TriCare and Medicare

[rmhaire]

No my example is not going in full blown nursing some . Just going for rehab for maybe 20 days. When they drop your mapd who's paying the Part A $1656 deductible when your own original Medicare . You already paid your $350 a day times 6 in the hospital ? Is the SNF who dropped your mapd eating that $1656?

OK, let's work with your example.

Depending on your plan, an MAPD offers SNF coverage for up to 100 days. Part A under OM covers 20 days at 100%. After 20 days, or days 21-100, the patient pays a copay of $209.50 per day. This would be covered by his supplement assuming he has one.

As far as the part A deductible, there is no carry over when changing plan types. MAPD to OM. So the $1,656 would be the patient's responsibility.

As far as the SNF eating the deductible, in 40 years of doing this stuff, I've never seen a medical provider eat a damn thing.

 

[rmhaire]

Very valid question. And who pays he 20% of the bill Medicare won't cover? I have zero confidence the SNF would eat that. Always stuff that comes up that I'm still learning. Which brings me to the biggest point of all. If agents who have been in the business for 10+ years still don't have a perfect knowledge; how is some goofball from India gonna be able to help?

The patient is responsible for the 20%. And the SNF won't eat anything.

As for learning this stuff, 40 years and I'm still learning. You'll never know it all.

I knew about the goofball part, but India? I am so going to hammer your maharaja-looking ass over that one.

 

[DonP]

OK, let's work with your example.

Depending on your plan, an MAPD offers SNF coverage for up to 100 days. Part A under OM covers 20 days at 100%. After 20 days, or days 21-100, the patient pays a copay of $209.50 per day. This would be covered by his supplement assuming he has one.

As far as the part A deductible, there is no carry over when changing plan types. MAPD to OM. So the $1,656 would be the patient's responsibility.

As far as the SNF eating the deductible, in 40 years of doing this stuff, I've never seen a medical provider eat a damn thing.

So all these yrs the snf pulling the patient off a mapd to orginal medicare is a huge disserve to the patient . They'll be stuck with big bills . I'll be honest I run into a lot of people on partial Medicaid , orginal medicare and lis . I bet you 90% tell me they have zero copays or bills of any type . Some facilities appear to be taking what Medicare pays as full payment on lower income people . When I run into that I don't move them to a mapd as I know they'll have copays and be pissed off

 

[rmhaire]

I bet you 90% tell me they have zero copays or bills of any type . Some facilities appear to be taking what Medicare pays as full payment on lower income people

That's because Medicaid picks up the copays and deductibles.

And Medicare pays very little in the way of long term care. These facilities are after their SS assignment.

 

[DonP]

That's because Medicaid picks up the copays and deductibles.

And Medicare pays very little in the way of long term care. These facilities are after their SS assignment.

These people are partial Medicaid were Medicaid has no cost sharing

 

[annon123]

That's because Medicaid picks up the copays and deductibles.

And Medicare pays very little in the way of long term care. These facilities are after their SS assignment.

Once people have gone through their assets for a nursing home and only have SS left and now are eligible for medicaid, they are left with very little in the way of SS. Then what SS leaves the people for anything they need (nursing homes don't provide everything) is pitifully low. In this state, last I knew, it was $30/mo.

 

[EckoRomeo]

I bet you 90% tell me they have zero copays or bills of any type . Some facilities appear to be taking what Medicare pays as full payment on lower income people . When I run into that I don't move them to a mapd as I know they'll have copays and be pissed off

I don't know about 90% but I find this often as well. Primarily in rural areas. They don't even have to be partials.

 

[rmhaire]

I don't know about 90% but I find this often as well. Primarily in rural areas. They don't even have to be partials.

The copays are still there. They're just not seeing them.

And no facility is taking Medicare as full payment. Medicare doesn't pay enough for long term care for that to happen.

 

[DonP]

I don't know about 90% but I find this often as well. Primarily in rural areas. They don't even have to be partials.

Take 90% to the bank from one of the top dual writers of Medicare in the country the last 4 yrs