Medicare Part A Pickle

[axeman462]

I can confirm as well many MAPD that I see now specifically say they cover unlimited days of inpatient hospital stay. If not MAPD or SNP, then straight-up Medi/Medi can be the option? A few weeks ago I actually met a lady who has both Medicaid and Med Supp with Mutual of Omaha. I was baffled that she has both. I remember reading it on a GOV site where it says it is possible, but I really don't know how to go about that route.

I have come across this before too, medcaid pays the premiums for the medsupp. not sure I see the real benefit of having a medsupp with medicaid though.
My understanding is that medicaid would act as the medsupp to medicare, negating the need for the medsupp. maybe I am missing something there?

 

[axeman462]

@axeman462 she is on OM + Medigap. Never on MAPD. She was a KP client of mine for several years before T65. She has gone past 90 days in the hospital and is eating away at her lifetime reserve. Hospital and her docs (on staff at NIH) informed her she is almost out of benefit. She has been in ICU almost 5 months . . . no way she can stay out of the hospital long enough to reset Part A coverage.

You will need to confirm this with Md or Ga Medicaid laws, but in Florida, there is a way to make Medicaid active retroactively, if a need can be proven. (i think up to 3 months, maybe 6?)

I would recommend looking into this. Even if the process take 4-6 weeks, she can have it effect Dec 1 or Nov 1 2021. Therefore making the continuity of coverage seemless.

Straight medi/medi (even if she decides to keep the medsupp), in my opinion would probably be her best bet here. Not sure I would even bother with a D-SNP.

As for the enrollment in Medicaid, that kinda falls on the hospital if they want to get paid. Unless, you want to set up a 3 way call with medicaid for her.

 

[rmhaire]

My wife was diagnosed with Alzheimer's when she was 55. She'll turn 70 on Christmas day. She has spent the last nine years on hospice. Here's a few things about hospice before you recommend it:

Hospice is designed for patients with a life expectancy of six months or less. Hospice could care less if you have original medicare or an MA plan. They only bill Medicare. Hospice is only about dying with dignity and comfort. They will not cover experimental drugs or air ambulance. They will cover ambulance. Your client will not see her regular doctor. Hospice companies provide their own in-house doctor. And there will be no more trips to the hospital. In fact, your client will have to dis-enroll from hospice before her local hospital will admit her. Medicare will require the hospice company to assess your client every 90 days and they must be able to show a decline or run the risk of being kicked off. I could go on but you get the point. Sounds like your client's case is unique.

 

[Travis Price]

https://medicaid.georgia.gov/how-apply

She can start her app online. Explain the situation and they may work with her online or over the phone (especially with Covid.)

Obvs GA is different from MI. We're working online until June, at least.

 

[somarco]

@rmhaire thanks for the summary. Sorry for what you and your wife have had to go through.

I have had a few clients (and a few friends, family members) transfer to hospice and it is not pleasant. One friend died the day after hospice was approved, one client lasted a couple of weeks following approval.

Another client with OM and an F plan was terminal for several months and receiving treatment @ Mayo. His wife constantly complained about the premium . . . less than $200/month and carrier had paid over $4,000 for the year.

One of the nurses told her to get him off the Medigap plan to "save money".

So she did just that and changed him to a MAPD without consulting me. Sometime in January he was put on hospice . . . and kicked back to Medicare . . . but no supplement plan. He lived a few more months and I never heard from the wife. My guess is her foolish move cost a lot more than the Medigap premium.

But nurses know more about Medicare than I do . . . at least that is what the wife thought.

As you can probably tell, I am grasping at straws, trying to find a solution where perhaps there is none.

Thanks for your input.

 

[axeman462]

@rmhaire thanks for the summary. Sorry for what you and your wife have had to go through.

I have had a few clients (and a few friends, family members) transfer to hospice and it is not pleasant. One friend died the day after hospice was approved, one client lasted a couple of weeks following approval.

