TriCare and Medicare

[annon123]

Not related to Tricare, but I've had two MAPD clients need SNF care in the past 6 months or so. The facility had them disenroll and go back to Medicare alone. In both instances the client really wasn't sure what was happening but went along with it.

Different facilities and not the same company. If I didn't know better, this is how the facilities are trained now. Just tell MAPD clients they need to go back on original Medicare.

Good to know! Thanks.

 

[Medicare bro]

Not related to Tricare, but I've had two MAPD clients need SNF care in the past 6 months or so. The facility had them disenroll and go back to Medicare alone. In both instances the client really wasn't sure what was happening but went along with it.

Different facilities and not the same company. If I didn't know better, this is how the facilities are trained now. Just tell MAPD clients they need to go back on original Medicare.

So they would just pay 20% then? They wouldn't be able to get a supp?

 

[annon123]

So they would just pay 20% then? They wouldn't be able to get a supp?

As an aside if this happens to someone who has TriCare plus MA and they drop the MA TriCare acts like a supp and D so they don't need a supplement.

Not sure about the specific situation Medicare bro was taking about though.

 

[rmhaire]

Not related to Tricare, but I've had two MAPD clients need SNF care in the past 6 months or so. The facility had them disenroll and go back to Medicare alone. In both instances the client really wasn't sure what was happening but went along with it.

Different facilities and not the same company. If I didn't know better, this is how the facilities are trained now. Just tell MAPD clients they need to go back on original Medicare.

They are all trained to do that. And for a very simple reason. To get paid.

Most SNFs and almost all nursing homes have their own doctor on staff. With the smaller nursing homes it's usually an outside doctor that comes in to treat the patients and he becomes their attending physician.

With OM, if your doctor requests it, it usually gets paid. Not that simple with MA. OM doesn't have algorithms or review panels.

As for OM alone, the only time that advice makes sense is Hospice. Since part A pays 100% of Hospice, it's the only time that makes sense.

 

[DonP]

They are all trained to do that. And for a very simple reason. To get paid.

Most SNFs and almost all nursing homes have their own doctor on staff. With the smaller nursing homes it's usually an outside doctor that comes in to treat the patients and he becomes their attending physician.

With OM, if your doctor requests it, it usually gets paid. Not that simple with MA. OM doesn't have algorithms or review panels.

As for OM alone, the only time that advice makes sense is Hospice. Since part A pays 100% of Hospice, it's the only time that makes sense.

Here's a question . You're in hospital with mapd at $380 x 5 nights or $1900 . You go in snf and they drop your mapd . Who's paying the $1676 part A deductible on OM your about ti get hit with ? Does the facility eat the charge? Who's paying the $209 a night days 21-100? Does the facility sign you up for Part D since you have no rx coverage ?

 

[billyb]

I noticed one of my longtime UHC MAPD clients wasn't active. She calls me monthly for help. Found out she recently had a stroke and has terminal cancer. She went to a local SNF and they disenrolled her from UHC and enrolled her with Wellcare. I am not sure what plan but I don't think they helped her.

 

[Medicare bro]

Here's a question . You're in hospital with mapd at $380 x 5 nights or $1900 . You go in snf and they drop your mapd . Who's paying the $1676 part A deductible on OM your about ti get hit with ? Does the facility eat the charge? Who's paying the $209 a night days 21-100? Does the facility sign you up for Part D since you have no rx coverage ?

That's what I'm wondering. I'll check because I saw a couple of weeks ago this happened to one of my clients.

 

[rmhaire]

Here's a question . You're in hospital with mapd at $380 x 5 nights or $1900 . You go in snf and they drop your mapd . Who's paying the $1676 part A deductible on OM your about ti get hit with ? Does the facility eat the charge? Who's paying the $209 a night days 21-100? Does the facility sign you up for Part D since you have no rx coverage ?

That's more than one question but here goes.

If you go into the hospital with a MAPD @ five nights, that's on the MAPD. Hopefully you sold them a HIP plan.

The rest of your scenario doesn't happen like that. Here's what really happens.

You leave the hospital and you're sent to a SNF. In most cities the local nursing home and the SNF are in the same building. Same nurses and same doctor. The only thing that's really different is your care plan. And it only takes a few key strokes to change from one to the other.

And nobody is in a SNF for a 100 days. You'll be coded as a nursing home patient and that's when the fun really starts.

The average daily rate for a nursing home is a little over $300 a day and even higher depending on your zip code.

You be asked to sign a contract that will assign you SS benefits and maybe more. And you'll probably be asked to sign up for Medicaid. Medicare isn't going to pay for it. Or you can start out in Spend Down mode but that won't last very long.

As for your drugs, you'll be getting those from the nursing home or SNF. You won't be getting those from your regular pharmacy anymore.

And to get a better feel for all this, the average stay in a SNF is a little less than 30 days. The average nursing home stay is over 400.

 

[DonP]

That's more than one question but here goes.

If you go into the hospital with a MAPD @ five nights, that's on the MAPD. Hopefully you sold them a HIP plan.

The rest of your scenario doesn't happen like that. Here's what really happens.

You leave the hospital and you're sent to a SNF. In most cities the local nursing home and the SNF are in the same building. Same nurses and same doctor. The only thing that's really different is your care plan. And it only takes a few key strokes to change from one to the other.

And nobody is in a SNF for a 100 days. You'll be coded as a nursing home patient and that's when the fun really starts.

The average daily rate for a nursing home is a little over $300 a day and even higher depending on your zip code.

You be asked to sign a contract that will assign you SS benefits and maybe more. And you'll probably be asked to sign up for Medicaid. Medicare isn't going to pay for it. Or you can start out in Spend Down mode but that won't last very long.

As for your drugs, you'll be getting those from the nursing home or SNF. You won't be getting those from your regular pharmacy anymore.

And to get a better feel for all this, the average stay in a SNF is a little less than 30 days. The average nursing home stay is over 400.

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?

 

[Medicare bro]

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?

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?