Community Chat

[conlt]

Your advisor is right, I will give an example. My mother is 93 and has Medicare and a supplement. She fell December 2nd. She has been in and out of of the hospital and rehab ever since. Medicare covered 100% of rehab up until 21 days, When she hit that Medicare pays 80% and her supplement pays 20% up to 100 days. If she did not have the supplement we would be paying 20% of rehab. She gets out on Friday and she has to be out of the hospital for 60 days and the clock will reset for rehab with a qualifying hospital stay to 100 days (if that makes sense).

[Catty2]

My Medicare supplement is through my state retirement.  This year they changed to a United Healthcare Medicare Advantage plan.  I am on a specialty med for RA and it took me 2 months to get it approved.  It was denied twice and then it was resubmitted as a "needs to be on this med" situation and was approved.  Luckily, my dr. office gave me a month's worth or I would have been out long ago.  Also, the first "generic" script I refilled in the new year went from $3.35/month to $35/month.  So far not thrilled with this change and may look for something else when open enrollment time comes around.  Good luck.

[Carmie]

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@conlt wrote:

Your advisor is right, I will give an example. My mother is 93 and has Medicare and a supplement. She fell December 2nd. She has been in and out of of the hospital and rehab ever since. Medicare covered 100% of rehab up until 21 days, When she hit that Medicare pays 80% and her supplement pays 20% up to 100 days. If she did not have the supplement we would be paying 20% of rehab. She gets out on Friday and she has to be out of the hospital for 60 days and the clock will reset for rehab with a qualifying hospital stay to 100 days (if that makes sense).

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You are correct except that Medicare paid her rehab for the first  20 days at 100%, then days 21 to 100 in full, except for $170.50 a day which is the coinsurance for 2019. If the rehab days were in 2018, the coinsurance was $167.50 for days 21 through 100.

If she is hospital free for 60 days, her benefit period starts over again with a clean slate and her rehab days will be restored.

if she did not have a supplement that covers her skilled care for days 21 to 100, not all supplements cover that, she would owe $167.50 a day for 2018 and $170.50 a day for services in 2019.

That can add up quickly...

[conlt]

Yes, so her bill currently would be about $6700  for Rehab. without the supplement. The supplement makes a big difference. I have not received the hospital bills yet but the supplement will pay 20% of the Medicare covered charges. 

[Carmie]

@conlt   Yes, the supplement will pay 20% of the Medicare services that paid at 80% by Medicare Part B. 

Part B of Medicare covers all outpatient services as well as services provided by professional providers on an outpatient as well as inpatient admission.

Medicare Part A pays for inpatient facility services at a hospital, skilled nursing and rehab centers.

Medicare Part A = inpatient hospital and inpatient rehab bills.

Medicare Part B = 80% all outpatient bills and all bills from doctors. 

I don't think you will get any unpaid bills, unless she had her hair done or some other type of personal service.

Between Medicare and her supplement, everything should be paid 100%.  She has great coverage.

[jannabelle1]

@donniesmom, without recommending anything, I can tell you my experience. I had United Health Care when I was working and always had a good experience with them. After doing some research on Advantage plans versus Medicare by itself, I decided I wanted the Advantage plan because it would cover more than Medicare alone. I called the UHC retirement representatives to find out what would be covered, and specifically if my general practitioner was in the network - and she was. I'm in the HMO plan, but haven't had any issues with that. Hubby is in the same plan and sees more specialists because of health problems. He does have to get referrals to specialists from his primary physician, but that has never been a problem or an issue. Our primary care doctors and specialists are all part of a large health care network in our geographic metropolitan area, and all of them are part of the UHC Advantage network. I would never leave the Advantage plan - and we pay nothing extra for it. All claims are handled by UHC under the terms of Medicare.

[NicksmomESQ]

 @Carmie  In New York can providers bill for the Medicare excess fees? 

[Carmie]

@NicksmomESQ No, New York providers cannot bill you the excess fee. You can look it up under the MOM Law.

The other states are PA, CT, MA, OH, VT, RI and  MN.

[Cakers3]

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@donniesmom wrote:

Hi--I am trying to navigate the confusing maze of Medicare. I basically understand Original Medicare but am not sure about Medicare Advantage. I read that Medicare Advantage is like an HMO or PPO. Does anyone have Medicare Advantage and would you recommend it? This is just so confusing and overwhelming! Thank you in advance for your help.

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@donniesmom   The Medicare website can direct you to the help in your area.  Please make use of that feature.

Other senior centers also offer help with Medicare/Medicare Advantage plans; and many companies will actually send a rep to your house at your request.

Take advantage of any local presentations in your area; these are usually brokers who do not charge you to do the footwork for you.  Usually they have appetizers to boot!!

You are better off getting professional help since everyone here will have different answers depending upon what they have for coverage.

Good luck.

[NicksmomESQ]

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@Carmie wrote:

@NicksmomESQ No, New York providers cannot bill you the excess fee. You can look it up under the MOM Law.

The other states are PA, CT, MA, OH, VT, RI and  MN.

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@Carmie  Does this mean you would not need to pay for a supplement above basic Medicare? Or am I confused?