topic Re: Medicare Advantage plans & inpatient rehab in Wellness

Medicare Advantage plans & inpatient rehab

gidgetgh — Fri, 07 Apr 2017 22:56:31 GMT

Just wondering if anyone on a Medicare Advantage plan has ever had to use inpatient rehab?

Without going into too much detail, a friend of mine's family member was admitted a few weeks ago to a rehab center, after a life altering illness and lengthy hospitalization. The therapists evaluated this person and estimated a 3-4 month rehab.

Yesterday, just a few weeks in, my friend was told that the insurance company is now balking and might only cover through next week. This would leave my friend high and dry. My friend is of course, extremely upset and concerned and, to be honest, terrified.

It's horrifying as the family member is in no way, shape or form able to come home. The rehab center said they're starting to experience problems more often with advantage plans covering lengthy rehab stays

Anyone have experience with this? My friend was going to meet with the rehab social worker again today to see if there is an appeals process or any other options.

Re: Medicare Advantage plans & inpatient rehab

fthunt — Fri, 07 Apr 2017 23:12:26 GMT

Don't know much - but from what I've heard about M Advantage, I wouldn't be surprised about anything. I got tricked into signing up for it and when my doctor's wife found out about it - - she had a fit. I finally got out of it and back to what I had. Good Luck to your friend.

Re: Medicare Advantage plans & inpatient rehab

gracie2014 — Fri, 07 Apr 2017 23:13:10 GMT

Wow, how unfair! I had something pretty much similar happen to me last year...they can discharge without notice...my question is have they made discharge plans? Has anyone gone to the home to make sure everything is in place for the family member..so sad that people who are unable to advocate for themselves are put in this position..the rehab my mom stayed in discharged her without notice..we were given one date and they discharged her about a month earlier when we had returned home to pick up a few things and close up shop..she had experienced a stroke and cardiac arrest at the same time....the plan was for her home to become accessible...with a ramp,etc...they discharged her into my sister's care..they saw that my sister's husband was handicapped...but it was a brain injury...there was no way for her to take a real bath...a study was converted into a bedroom..it was truly awful....I would go to the head of the insurance company...there are others who can help out. Praying they work something out.

Re: Medicare Advantage plans & inpatient rehab

Kachina624 — Fri, 07 Apr 2017 23:13:58 GMT

I have a Medicare Advantage Plan and was in a rehab facility 2 weeks after knee replacement surgery in 2011. I didn't pay a penny.

Your friend should have received information from her carrier regarding her coverage, which may be different from mine. Not all Advantage Plans are the same. Why doesn't she call her company and discuss it with a representative? They would be able to tell her what the limit of her coverage is and how she would appeal a decision with which she disagrees.

Re: Medicare Advantage plans & inpatient rehab

Kachina624 — Fri, 07 Apr 2017 23:21:24 GMT

@fthunt My Advantage Plan has been absolutely wonderful. I've had it about 8 years, see the doctors and specialists of my choice, go to the hospital of my choice, and have had knee replacement surgery. I've never paid a single cent out of pocket. How could it possibly be any better?

Re: Medicare Advantage plans & inpatient rehab

gidgetgh — Fri, 07 Apr 2017 23:26:54 GMT

@Kachina624 wrote:
I have a Medicare Advantage Plan and was in a rehab facility 2 weeks after knee replacement surgery in 2011. I didn't pay a penny.

Your friend should have received information from her carrier regarding her coverage, which may be different from mine. Not all Advantage Plans are the same. Why doesn't she call her company and discuss it with a representative? They would be able to tell her what the limit of her coverage is and how she would appeal a decision with which she disagrees.

Thanks. This happened very late yesterday afternoon and I spoke with my friend early this morning. They were going to spring into action today.

Re: Medicare Advantage plans & inpatient rehab

gracie2014 — Fri, 07 Apr 2017 23:26:55 GMT

Not sure @Kachina624...actually yes I do!!!! My dad did not think my mom was going to survive so to save $35 a month which would have covered the rehab facility, he chose to not opt for that choice. He was a retired federal employee with excellent insurance...

