Post WWII Truman had a plan for national health care. It was shot down by the AMA, fearing too much federal control over physician practices. When Harry Truman Pushed for Universal Health Care - HISTORY
Then in 1973 Nixon signed into law The Health Maintenance Organization act, which tends to be thought of as legitimizing profit making in health care.
The profit motive, especially in long term care is despicable. Barebones staffing, inadequate food, on and on. But facilities look nice!
@HImom ā¦I think you have this on the wrong threadā¦
tbf, individual State insurance commissioners are also against losing their clout and lobbied Congress to maintain their control during the ACA discussions. (part of the tribal warfare)
Do you know how many days are covered in Skilled Nursing facility. I was made aware that our Basic Blue Cross Blue Shield doesnāt cover SNF next year.
SNF are only covered if they are not custodial care. IOW, usually they arenāt covered unless some rehab is associated with the stayā¦at least that is my understanding.
Yes, thatās my understanding, one of my relatives did stay in such facility for a long time. This is just in case. Iām debating in switching to GEHA, but my husband said to leave it this year. This is his retiree insurance in addition to part A and B.
Skilled nursing (custodial) is covered by Medicaid if assets go below, I believe, $2k. There is a five year ālookbackā period so that if someone gives all their money to a child, for instance, to qualify for Medicaid, it has to be five years before entry in the SNF.
I wasnāt thinking about custodial care, just a case of when you fall down ill and you need nursing home for whatever reason.
Thatās usually considered rehab, and that usually is covered by Medicareā¦so long as the person was hospitalized firstā¦I think for three days. Someone would need to verify this!!
If someone falls or something like that, and needs rehab and some care to get back up to steam, I believe that is covered.
There are a bunch of requirements for it to be covered. You have to be a hospitalized patient for like 48 hours (not just in the hospital, you have to be correctly classified). There are more requirements as well that the discharge planner should cover. I believe coverage is for up to 60 or 90 days if you continue showing progress.
Checking possible āmedigapā or MA policies for skilled nursing rehab care coverage post a Medicare qualifying hospital stay can be important. I believe Medicare has coverage for up to 21 days and have seen Medigap policies that cover up to 100 days. If more than 21 days in rehab is necessary, the coverage can be very helpful; worth doing a cost benefit analysis. A stay qualifies for a direct transfer to rehab after a 3 day hospital stay that is not considered āobservationā and a determination that a person can actively participate in rehab. Check early to be clear how the hospital is classifying the stay. It is not always obvious.
Suggest taking advantage of local and state resources to understand Medicare options. It is extremely complicated and it is easy to have a bit of info out of context. States can vary in options also.
Thanks, @HImom. Missed your post. Some documented progress during rehab over time is necessary for coverage.
Thereās a thread about this from Bogglehead Forum.
https://www.bogleheads.org/forum/viewtopic.php?t=391679
I thought Iād update this topic.
My mom recently fell and need to be hospitalized and moved to rehabilitation center.
The business office and administration department were very pleased that mom had a supplement plan and not an advantage plan.
When you have a supplement, you can be admitted to the rehabilitation facility right away. With an advantage plan, you need to be approved. My mom had no issues and was able to get the help she needed right away. No pre approval.
Last year mom looked into an advantage plan as it would have been cheaper. Everyone in the family was happy that she didnāt.
Just another data point on the differences.
Medicare covers 20 days in rehab. Her supplement covers 100 days total. 80% coverage until she meets her deductible which is $1500, then they cover 100%
Mom had a stern talking to that she be compliant and work hard in rehab or they would kick her out.
Medicare required a 3 day stay in the hospital before she could find a placement in a rehab center
This varies by Advantage plan. My plan does not require pre-approval for this.
But as Iāve saidā¦my advantage plan is with a very very very large group who negotiated some extra things into the contract.
Iām glad this worked out for your mom @deb922
I just wish folks wouldnāt assume that what applies to one Advantage plan applies to all of them. Thatās just not true.
My point was that the center was relieved that she didnāt have an advantage plan.
I have no idea if some advantage plans do not require pre approval. Just that finding a placement wasnāt easy and the center was happy not to have to deal with an advantage plan.
Other plans may be different. As I said, this is a data point of one. Everyone should explore these things when picking their plans.
As I understood the business office, most of the advantage plans do require pre approval. If yours doesnāt, then you are very lucky. We are very lucky that my mom choose a plan that has low costs for her when she had a catastrophic incident.
one of my many jobs that Iāve had since I started working at my company out of college was as a licensed agent. I was licensed in all 50 states, but let them lapse over 10 years ago when I changed roles. Itās really interesting to be reading this thread from a consumer perspective.
Insurance, even medicare, is state dependent. Different things are covered in different states.
I turn 65 in 2023. I get mail about seminars and coverage every day in the mail. All of them claim to have the perfect plan for me. I sure hope so!
And I can say that my good friendās husband, who has the same Advantage plan that my husband does, had no problem getting back surgery out of state or additional therapy when he got back to Maine. He has other significant health issues, including diabetes, and has been very happy with the plan.
Me tooā¦on all counts!
The list of covered services is the same everywhere. Medigap, enrollment windows, etc. can vary by state. Certainly what we as providers are paid varies by region. From the patientās perspective, Medicare A and B are the same in all 50 states.