Posts tagged 'Long-Term Care'
Every year in mid-November, enrollment for Medicare and Medicare Supplements begins. It can be a confusing time due to changes in coverage, changes in premiums and any fine print that comes along with the process.
Many seniors on Medicare are very worried about premiums going up for 2009. That is understandable, especially if a person is on a fixed income with very little or no wiggle room for extras.
The good news for 2009 is that the Centers for Medicare and Medicaid Services (CMS) has announced that Medicare Part B premiums, which cover some services that Part A does not cover including outpatient services, doctor services and other services. This means that any individual earning under $85,000 per year or any couple earning under $170,000 per year will pay the same Part B premiums that they paid in 2008.
Premiums are based on income so some premiums could be higher if you have a higher income. One important issue to think about is skilled nursing care, since Medicare and sometimes Medicaid will only pay for a specific amount of care. The care has to be administered after a minimum stay in the hospital and it also leaves a person responsible for part of the bill (currently at $128 per day) out of their own pocket after the first 60 days of care.
That is where it is important to look at additional care in the form of supplements, especially since Medicare will only cover 100 total days. Most seniors do not think they will ever need much care such as a nursing home or long term care facility, but statistics show that a high percentage of seniors spend up to 2.5 to 3 years in a nursing home or long term care facility between the time that they become eligible for Medicare and the time that they pass away.
So, during this time of the year while you can choose the coverage you feel is best, be sure to look at what is not covered and research options to fill the gaps.
Long term care has long been an important issue that needs to be addressed and has been debated many times. With Medicare and Medicaid systems under so much financial strain and with proposals in the works for revisions and provisions, it seems that Congress on both sides of the aisles is grappling with the issue of Long Term Care funding.
This is a serious issue, as it affects millions of individuals and their families and over 10 million individuals who are living at home and receiving services in there homes and in the community. These people need assistance and services and are normally on a very limited income, being cared for by family and friends. They are often in situations where they are trying to stay at home and in the community in which they live, receiving their supports there, rather than ending up in an assisted living or long term care facility.
It has been shown that when a person can stay in the community and in familiar surroundings receiving long-term supports that is the best situation for them if their situation and condition permits. Congress – and other organizations – is looking further into the cost savings and health effects of helping people stay in the community vs. a healthcare facility. There are various studies that have taken place and are taking place – especially in the recent past and currently – trying to determine to continue to fund the essential service of long term care.
With Congress presently looking at ways to buy time so that Bush Medicare cuts - which affect Medicaid drastically – won’t take place immediately, there is a good chance to work on long term care issues at the same time.
In the meantime, if you are dealing with long term care issues, be sure to keep current with what is happening. For current information you can log into www.CMS.gov.
Once again, President Bush’s attempts to save and/or move money around are being called “ill-considered” and “a serious detriment to seniors and long term care.”
Bush has proposed $770 million in cuts to Medicare A national nursing home funding cuts scheduled to take place in a few weeks. Not only is the bill considered harmful to seniors, even Mike Leavitt, Health and Human Services Secretary and key members of the House and Senate are working hard to garner opposition to these cuts.
The consensus is that the Bush Administration’s proposed cuts will drastically and negatively affect high quality skilled nursing care for seniors. There is also extreme concern that reductions of this magnitude will severely diminish access to nursing home care and compromise quality of care received by the nation’s seniors.
In addition, there are studies and reports by the American Healthcare Association and Alliance for Quality Nursing Home Care showing the economic impact of the proposed Bush cuts. Not only would they compromise access, quality and care, they will also have a net negative economic impact of $4.5 billion for 2009, approximately $1.8 billion in lost wages, 43,530 lost jobs, and $661 million in lost federal, state and local taxes.
“In the final analysis, the Administration’s ill-considered change to Medicare policy would have unfortunate results for patients, taxpayers and the Medicare plan itself,” was the comment by Patty Cullen, President of the Care Providers of Minnesota. Leaders from South Dakota, Maine, New Hampshire and other states have explained in various ways that because nursing homes rely on Medicare reimbursements, these cuts would have a visible and devastating effect on state Medicaid programs.
Whichever side of the issue people are on, it is good that both sides are being revealed and it would be good for all sides to truly study the situation – and the information from all those who are making points about how this could seriously cripple nursing home services to seniors. It is important to explore the facts before it is too late.
When elderly individuals go into along term care facility or a similar facility and self pay, the cost can be astronomical. Making sure that the person is comfortable, well cared for, in a clean environment and positive atmosphere is not a low budget issue. What happens, though, when a private pay individual converts to Medicaid?
