Anyone Knowledgeable Here About Medicare/Insurance?

She's a current patient, soon to be former. It's hard to not hear when she talks to Burnout or when Burnout cries on my shoulder (not literally). Being involved in all this mess, however unwillingly, is one reason I HATE private duty nursing.

And don't forget - Medicaid has a lookback period- 5 years is it? i don't quite know how that works. But if Medicaid thinks you transferred assets to someone else's name within 5 years, they can and do deny you coverage because they think you're hiding assets.

Thats not exactly true, I've done alot of training r/t and your patient should talk to an experienced elder law/estate planning lawyer. Also many people who go past the 100 days either self pay for additional services, or get services through the state.

I'm not sure what your role in this is: nurse, aide, family member... BUT if your role is through a facility or agency then your facility/agency HAS to ensure a SAFE discharge plan happens whether she be in the facility or her own home-can't just walk away and say good luck. So if she's a facility patient you need to speak out and raise your concerns, and if she's in her own home you need to let your agency know she's not safe and needs to be evaluated for home safety, which may involve reporting her as an elder at risk to EPS. Once reported they can often bring in additional resources. There are many options, including AFC/SL. But the most important point of this is she cannot be dc'd without a SAFE discharge plan.

Sorry but you really need to take a step back and look at your involvement in this. If you were a family member looking for help finding resources that would be different, but it sounds like you are working for the Home Health or Private Duty agency that covers her care. As such, finding her financial assistance is well outside your responsibility and your knowledge base.

While the lack of county resources is discouraging that doesn't make any significant difference in what your patient qualifies for as far as aid. The guidelines for that are set at both the State and Federal level. What she needs from your agency, not you, is a referral to the appropriate agencies/facilities/doctors from a social worker. If your employing agency doesn't have one on staff the state Ombudsman can assist with finding somebody to help guide your patient.

I am scared that the way our med care is handled here in America can cause people (like me, for instance) to become bankrupt, homeless. I want to know how to prevent this.

I have never crossed the line with this pt or any other, so everyone who is concerned about that can relax. I don't volunteer my time with patients, I follow the rules and ethics of our profession.

Like I said, though, this situation could easily happen to me or someone I love and I want to avoid it if possible. Cure for fear = knowledge. Perhaps I should have sought it more directly at Medicare.gov or something.

This is so true. I am dumb as a rock about health care insurance, medicare, medicade, etc. I am so lucky my husband was a social worker and has a good handle on that stuff.

Luckily, or stupidly, I grew up thinking social security, medicare, etc., was government aide for people who through misfortune ended up homeless, penniless, etc. I always assumed I would have to pay for any care I needed when I got old, therefore always put a lot of money into my retirement account.

Honest to goodness....I really didn't know for a long time that I would get money from Social Security when I retired! I thought social security money went to "poor" people.

This is so true. I am dumb as a rock about health care insurance, medicare, medicade, etc. I am so lucky my husband was a social worker and has a good handle on that stuff.

Luckily, or stupidly, I grew up thinking social security, medicare, etc., was government aide for people who through misfortune ended up homeless, penniless, etc. I always assumed I would have to pay for any care I needed when I got old, therefore always put a lot of money into my retirement account.

Honest to goodness....I really didn't know for a long time that I would get money from Social Security when I retired! I thought social security money went to "poor" people.

I think you are confusing Medicare with Medicaid, and Social Security with SSI benefits.

Every worker and the employer pay taxes (FICA) for Social Security and Medicare all their working years. Medicare recipients also pay a monthly premium for Medicare coverage. Social Security benefits are based on your employment earnings (and therefore indirectly how much FICA tax you and your employer paid in) over your past 35 years. Medicare and Social Security are therefore not just for the poor.

(Before someone jumps in, no you don't have an individual SS "account" that has your contributions in it, but you and your employer did pay FICA taxes which in theory were supposed to be for that. LBJ raided the SS fund decades ago, so now FICA taxes go into--and straight out of!-- the general treasury, but that's another story...)

Medicaid and SSI payments (what used to be called "welfare") are for those with little or no assets or income. I don't know the details of how benefits are determined, but I think they are what you were probably thinking of as being for "poor" people.

