Wellness

[Carmie]

You said he has straight Medicare only.  I take that to mean he has Medicare Part A and Part B.

With this Traditional Medicare, he can receive services in all 50 states by any doctor or provider who accepts Medicare.

if he has been in the hospital within the last 60 days, he is still in the same benefit period. That means he can go back in the hospital and Medicare will pay 100% of his inpatient care.

If he has been out of the hospital for 60 days, he is in a new benefit period.  That means Medicare will pay 100% of his inpatient bill, but he would be responsible for a deductible of $1364.

it sounds like he could benefit from skilled nursing care at a facility.  To use this benefit, he would have to be in the hospital for three days and transfer to a Skilled nursing facility.  The first 20 days of this care are covered 100% by Medicare.  If he needs more days, he I'll need to pay $170.50 up to 100 days.( days 21 to 100)   If he is hospital and skilled care free for 90 days, he will get all of his skilled days restored.

i think he might have used some of these services already...

he might also benefit from Home Health Care. This covers physical therapy, occupational therapy, wound dressing and many other services that can be provided in the home.  There are no limits on this type of service as long as medically necessary and Medicare covers this 100%.

if he needs a doctor or any other type of health provider, he can go anywhere to anyone he chooses who accepts Medicare.  He will be responsible  for 20% of the Medicare allowance. He will also be responsible for 20% of the Medicare allowance for x-rays, labs and all outpatient diagnostic services....including surgery.

He does not have a lot of insurance, but lucky him that he has Traditional Medicare.  It is portable and works anywhere.

edited to add.  I think it is strange that he did not receive any bills in TX if he has Traditional Medicare.

You might want to make sure he does not have a Medicare Advantage Plan.  If he does, I would suggest that his family get him coverage in TX, especially if he has an Advantage HMO.

Xxxx

I would also call the Virginia Office on Aging and see if he is eligible for a Senior Life Program.  These programs allow a person to stay at home to live instead of being placed in a nursing home.  All services are provided free of charge, even RX drugs, glasses and dental care.

He will be transported to doctor visits and aids and care givers will be provided.  These programs are based on income.He would need Medicare to be on this type of program.

[Carmie]

---

@Kachina624 wrote:

Normally a person is sent to a nursing home/rehab center when they're unable to care for themselves post surgery.  I wonder if there was a social worker involved?  Sounds as though Medicare in Texass is rather sloppy.  I think the OP didn't  get complete info on this story.

---

He probably used all 20 of his rehab days.  After 20 days, the patient is responsible to pay $170.50 a day up to day 100. The first 20 days are paid 100%.

Many patients who do not have a supplement or Advantage Medicare that covers days 21 to 100 at 100% are sent home.

In 90 days if he is inpatient hospital free, the days will reset and he can get another 20 days paid at 100% provided he is transferred from an inpatient hospital admission.

[Silver Lining]

---

@Mindy D wrote:

I our cousin is a type of paraplegic with an incomplete spinal cord injury. This type of injury allows him to walk with leg braces but he has no feeling in feet and lower legs. This injury happened in an accident 25 years ago. Recently, he fell and fractured his hip and hurt his shoulder. He had surgery for the fractured hip. This happened only three weeks after he had surgery to remove his gall bladder during an attacking of pancreatitis. After the hip surgery, he was in rehab for two weeks and then was sent home. He lives alone and could not do anything. He had one week of at home physical therapy. Thank goodness his youngest daughter and her husband stepped up to the plate and drive from Va to Texas to help him.  They decided to take him back to Va. with them. His house had been listed for sale before this and was also n run down condition due to his physical limitations. His nephew drilove him to Va. while his daughter stayed st the house in Texas throwing out as much junk as possible and getting the house ready to close up. She packed any valuable she could. He doesn’t have many. After four days in va he was hospitalized with a blood clot in his lungs. He’s now bsck at his dsughter’s on A blood thinner.

He he is taking up to 900 steps dsily with assistance.

Now he’s in Va. he needs to know how he gets a doctor there and what he is supposed to do. He had a walker but he doesn’t know if he can use crutches, if he needs therapy, if he needs medicines. He had no follow visit after the hip surgery while in Texas. He needs to know if he needs to have a follow up in Va. He is on straight Medicare in Texas. No Medicaid, no supplement, no Advantage plan. For some reason, he never gets any bills for his medical care in Texas. I guess the providers just. I’ll Medicare and that’s what the providers take as payment. If you know of anyone that revouperated in a state other than their home state I’d appreciate input. Same for how the visits should be post hip surgery.Did u need follow up visits and follow up X-rays to eee if the bone is healing.

pleaee excuse typos. I’m posting on mobile.

---

@Mindy D.   The people on this board should read the post carefully before stating their opinion and giving advice. They missed the point that your cousin was hospitalized with a blood clot in his lung after four days in Virginia. He's currently staying with his daughter. 

Since he was hospitalized there the state has his medicare identification/eligibility info. He was examined and an assessment made while in the care of that hospital. I think he and/or his daughter would have discussed his recent surgery, rehab and home treatment. 

@Mindy D , I think he and his daughter can get guidance from the hospital where he was admitted for the blood clot as to follow-up.The doctor(s) who prescribed the blood thinners can ask for his medical records from Texas if he wants to remain in Virginia and needs follow-up for the hip surgery.

I DON'T MEAN YOU, @Carmie . You always get the facts and give excellent information.

[Mindy D]

The hospital for the clot didn’t discuss anything. I’m
not surprised.
I spoke with him tonight and he said he made an appointment with his daughter’s primary care doctor. He will go there to be monitored for his blood thinner and his health and the PC doctor can refer him to specialists and continuation of physical therapy and order any tests he needs. The doc can also request any needed records from his Texas primary care doctor and from the hospitals and PT company he was using in Texas. This plan should work. I’m just glad he’s able to walk 900 steps already. That’s insanely good fir a paralyzed person let alone for a guy with a broken hip following surgery and besides having had his gall bladder removed two months ago, surviving pancreatitis and a blot clot in the lung. He is not very old, I think he’s 65 and even though he is paraplegic he has been swimming near his home in Texas for years. Additionally, he is a veteran of physical therapy to the maximum...he’s been through three years of physical therapy years ago.... he could not walk at all back then and the prognosis for his spinal cord injury was much worse than it turned out. He still does not have it easy. He had to self catheterize every time he needs to urinate and spinal cord injury leads to chronic bowel problems. I think all this is why he is improving . Plus the relief that his daughter is taking care of him is huge. He says he has a great deal of anxiety though.

[Silver Lining]

@Mindy D , that's great news!! He and his daughter and YOU got the ball rolling and he's on his way to recovery.Your cousin is a trooper and a brave man for having done everything he could for years to maintain his well-being. His recent illnesses and surgeries have surely been difficult. Now he's coping with the cross-country move and adjusting to the changes. You are a source of comfort to him and his daughter. Hopefully, his anxiety will fade as he recuperates.