to Plan A.

Is it even possible for him to change Medicare plans right now? Would there be any cascading effects?

Blue Cross Blue Shield said a case manager is assigned to it, and they say BCBS will only cover it if it's requested by the hospital....we're kind of assuming BSBC will have to cover it if his Medicare does not cover it.

I'm sure I haven't given all necessary information, please ask for any clarifications, and let us know how to proceed.

I know it's christmas day, but that only adds to the urgency...he is scheduled to be released from the hospital tommorow, yet we're having trouble communicating with all the necessary parties due to the holidays.


Thanks in advance Senior Health Experts!

 

[Chazm]

My grandfather recently had heart valve replacement, and now he needs to come out of the hospital and into a Skilled Nursing Rehab facility.

I specialize in FE, so I don't know anything about senior health and really need some help here during christmas.

Seems that each of the Skilled Nursing facilities is saying he won't be covered because he's on Plan B, some say he needs to switch to Plan A.

Is it even possible for him to change Medicare plans right now? Would there be any cascading effects?

Blue Cross Blue Shield said a case manager is assigned to it, and they say BCBS will only cover it if it's requested by the hospital....we're kind of assuming BSBC will have to cover it if his Medicare does not cover it.

I'm sure I haven't given all necessary information, please ask for any clarifications, and let us know how to proceed.

I know it's christmas day, but that only adds to the urgency...he is scheduled to be released from the hospital tommorow, yet we're having trouble communicating with all the necessary parties due to the holidays.


Thanks in advance Senior Health Experts!

You were fed horrible advice. First off, insurance isn't there to cover something you aren't paying for. He can't just switch now. Plan A and B do NOT cover days 21-100 in rehab. Medicare will cover his first 20 days and he will be charged a copayment after that ($144.50 day in 2012). Find out how long they will estimate him to be there. It might not cost him much

 

[rousemark]

This may explain what you want to know.. After you read it, you can come back with any specific questions you have:

http://www.medicare.gov/publications/pubs/pdf/10153.pdf

 

[Chazm]

This may explain what you want to know.. After you read it, you can come back with any specific questions you have:

http://www.medicare.gov/publications/pubs/pdf/10153.pdf

This is an insurance forum with a FE agent that needs help for his grandfather. He doesn't sound like he is trying to sell him, he just needs help. Why give him the Medicare and you book? Do you make all your clients read that when they need help?

 

[GreenSky]

I believe the confusion is that the SNF may believe (and I hope incorrectly) that he only has Medicare Part B rather than a Medicare supplement Plan B.

Assuming he does indeed have both Medicare A & B , the 1st 20 days of skilled care is covered at 100%. For a heart valve replacement it may not be necessary for him to remain in the SNF for more than the 20 days.

Bottom line, as long he does indeed have "full" Medicare (and since he has a supplement I'd lay odds that he does), there should be nothing to worry about - at least for 20 days.

Merry Christmas.

Rick

 

[PaperHanger]

Some more info, and I appreciate but am confused by some responces.

He is 88 yrs old. Retired FAA Govt Employee. Served in WWII.

He does NOT receive Social Security Retirement, he is on a federal pension.

He does NOT have Medicare Part A at all

He ONLY has Part B. At 88 yrs old, he is on Medicare.

He also carries a Blue Cross Blue Shield as a retired federal government employee. Since he was was a career federal employee, did not pay into social security, does not recieve social security retirement....blah blah...the federal govt gives him lifetime coverage BCBS. Maybe this is a Medicare Advantage 'C'??

Page 13 of the brochure specifically states he must have Part A for the SNF to be paid.

He went into the hospital on Dec 13. He is expected to move to SNF tommorow. He is expected to stay there 7-10 days.

 

[BobbyMcGee]

My guess is there will be some additional coverage for the SNF after the 20 days thru his plan. I'm sure the statement of benefits are online if you google the plan name.

 

[G.Gordon]

Sounds like he or his family will pay out of pocket. Most retiree packages do require part A. Are you 1000% sure he does not have it? Have you looked at his Medicare card?

 

[SportsNut]

Fed'l Civil Service retirees prior to 1/1/83 did not qualify for Part A w/o paying a premium. Grandad likely hit retirement just prior to 1983 [age 55 with 30 yrs of service... so he may have hit retirement age about 1980-ish]. So he likely doesn't have Part A. He could acquire Part A for a cost but not in time to handle this issue, but maybe best to contact SSA and determine what his buy-in might be for future events.

Sounds like you are stuck with what the BC/BS plan will pay, then it is oop covg. Sorry.

 

[PaperHanger]

Thanks SportsNut! I think that is exactly the situation. You did the math and figured it out. I believe the Fed Govt gives him this BCBS instead of having to get Part A. Those old school Federal employees have it so good. Heck when my gd buys a car, he just writes a check. He isn't rich per say but he's got everything covered and hasn't worked since I was a little kid.

The real issue seems to be the SNF does not understand this, their trained monkey at the intake desk is only programmed for Part A coverage.

BCBS is actually telling us that these facilities are in-fact in their network, and he should be covered. It's apparently the lack of experienced staff at manning the phones at SNF during christmas who are giving mis-information.

Also one of granddad's daughters is in the loop now, she's a retired postmaster, so she is helping to figure out this mystery. She wasn't one of the old-schoolers...she told me she gets 1% of her salary for every year served. So 20 years at USPS only pays 20% salary for life.

thanks for all the help, I think this may be on track!!