Another client with OM and an F plan was terminal for several months and receiving treatment @ Mayo. His wife constantly complained about the premium . . . less than $200/month and carrier had paid over $4,000 for the year.

One of the nurses told her to get him off the Medigap plan to "save money".

So she did just that and changed him to a MAPD without consulting me. Sometime in January he was put on hospice . . . and kicked back to Medicare . . . but no supplement plan. He lived a few more months and I never heard from the wife. My guess is her foolish move cost a lot more than the Medigap premium.

But nurses know more about Medicare than I do . . . at least that is what the wife thought.

As you can probably tell, I am grasping at straws, trying to find a solution where perhaps there is none.

Thanks for your input.

...you may want to check your notes when it comes to hospice care. There is almost always nothing out of pocket when it comes to hospice.
Even when there is, its very minimal. Often less than a monthly premium for a medsupp.
Even when an individual has MAPD...

 

[somarco]

There is almost always nothing out of pocket when it comes to hospice.

Hospice covers care relative to the terminal condition. My client had cardiac issues in addition to terminal esophageal cancer.

Medicare only covers your hospice care if the hospice provider is Medicare-approved.

Your hospice benefit covers care for your terminal illness and related conditions. Once you start getting hospice care, your hospice benefit should cover everything you need related to your terminal illness.

After your hospice benefit starts, you can still get covered services for conditions not related to your terminal illness. Original Medicare will pay for covered services for any health problems that aren't part of your terminal illness and related conditions. However, you must pay the deductible and coinsurance amounts for all Medicare-covered services you get to treat health problems that aren't part of your terminal illness and related conditions.

How hospice works | Medicare

 

[rmhaire]

You're both correct on this one. Once you go on hospice, almost everything is paid. In fact, after nine years of dealing with hospice, I've never been billed for any of my wife's care. I get an EOB from medicare every 90 days so I know what hospice charges. And the fact is we are all in the wrong business. We should all start hospice companies instead of selling insurance. Just picture a couple of thousand per week per patient.

When you decide to go on hospice, hospice becomes both your doctor and your hospital. In fact, they tell you when you sign up not to call 911 and ask for an ambulance. It ain't coming.

Hospice is not about getting well. It's all about dying.

Hospice is just like your doctor or hospital when it comes to Medicare. Medicare will only pay for what hospice bills them for.

Not all hospice providers are the same. Some cover more than others. An example is Levothyroxine. My wife takes it for a thyroid disorder. Most hospice companies won't cover it. They look at it as a non-essential maintenance drug.

Hope some of this helps Somarco

 

[axeman462]

Hospice covers care relative to the terminal condition. My client had cardiac issues in addition to terminal esophageal cancer.

Medicare only covers your hospice care if the hospice provider is Medicare-approved.

Your hospice benefit covers care for your terminal illness and related conditions. Once you start getting hospice care, your hospice benefit should cover everything you need related to your terminal illness.

After your hospice benefit starts, you can still get covered services for conditions not related to your terminal illness. Original Medicare will pay for covered services for any health problems that aren't part of your terminal illness and related conditions. However, you must pay the deductible and coinsurance amounts for all Medicare-covered services you get to treat health problems that aren't part of your terminal illness and related conditions.

How hospice works | Medicare

You dont lose mapd when hospice kicks in. The mapd coverage is still there as it always has been for non hospice related issues. But hospice specifically as seen below on Medicare.gov has little to no out of pocket.

And in relation to what you said, as long as the provider is approved by Medicare... of course.

Hospice Care Coverage

 

[kgmom219]

1. If she leaves the hospital, the reset should occur.
2. I would also call the Center for Medicare Rights, but I if she's hitting the 60 days of lifetime reserve days, why isn't she in a SNF? Long Term Hospital Care Coverage
3. What is the current legal address? Is it Georgia or Maryland?
4. Also think MSA plan might work in this situation. Does she have the $3K-ish?
5. Hospice should also come into play