Medicare Supplement Insurance . . . It Can Be Tricky

George, an 85 year old, was surprised when he received a $4000 bill for his pacemaker replacement procedure, after he was told that it would cost him $250.   He’d called his Medicare Advantage plan before the procedure and was told that he would be responsible for a $250 inpatient hospital co-pay.  Unfortunately, the hospital and the doctor’s office did not tell him that his procedure would be done as an outpatient with an overnight stay.  He stayed overnight but since he was never an inpatient, the bill was applied to his $6500 deductible for outpatient services.  

It’s a constant refrain!  You’re a senior, on medicare, you do everything you’re told but somehow you still owe $4000.  Again – these insurance companies DO NOT WATCH OUT FOR SENIORS and make the simplest of “medical procedures” complicated on the non-medical side.  A simple medical procedure mixed with insurance is like a game with no rules.  It doesn’t matter what plan you choose, there is still many a “slip between cup and lip”.  No other industry in the U.S. is allowed to operate this way.  It’s illegal!

This is especially true if you have a Medicare Advantage plan. These plans are less expensive than regular Medicare with a supplement for a reason.  They may add extra benefits, but they are often more complicated to understand. So what do you need to do to avoid surprises or issues? Plan ahead, ask a lot of questions and advocate for yourself, your partner, your family members or call Parent Your parents.  We can do it for you. 

Parent Your Parents is pleased and proud to announce the advent of Ann McGuire, R.N. to our growing group of experts.  Besides being a RN she is also a certified case manager and knows the pitfalls of senior insurance issues.  Please go to our website, ParentYourParents.com to see her photo and biography.  She and I will be collaborating on more articles to assist you with getting through the insurance maze  . . . little things like what to do if you’re sent to the emergency room.

Bottom line:  remember – insurance when going to a clinic or hospital for any procedure can be very tricky.  It’s not because the doctor wants to charge you more, it’s because of the intricacies of how Medicare Advantage plans work.  

Nursing Homes – Often the End Game

I am confident most of you heard the news about the eight seniors who died from overheating.  They were all in a licensed “nursing home” in Hollywood Hills.   ‘Nursing Home’ is a euphemism for a home for seniors who are at the poverty level and qualify for medicaid.

Nursing homes are like every other industry — they have to make money to survive.  In the case of nursing homes they’re paid by the state medicaid fund and it’s per pa

The nursing home visit

tient.  This fund is made up of state and federal dollars.  Obama Care expanded medicaid in the states who took the federal dollars but Florida is not one of them.

Bottom line, these are not the luxurious environments for either staff or residents.  In my parents case, Mom had been in a lovely residential facility where she was one of three or four people.  Her Long Term Care Insurance paid for it.  She outlived her two year policy and we had to place her in a Nursing Home.  It was our only realistic option as Mom’s care in an Alzheimer’s facility would be close to $7000,00 a month.  Mom and Dad couldn’t afford it and neither could the children.

In pursuit of the best we could find, I  went to several nursing homes and learned more than I needed to know.  All these homes are very austere and it’s a shock!  Bare floors, usually

formica, and waiting rooms with plastic chairs.  Almost all the receptionists were behind a barrier — some better designed than others.

The patient population is made up of mostly Alzheimers and Dementia sufferers.  All the residents are in a wheel chair, a portable bed or never moved from their beds.

Another surprise, the aides often use pulleys attached to patients to change their clothes, move them to the shower or simply change their diapers.  Depending on the home, these medical aides must change and clean about 19 patients each.  Some work in tandem others work solo — it all depends on the chore.

Further, most patients are only bathed twice a week, maximum three times a week.  During one of these showers their hair is washed.  Bottom line, it’s not how we envision our last days, weeks, months or years of life.

On the good side, the ‘better nursing homes’ have excellent care.  They hire a team of Geriatric Doctors that include Psychiatrists.  These Geriatric groups come to the Nursing Home through a PPO and the doctors physically visit once a month.  There is usually a Podiatrist group that also visits once a month (Medicare pays for podiatry services) and a dentist who comes once a quarter. The day to day care is with the Registered Nurses (RNs), Licensed Professional Nurses (LPNs), physical therapists and medical technicians.  They also have a contracted Hospice service.

Here are some tips when you need to look for a nursing home:

What is the turn-over rate of its employees

Needless to say, the less turnover the better the place.  If the staff is not leaving then something is going well — usually their paid above average wages

Is there a hair salon

If there is a hair salon then there’s a market for it.  This means the residents take pride in how they look.  People who take pride in themselves care about their environment.

Is it clean

As we all know, cleanliness is godliness

Is there a smell

Again, if it smells that means it’s really not clean – no matter how good it looks

Is there a smile on the faces of the staff

A smiling staff means a happy staff

Again, hopefully it doesn’t come to this but if it does, know how to choose the best one.