As I’m preparing this column, Halloween is just around the corner. By the time you read it, Halloween will only be a fuzzy memory as we scramble to prepare for Thanksgiving. The stores already remind us that Christmas is just around the corner, so as we finish our Thanksgiving dinner, we’ll be racing ahead to mail Christmas cards, put up our decorations, and shopping for those special gifts for our loved ones. In 60 days, it’ll be a blurred memory. Now that is scary!
But, that’s not what this column is about. Mixed into the shuffle of this holiday season is the annual Open Enrollment Period. October 15th through December 7th each year is also the time that many of us on Medicare will need to make some extremely important decisions regarding our health insurance. Even before our 139-page annual “Medicare & You” booklet arrives in the mail, scores of ads from participating insurance companies have filled our mailboxes. The unwanted phone calls have now doubled with pre-recorded messages urging us to join their plan.
It’s the busiest time of the year for many of us, and in the back of our minds, we know that we need to devote some time to this situation also. Some of us have been notified that there have been changes made to our policies. January 1st our benefit changes take effect. Deductibles and co-pays may have changed. Rates may be changing. Some plans may have been discontinued. Coverage may no longer be available in our county or state. All our prescription drug plans are subject to changes in coverages, co-pays, and premium costs. This is scary!
Many people we talk with have limited information about their current coverages and seldom know about specific new changes that will be occurring. However, if they’ve been recently hospitalized and unpaid bills are sitting on their desk, they know exactly what their coverages were and were not. But, at that point, it might be too late. Often, the coverages needed are no longer available or changes will require waiting for the next Open Enrollment Period to roll around. That can be costly.
As Medicare beneficiaries, we are responsible to know about our current coverage and what changes are being made. That’s why it’s a good idea to have a periodic review of our medical insurance coverage. No one plan or company is best for everyone. All our needs are different as is our ability to pay. Sometimes our choices are limited due to pre-existing conditions. This is why it’s so important to make the best choice possible when we turn 65 and our acceptance is guaranteed.
Many years ago, I attended a seminar that was specifically about Medicare and nursing home care. I have included this information in previous columns and want to share it with you again, because it is so important. I’ve heard horror stories about people who didn’t realize that they did not have coverage until they were discharged from the nursing home. This is a synopsis of that seminar and it’s so important, I suggest that you make a copy and put it on your refrigerator door, so it can easily be seen by someone that may need to make decisions on your behalf, if you are unable. You will need to meet all nine of these specific requirements to receive benefits. This is really scary!
WILL MEDICARE PAY FOR YOUR STAY IN A NURSING HOME?
- Are you covered under Medicare Part A?
- Has Medicare approved your physician’s recommended plan of care?
- Has your physician prescribed Daily Skilled Nursing Care in your plan of care? Will you receive skilled care daily (at least five days a week) such as rehab therapy, etc?
- Are you being admitted into a Skilled Nursing Home that has been certified and approved by Medicare?
- Does the extended care need to be provided in a skilled nursing care facility according to Medicare standards or could it be provided at a lower level of care or at home?
- Have you been hospitalized as an inpatient for at least 3 days? This does not include the date of discharge. This does not include any days spent in the hospital while under observation.
- Are you being admitted into the skilled nursing home for the same reason you were hospitalized as an inpatient?
- Are you being admitted into a skilled nursing home within 30 days of your discharge from the hospital?
- Before admission to the skilled nursing home, is the patient expected to improve? Does the patient show improvement capability? After admission, does the patient show rehabilitation potential? If the patient does not show improvement (chronic diagnosis) or declines in health or is determined to be terminal, qualification status will be lost.
It has been estimated that 50% of people over 65 will spend time in a nursing home. Nursing home costs could exceed $300 per day. If you want a policy review or if we can help in any way during this Open Enrollment Period, give us a call. If you have any specific questions regarding Medicare or your personal life or health insurances, send us an email. With your permission, we may include it anonymously in a future issue.