Well, one would think that because all of the payments are now guaranteed, albeit possibly lower, that these facilities that have been raking in money from these individuals and their families, that they would leave grandma, grandpa or aunt Minnie in comfort and without worry without changing a thing.
Unfortunately, this doesn’t always happen. In fact, there is an investigation taking place in New Jersey regarding the company Assisted Living Concepts, owner of eight assisted living homes in southern New Jersey. The investigation was started by the Public Advocate for the state, who has filed papers against the company because of their alleged practice of discharging the elderly when they change from self pay to Medicaid.
Public Advocate Ronald K. Chen is asking for the names, admission and discharge summaries, as well as contact information for every resident of the company who is or has been a Medicaid beneficiary.
Chen says that the investigation was sparked because there is an indication that this company “is placing elderly vulnerable residents at risk by displacing them from their homes in violation of ALC’s state license. Our primary concern is to protect the safety well being and peace of mind of these residents.”
The representative of Assisted Living Concepts, Laurie Bebo, who is also the CEO of the company, refuses to cooperate with the subpoena and states that the company does not have any Medicaid conditions in their license; therefore, they do not have to honor Medicaid patients.
Chen says that state licenses for all eight facilities stipulate that at least 30% of the residents of each of the facilities are to be Medicaid eligible and no resident would be discharged because or if they spent all their money.
Assisted Living Concepts operates more than 200 assisted living residences in 17 sates, containing more than 8,000 units, so this is no small issue. New Jersey may just be the tip of the iceberg.
Understanding how Skilled Nursing Rehab works and where Medicare fits in is extremely important. There are a lot of facts that can affect your situation and create some serious issues for you if you or someone in your family needs this type of care.
The way Medicare handles Skilled Nursing Rehab is that the original Medicare plan pays 100% of the first 20 days. Most of the time, if there is any improvement that the facility can say is enough improvement; Medicare will try to have you discharged within those first twenty days.
After the first 20 days, the Medicare beneficiary pays $128 and Medicare pays the remainder of the day’s bill for up to 100 days. Looking at these figures, this is where supplemental insurance becomes very important. This could be a Medigap/Medicare Supplement plan or it could be an employer retiree plan. This type of plan will pay most or all of the $128 per day out-of-pocket expenses that are your responsibility.
Because Medicare is a health insurance plan that provides medical benefits, in order to receive those benefits, they have to determine that there is a medical need. If you are in a medical facility or skilled nursing rehab center, Medicare has determined the need, they will pay their share, however, when your condition improves, they will not continue to pay.
Sometimes and individual or family does not agree with the decision that the person is ready to be released even though that person has improved. If that happens, it is important to very firmly and specifically relate your concerns to staff, the social worker, the doctor and the social worker. If the person has had a stroke and is still unable to get in and out of the house safely, still have severe balance issues or other barriers, specifically let the facility and all the individuals we mentioned know.
Regardless, it is very important to study the issue of Skilled Nursing Rehab and Long Term Care very carefully. Take the tie to do some research on the net, through your doctor and even at your local hospital and find out what good policies are available and how they work. Be prepared so that if you or your family is ever in the situation where you need this type of coverage, you will be ready.
The New England Journal of Medicine recently released an article regarding the place that Long Term Care will play in the future. Because it affects such a large part of the population, it is an important topic to tackle.
The article brought out that there are serious flaws in the long term care system and that these flaws expose the people who need the care the most to serious financial risk. How will those who cannot afford the financial risk be able to be taken care of? That is an important question that has not been addressed enough – even by the candidates that are currently running for office.
For now, of the nearly 10 million individuals who need assistance with daily living, most live at home and receive assistance from their family and friends. Because most Americans enter retirement without large sums of money set aside, they must be quite frugal regarding day-to-day living, much less money for extras, including medical care – especially long-term care.
State governments are struggling with the funding of long-term care through Medicaid. As costs for long term care get higher, Medicaid works to keep up the best it can, but with current flaws and no definite solutions in sight, Medicaid could very likely buckle under the strain
In addition, when Baby Boomers are factored into the equation, the picture becomes even more abstract. The solution is not cut and dried, nor is it an easy one. As we look at the legislators who will take office after the elections, it will be important for them to look at the issue of long-term care and raise awareness about it. There has to be a long look at where Medicare and Medicaid fit into long term care and acute care, as well. New approaches must be explored.
Most importantly, though, the discussion needs to begin and the questions need to be asked This should all be done in earnest with open minds truly looking for realistic answers to this situation.
Keep your eyes on the news and check with www.medicare.com and www.medicaid.com and AARP. Make sure you know what your situation is with regard to long-term care and your Medicaid or Medicare benefits.
