Beth Deems at Mission Health Care discusses Medicare. Medicare Part A covers inpatient hospitalization and inpatient skilled nursing rehabilitation on a short-term basis at 80%. Part B (an option for which you pay extra) provides outpatient coverage, including doctor’s office visits. Part D covers prescriptions. And Plan F is a supplemental policy you can buy to help cover things such as co-pays and the 20% that Medicare may not cover. Like all Federal programs, it is subject to change.
View Episode Transcript
*The following is the output of transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors.
This is a special presentation of Answers for Elders with Careage. Well, welcome back to the program everyone. I have one of our favorite people, Beth Deems, from Mission Health Care, and they are a Careage community. They do skilled nursing and acute care rehabilitation, and Beth is going to explain to us a little bit about what that’s all about. But we’re going to talk today a little bit about the most confusing topic for so many of us and that is basically, believe it or not, Medicare. We know what the rules are now and of course, obviously best going to give that to us. So welcome to the program Madam Beth. Thank you, Suzanne. Lovely to be here. I am so glad you’re here because it is confusing. Medicare is one of those situations that, especially when you’re helping a senior parent, obviously there’s different you know you’re going to go part D, part be, or whatever the numbers that you have to fix. So why don’t you just give us an overview of how Medicare works? Okay, well, you have Medicare A, which is your inpatient anytime you go into the hospital, right you use your Medicare A. You also use Medicare A for skilled nursing, for short term rehab, but then you have Medicare Part B, which is an option that you pay for. HMM. Everybody gets Medicare A, but Medicare B you have to pay for and that is your outpatient to go through that doctor. Correct. Then you have your Medicare D, which is your prescription plan. Correct. So a lot of times you can get your be in your d grouped under one plan, like maybe through Atna or Blue cross. But then you need a supplement because Medicare usually pays eighty percent, right, that twenty percent. So you get a supplemental program that pays that extra twenty percent. Hmmm, and plush your copays. There are copas to go into the hospital, but that supplemental plan, Plan F, is one of the most comprehensive ones that will cover those copays and the twenty percent. You’re amazing. You know all of this stuff. How many of us? I Beth, I took care of my mom for six years and I have to say that this is probably one of the most confusing scenarios. And of course I was taking care of her in, you know, the mid two thousands when all of this stuff changed and of course we’re probably looking and the future that there may be some changes. So you know, a lot of us are now confused of where we at now. What’s going to happen in the future? We don’t know, with the new healthcare plans, ectera. But right now we’re just going with what is today. And so let’s talk about if your parent is in the hospital and the objective of the hospital obviously is to release them to a skilled care rehab facility as soon as possible in most cases, if they have had a stroke or a heart does it, you know, heart attack or wound or broken bone or anything like that. So what happens at that point? Well, this is where it gets a little confusing. The most important qualifying thing that you have to have while you’re in the hospital is what’s called a three-day qualifying stay. That means you have to actually be admitted into the hospital and you have to be admitted for three midnights. Now the hospital does something called observation. Observation does not count. So you’re actually in the hospital. You can be in an observation bed for three days, amazing, and that doesn’t count as your qualifying stay, you have to be admitted. So are you then responsible for the payment? Yes, and if you’re in observation and you don’t get to use your Medicare in a short term Rehab. So let’s say you go into the emergency room at ten o’clock at night, and you are there for five days. Now you assume that they admitted you because you’re there for five days. Sure, but you came in at ten PM. Let’s say they didn’t formally admit you until one am. You’ve got you’ve missed that one midnight. Now you’ve been in there for five days. So you still have sure for more days, but you can’t count that first one because they didn’t admit you until one am, which is past the midnight. So how costly does that get to your a parent? So if a person is admitted to observation and not admitted, but yet they need to come to a short term Rehab, they would have to pay out of pocket for the board, room and board, which is roughly around four hundred and fifty dollars a day, holy mom. And then their part be Medicare would pay for their therapy. Right. So everyone out there that’s taking care of senior parent. The moral of this story is you need to get your parent admitted immediately. This is a vital, important and sometimes you have to fight for that. We’ve had residence where they’ve said, oh no, that’s not a qualifying they were not going to admit them and the family has had to really fight to have them changed from observation to being admitted. That’s powerful. That’s very powerful and and because it’s Medicare, this is a federal thing. It’s not a state thing. So obviously, no matter where your parents are in the country, whatever you’re doing with your folks, obviously you need to realize that the number one thing is four hundred and fifty dollars a day can be extremely heartbreaking and costly. Now one of the other scenarios that I’d like to talk about is a lot of people don’t want to come to a short term rehabilitation. They they think they can do it. They’ve been admitted maybe for four days with a hip fracture and they’re going to go home with home health and they think that they can do it right and so they’ve had that three-day qualifying stay at the hospital, but they choose to go