Re: Medicare Advantage plans & inpatient rehab

gidgetgh — Fri, 07 Apr 2017 23:29:01 GMT

@gracie2014 wrote:
Wow, how unfair! I had something pretty much similar happen to me last year...they can discharge without notice...my question is have they made discharge plans? Has anyone gone to the home to make sure everything is in place for the family member..so sad that people who are unable to advocate for themselves are put in this position..the rehab my mom stayed in discharged her without notice..we were given one date and they discharged her about a month earlier when we had returned home to pick up a few things and close up shop..she had experienced a stroke and cardiac arrest at the same time....the plan was for her home to become accessible...with a ramp,etc...they discharged her into my sister's care..they saw that my sister's husband was handicapped...but it was a brain injury...there was no way for her to take a real bath...a study was converted into a bedroom..it was truly awful....I would go to the head of the insurance company...there are others who can help out. Praying they work something out.

My friend doesn't have an end game plan yet because it depends on the success of the rehab. There's a goal certainly of coming home. But no way could that happen now.

Re: Medicare Advantage plans & inpatient rehab

conlt — Fri, 07 Apr 2017 23:46:37 GMT

I have said it many times on these boards and people always argue with me but the Medicare Advantage Plans do not pay just like Medicare. I have worked in health care specifically with the elderly as a RN executive in home care. My business is a Medicare business. I think the advantage plans are fine for a healthy individual who wants to save money on prescriptions however, I have seen many times when they don't want to take care of someone who needs more intensive care. When Medicare rolls around for me I am taking straight Medicare, a supplement to cover the other 20% and then a part D drug plan. My 91 year old mother is on this and she never pays a dime for anything other than her insurance. Please be careful with the Medicare Advantage plans, you never know when a critical illness is going to happen and you need good coverage.

Re: Medicare Advantage plans & inpatient rehab

gracie2014 — Fri, 07 Apr 2017 23:52:26 GMT

Praying for this person!

Re: Medicare Advantage plans & inpatient rehab

gracie2014 — Fri, 07 Apr 2017 23:54:20 GMT

Thanks, Halo!

Re: Medicare Advantage plans & inpatient rehab

KarenQVC — Fri, 07 Apr 2017 23:54:33 GMT

From my work in this area, I believe the ship has sailed on the mother staying in a SNF. I would recommend placing the mother in a basic nursing home bed while plans for the future are being made. This will be private pay of about $8000 per month, but the patient will be safe. If she stays in the NH for the duration, Medicaid would eventually kick in. Have your friend ask the discharge planner about this option.

Re: Medicare Advantage plans & inpatient rehab

software — Fri, 07 Apr 2017 23:55:33 GMT

My late parents did as you recommend. It worked for them. They both eventually were diagnosed with cancer but never paid a penny out-of-pocket. I wouldn't have believed them but toward the end, I handled their finances for them.

I plan to do the same. I do not have a cancer diagnosis but I do have health problems.

@conlt

Re: Medicare Advantage plans & inpatient rehab

Kachina624 — Sat, 08 Apr 2017 00:09:21 GMT

@conlt wrote:
I have said it many times on these boards and people always argue with me but the Medicare Advantage Plans do not pay just like Medicare. I have worked in health care specifically with the elderly as a RN executive in home care. My business is a Medicare business. I think the advantage plans are fine for a healthy individual who wants to save money on prescriptions however, I have seen many times when they don't want to take care of someone who needs more intensive care. When Medicare rolls around for me I am taking straight Medicare, a supplement to cover the other 20% and then a part D drug plan. My 91 year old mother is on this and she never pays a dime for anything other than her insurance. Please be careful with the Medicare Advantage plans, you never know when a critical illness is going to happen and you need good coverage.

@conlt I don't know what you're talking about because my plan has no maximum lifetime limit. Mine also has a part D drug plan. It covers everything I would ever need. These plans are not all the same.

Re: Medicare Advantage plans & inpatient rehab

Carmie — Sat, 08 Apr 2017 00:15:53 GMT

Every Advantage Plan is different with a different set of benefits. You friend needs to read her benefit booklet or call CS at the insurance company.

I can tell you from experience that MOST, But not all Advantage plans cover 20 days of inpatient rehab after a three day hospital stay.

Once you are hospital and rehab free for 60 or 90 days depending on your policy, you get another 20 days.

Every time someone asks for Medicare information on this forum, I always tell them to be sure they have at least 100 days of IP rehab at a skilled nursing facility ( SNF)

This benefit is so important and often overlooked. Traditional Medicare covers the first 20 days at 100%. After that you have a large copay from day 80 to day 100. That's why people choose Plans C! H or F, these plans will pay 100%

Advantage plans are all over the place with no cut in stone rules.