Btw, I don't think you were stupid for planning for your retirement at all. I did the same thing and am very thankful I did. No one gets rich from their Social Security benefit! It's better than nothing and helps, but is certainly no windfall. It wasn't meant to fully fund retirement.

Don't feel guilty about your Social Security benefit or Medicare; you and your employers have paid plenty of taxes and you are paying a Medicare premium each month.

I am scared that the way our med care is handled here in America can cause people (like me, for instance) to become bankrupt, homeless. I want to know how to prevent this.

I have never crossed the line with this pt or any other, so everyone who is concerned about that can relax. I don't volunteer my time with patients, I follow the rules and ethics of our profession.

Like I said, though, this situation could easily happen to me or someone I love and I want to avoid it if possible. Cure for fear = knowledge. Perhaps I should have sought it more directly at Medicare.gov or something.

You are wise to be proactive in regard to your future healthcare needs, but don't stress constantly about it. It seems your patient may be causing you to worry a little too much.

I've lived a long time, and I've never personally known anyone who became homeless, or even literally bankrupt, from healthcare bills. It may happen, but it's certainly not common. I do know a couple of people who are paying on their portion of a hospital bill monthly, but they are paying it just as they would any other bill.

Some people have to go into nursing homes, but that's because of their physical condition and isn't the same as being homeless.

As for yourself, many employers sponsor health insurance and/or offer other plans that help with healthcare expenses. Take advantage of those during your working years.

I'd also advise you and anyone to contribute to IRA's, 403b or 401k plans, or savings so that in your retirement years you have a source of income other than Social Security benefits, which were never intended to fully fund retirement. One of the reasons for having a nest egg is to provide for expenses such as healthcare expenses that aren't covered or fully covered by insurance or Medicare.

Medicare (for people over 65 and a few others) pays the bulk of most medical expenses if you choose a provider who accepts Medicare, and there is "Medicare Supplement insurance" that helps with or pays the deductibles and co-pays. There is also "long term care insurance" that will pay for custodial care for those who want to protect their assets.

For those with little or no assets or income, or who have had to spend their assets, there is Medicaid which pays for medical care and even pays for custodial care.

If you start planning now and make wise financial decisions, the chance is very good that you won't ever face disastrous uninsured healthcare costs. You will be able to get Medicare coverage when you are 65.

If your patient doesn't have to have skilled medical care or therapy, and doesn't improve enough to live alone, she will have to use her assets to provide custodial care for herself, unless a family member or friend is able and willing to provide her long term care. When her assets are spent, she can qualify for Medicaid and get custodial care. I don't think she will ever wind up out on the street because of healthcare expenses, nor you.

Social workers and patient reps advise on such situations all the time. Getting them involved is about all you can do. Please don't let this stress you out so much.

I would think that the SW would direct her to a local Aging and Disability Resource Center. ACL.gov may be helpful. We have a wonderful ADRC in my county. They handle the exact scenario you are describing; they work with the patient and figure out all the options based on the pt's finances and how to go about planning for LTC needs.

FYI, starting in January, Medicare advantage plans are going to have a non-skilled in home benefit like Medicaid (homemaker, aide, etc).

I am scared that the way our med care is handled here in America can cause people (like me, for instance) to become bankrupt, homeless. I want to know how to prevent this.

I have never crossed the line with this pt or any other, so everyone who is concerned about that can relax. I don't volunteer my time with patients, I follow the rules and ethics of our profession.

Like I said, though, this situation could easily happen to me or someone I love and I want to avoid it if possible. Cure for fear = knowledge. Perhaps I should have sought it more directly at Medicare.gov or something.

Sadly, people do become homeless and bankrupt all the time in our country due to their health care costs/debts. I work for a non-profit MCO and see it all the time. Our staff is frequently scrambling to find placement for frail elders losing their housing all the time. It really is frightening and my job has been a huge wake up call for me. Not that it needed solidifying before, but I'm doubtful anyone could work for my agency and not fervently believe we need universal health care in this country. It's so sad to see how people are reduced to absolutely zero assets at the end of their lives. So many literally have nothing at the end. It's just not right.