home. So they go home and things are just really tough and they’re just not making it, even with the home health as helpful as they are. This patient just wasn’t quite ready for that. You have a thirty day window after you’d leave that hospital, after a qualifying stay, that if you’re failing at home, you can be admitted straight into the short term Rehab. That’s how awesome. So you have that thirty days. Now after the thirty days it gets much more complicated. But so remember if you go home and it’s you just think to yourself, Oh, I was wrong, I should have gone to the in patient Rehab. You can make that phone call and you’ve had that qualifying stay and you’re within your thirty day window, we can get you in. That’s amazing. That’s amazing and that’s good to know because a lot of people don’t know that piece. So if far as if I have Medicare okay, I I’m just going to ask because I you are with a skilled care facility and I remember when I had my mom, she would go to a skilled nursing facility and in the early days they just would transfer her out and I never got to think about, well where, they just told me where she was going. They never gave me a choice. I didn’t know that I had a choice. I do now. In other words, I don’t care if I if Mom’s in a hospital in Renton, I could bring her to mission health care absolutely and I can make that choice absolutely, because I don’t think discharge planners really give us the full facts in the hospitals of this whole thing and then it’s just kind of like you’re at this the mercy of whatever they tell you. And so the idea would be, obviously, is to if as soon as your parent gets in the hospital, you need to start looking at their next step and making sure that you check their Medicare benefits, you understand what specifically that they have. That’s really important piece of this, isn’t it? And that’s one of the things we do at mission when we get the inquiry from the hospital as we check benefits, so we are usually able to let the discharge planner or the social worker know, hey, they have a cope right. So we are talking to Beth Deems from Mission Healthcare and Bellevue and they are a carriage community, part of several here in the area and pass in the Pacific Northwest so Beth. What qualifies a patient? But his sides that there’s this this like this thirty day rule or whatever. I know that a lot of people they’re in Rehab and then all of a sudden their note that give notice. At least this was what happened from my mom, by the way. Her benefits run out in seven days and we’re going to release her into assisted living. Well, you have up to a hundred day benefit on Medicare, right or short term Rehab. It doesn’t mean you’ll get all one hundred days because you need the patient needs to be continuing to show progress and if they’ve reached their plateau to where there is no progress, then we have to give a forty eight hour notice. Perfect. Perfect. So so when you give that forty eight hour notice, then the supplemental policy can take over and pay more. No, not, not, ok, can’t. Ah, complemental policy only pays what Medicare doesn’t pay for. Ah, so they pay the difference, the twenty percent. See, this is different. Medicare pays a hundred percent for the first twenty days and skilled nursing and then eighty percent from day twenty one to a hundred. Got It. Got It. So Medicare will cover obviously skilled care. It also covers you. When we talked about therapy. Explain to me with the therapy is that they get the part B will cover outpatient therapy or if you’re in a skilled nursing facility, not under Medicare, maybe private pay or, okay, under Medicaid, then it will pay for therapy but it will not pay for the room and board. Okay. So so that. So the skilled care has to do with obviously, in physical therapy there’s actually I know that they used to take my mom to a room and they would work with her in various exercises and of course there is a different prince everyone between physical therapy and occupational therapy, which we had a guest on earlier. That gave us an explanation. But you guys do both. Is that correct? As well as speech here and speech there for those that have had the strokes. Absolutely that’s important, and speech therapist work with swallow difficulties and also cognitive difficulties. Right, right. So Um, what other information do we need to know about Medicare? The other thing about Medicare and skilled nursing is that after you discharge from a Medicare stay on skilled nursing. You again have that thirty day window when you go home, that if you still have days left over, that if you need to come back, you can perfect perfect. So, Beth, how do we reach you? My phone numbers two thousand and six nine and twenty two hundred eight hundred and seventy three, or my email is [email protected] Perfect. And then you guys have a website, don’t you? Yes, missionhealthcare.com perfect. Thank you for so much for being on the program thank you so much, Suzanne. This has been a special presentation of Answers for Elders with Careage. For more information for Careage, go to Careage.com. That’s Careage.com.
Suzanne Newman, host of the Answers for Elders radio show and podcast, proclaims often, “Caring for my mom was the hardest thing I ever have done, but it was also my greatest privilege.” Following a career of over 25 years in sales, media, and marketing management, Suzanne embarked on a 6-year-journey caring for her mother. Her trials and tribulations as a family caregiver inspired an impassioned life mission outside of the corporate world to revolutionize the journey that so many other American families also find themselves on. Answers for Elders provides education, help, and support to families, caregivers, and seniors across the country who are experiencing their own unique journey within the complicated world of Eldercare. Each week, Suzanne is joined by vetted professional experts in over 65 categories including health & wellness, life changes, living options, money, law, and more. Suzanne lives in Edmonds, Washington with her husband, Keith, and their two doodle dogs, Whidbey and Skagit.