Re: Medicare Advantage plans & inpatient rehab

KarenQVC — Sat, 08 Apr 2017 00:23:26 GMT

Another thing, you may not qualify for all the days your plan may pay for. You have to require skilled nursing or intensive rehab. If you don't make progress in rehab, you are discharged. Bummer.

Re: Medicare Advantage plans & inpatient rehab

Carmie — Sat, 08 Apr 2017 00:26:23 GMT

@Kachina624 wrote:
@conlt wrote:
I have said it many times on these boards and people always argue with me but the Medicare Advantage Plans do not pay just like Medicare. I have worked in health care specifically with the elderly as a RN executive in home care. My business is a Medicare business. I think the advantage plans are fine for a healthy individual who wants to save money on prescriptions however, I have seen many times when they don't want to take care of someone who needs more intensive care. When Medicare rolls around for me I am taking straight Medicare, a supplement to cover the other 20% and then a part D drug plan. My 91 year old mother is on this and she never pays a dime for anything other than her insurance. Please be careful with the Medicare Advantage plans, you never know when a critical illness is going to happen and you need good coverage.
@conlt I don't know what you're talking about because my plan has no maximum lifetime limit. Mine also has a part D drug plan. It covers everything I would ever need. These plans are not all the same.

I know what she is talking about. I worked in Health a Insurance for over 25 years, and I agree with Halo117.

You might be surprised what your Advantage plan does not cover at 100%. You won't know until you need that benefit.

One of my family members is in the hospital right now. She has an Advantage plan that covers just about everything. She pays $90 a month for it.

I just checked into her benefits today. She has a $200 deductible for the first through the 7th day of an inpatient admission. She has been there four days already and will probably owe $1400 at least for seven days when she is discharged.

She used to have Traditional Medicare and Plan F which paid 100% of all her inpatient admissions. She dropped that insurance on Jan. 1. I have no idea where she will get the money to pay this bill. She is living on $1200 a month from SS.

Re: Medicare Advantage plans & inpatient rehab

Carmie — Sat, 08 Apr 2017 00:30:09 GMT

@KarenQVC wrote:
Another thing, you may not qualify for all the days your plan may pay for. You have to require skilled nursing or intensive rehab. If you don't make progress in rehab, you are discharged. Bummer.

Once you reach your maximum improved potential, you are no longer covered. Maintenance rehab is not covered in a SNF.

You are 100% correct. That is true of all policies. You need long term care insurance to cover those types of services.

Re: Medicare Advantage plans & inpatient rehab

Carmie — Sat, 08 Apr 2017 00:54:09 GMT

@Kachina624 wrote:
I have a Medicare Advantage Plan and was in a rehab facility 2 weeks after knee replacement surgery in 2011. I didn't pay a penny.

Your friend should have received information from her carrier regarding her coverage, which may be different from mine. Not all Advantage Plans are the same. Why doesn't she call her company and discuss it with a representative? They would be able to tell her what the limit of her coverage is and how she would appeal a decision with which she disagrees.

Two weeks of rehab is covered by all Traditional and Advantage plans if medically necessary if you spend at least three days as in inpatient,

The OP is talking about months of rehab. You would need Traditional Medicare and a supplemental Plan C, H or F to get 100 days paid in full. ( there are other plans that cover SNF too up to 100 days) , but these are the most popular,

You cannot appeal your benefits. You can only appeal a denied claim or a claim that you feel did not process correctly according to your purchased benefits. If the claim paid correctly, there is nothing anyone can do. You get what you pay for.

Re: Medicare Advantage plans & inpatient rehab

tucsongal — Sat, 08 Apr 2017 01:01:34 GMT

@conlt wrote:
I have said it many times on these boards and people always argue with me but the Medicare Advantage Plans do not pay just like Medicare. I have worked in health care specifically with the elderly as a RN executive in home care. My business is a Medicare business. I think the advantage plans are fine for a healthy individual who wants to save money on prescriptions however, I have seen many times when they don't want to take care of someone who needs more intensive care. When Medicare rolls around for me I am taking straight Medicare, a supplement to cover the other 20% and then a part D drug plan. My 91 year old mother is on this and she never pays a dime for anything other than her insurance. Please be careful with the Medicare Advantage plans, you never know when a critical illness is going to happen and you need good coverage.

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