So sorry you are going thru this. I'm assuming she had a qualifying 3 midnight hospital stay prior to admission to skilled nursing facility. I work in a skilled facility as an MDS coordinator and occasionally we don't have people to heal as expected. Unfortunately 100 days is not always enough time to heal to get patients back to prior level. I'm glad you mentioned she has a secondary insurance. This is huge- many don't relize that Medicare only pays at 100% for the first 20 days. After that it's a 20% copay or usually secondary insurance will pick up. If she has exhausted her 100 days and truly can't afford, it may be worth applying for Medicaid. Medicaid-if approved will retro back to the date application was submitted. Or if she can afford to pay privately... even for a few weeks. While it's a lot of $ it may be worth investing the additional time for Care in the snf and continuing rehab under Medicare part B. I know Medicaid is probably not what anyone WANTS to do but especially if there is a spouse, etc there are ways to become approved even if there are sums of $ around. You may have a large spend down. Unfortunately if their (mom and dad) health is declining it may be worth spending down some savings if Medicaid will end up being the result! Best wishes to you all!!

You are wise to be proactive in regard to your future healthcare needs, but don't stress constantly about it. It seems your patient may be causing you to worry a little too much.

I've lived a long time, and I've never personally known anyone who became homeless, or even literally bankrupt, from healthcare bills. It may happen, but it's certainly not common. I do know a couple of people who are paying on their portion of a hospital bill monthly, but they are paying it just as they would any other bill.

Some people have to go into nursing homes, but that's because of their physical condition and isn't the same as being homeless.

As for yourself, many employers sponsor health insurance and/or offer other plans that help with healthcare expenses. Take advantage of those during your working years.

I'd also advise you and anyone to contribute to IRA's, 403b or 401k plans, or savings so that in your retirement years you have a source of income other than Social Security benefits, which were never intended to fully fund retirement. One of the reasons for having a nest egg is to provide for expenses such as healthcare expenses that aren't covered or fully covered by insurance or Medicare.

Medicare (for people over 65 and a few others) pays the bulk of most medical expenses if you choose a provider who accepts Medicare, and there is "Medicare Supplement insurance" that helps with or pays the deductibles and co-pays. There is also "long term care insurance" that will pay for custodial care for those who want to protect their assets.

For those with little or no assets or income, or who have had to spend their assets, there is Medicaid which pays for medical care and even pays for custodial care.

If you start planning now and make wise financial decisions, the chance is very good that you won't ever face disastrous uninsured healthcare costs. You will be able to get Medicare coverage when you are 65.

If your patient doesn't have to have skilled medical care or therapy, and doesn't improve enough to live alone, she will have to use her assets to provide custodial care for herself, unless a family member or friend is able and willing to provide her long term care. When her assets are spent, she can qualify for Medicaid and get custodial care. I don't think she will ever wind up out on the street because of healthcare expenses, nor you.

Social workers and patient reps advise on such situations all the time. Getting them involved is about all you can do. Please don't let this stress you out so much.

I'm not sure I agree with everything you said. You make it sound like getting into a nursing home is easy. It's not if you want a decent one and you're a male. That was the problem with getting my Dad into one, lack of male beds at a good place. And the place that he ended up in was rated decently but really wasn't that great. And you better hope you get in before you have to be on Medicaid, because nursing homes only have to have a certain percentage of beds for Medicaid patients, I think it's 10%. So they like to save empty beds for self-pay patients. And one full year here in Florida was $70K. And long term care insurance is showing to have some problems, not the least of which is how expensive it is. A lot of companies have stopped offering it and the number of facilities accepting it is limited. Unless you plan to commit suicide if you get very old and sick I think everyone (unless you're VERY wealthy) should worry about what will happen to them.

Nursing homes, Medicare, Medicaid, and insurance are all areas that might require a specialist to figure out. If your client does not have a sound-enough mind (or the patience, or the wherewithal) to wade through all of this, you can direct her (or better yet, your agency's SW can direct her) to n4a | National Association of Area Agencies on Aging (National Association of Area Agencies on Aging). They advocate for elder services and help with solutions to financial and legal problems for elderly people.

I agree with you that our country is lacking in elder services. In some states, simply signing over your paid-off house will get you into a (not-so-nice) nursing home; other states require you to pay your own way, even if you lack the resources.

In the meantime, until we, as a country, can fix this, there are organizations out there that offer free legal and financial advice for elderly people like your client.