216-346-7002 BG@BradleyGreene.com

What's the difference between Medicare and Medicaid?

by | Jun 24, 2016 | Elder Law, Life Care Planning, Medicaid Planning, Medicare

The world of health insurance is a complex one, even for those of us who work in it every day. So it’s no surprise that many seniors and their adult children struggle to make sense of all their insurance options. It can be overwhelming to try and determine what services are covered and what coverage you are eligible for. Two of the most frequently confused programs are Medicare and Medicaid. In fact, some people aren’t even sure which one they have!
The following information should clarify several major differences between the two programs and help you understand when/how/if you may be eligible for benefits.
Medicare is a national health insurance for Americans over the age of 65 and the disabled. This is intended to pay for standard medical care and short term nursing care or rehabilitation. This is a federally funded program and benefits are the same for everyone (based on which Medicare plan you are registered for) regardless of what state you live in.  Medicare DOES NOT cover the cost of long term, custodial, residential, extended nursing home or assisted living care.  The video below explains in more detail each type of Medicare coverage and you can review options here for how to select care based on each person’s needs and finances.
Medicaid is a cooperatively administered health insurance program supported by both federal and state funding. The guidelines and benefits for Medicaid will differ depending on where you live. In the state of Ohio, Medicaid insurance covers nursing home, assisted living and long term care for seniors and disabled adults or children. In order to be eligible for Medicaid in the state of Ohio, a senior has to demonstrate an ongoing need for medical care or health care services in which the costs exceed his/her income.
Medicaid is not a guaranteed benefit. You have to qualify and apply for coverage based on income and assets. In some situations, such as when one spouse stays in the community, you do not have to exhaust all of your financial resources in order to apply for Medicaid. Planning ahead with the assistance of a qualified Elder Care attorney can make completing a Medicaid application easier when the time comes.
For more information about Trusts and Estate Planning or for assistance with a Medicaid application. Please contact our offices. For more information about your Medicare options, please visit Medicare.gov or contact one of our Care Coordinators who can direct you to local resources.

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What is a Continuing Care Retirement Community?

by | Jun 16, 2016 | Aging, Cleveland, Elder Law, Life Care Planning, Medicaid Planning, Medicare

Aging in Place: A person can spend the rest of his life in a Continuing Care Retirement Community, moving between levels of care as needed. Continuing care retirement communities are retirement communities with accommodations for independent living, assisted living, and nursing home care, offering residents a continuum of care. 

With all of the options in senior living, it can be overwhelming to decide what type of care is best for you or a loved one. From nursing homes to assisted living and senior apartments – there are many different levels of care to choose from and not all retirement communities offer the same variety of services and support.
The main thing that distinguishes a Continuing Care Retirement Community from a traditional nursing home or assisted living facility is that they provide multiple levels of care at one geographic location. This typically includes long term care, skilled nursing care, assisted living and senior apartments. Some communities also have private homes or condos on the same campus for truly independent living within the larger retirement community.
There are a couple of situations in which this type of setting is ideal for our clients:

  • For married couples in which one spouse is healthy and independent while the other person requires nursing care. Each person might receive different levels of support within the same community.
  • If you/your loved one requires more care in the future, they can stay within the same care system and be cared for by familiar staff. This is particularly helpful when rehabilitation is necessary – residents can go to the skilled nursing unit for therapy, or a brief stay and then return to assisted living or senior apartment afterwards. Residents of the community often get priority placement in facilities where a rehabilitation bed might be hard to come by.
  • In cases of dementia, this limits the need to introduce your loved one to a completely new place and entirely new staff if/when dementia progresses. Moving within the same community might involve less of an adjustment than moving to an entirely new facility.

It may also be easier for you/your loved one to receive additional care and services in a senior apartment (and stay there longer) if you live within a system that has a lot of services for residents with higher needs. For example, you might be able to have meals delivered because they are connected with a full service kitchen, etc. Or therapy services can be provided in independent apartment by staff from the Occupational and Physical therapy departments.
Like other residential care settings, there are a variety of ways to pay for the services and support of Continuing Care Retirement Communities. Some services on a private pay basis, while long term care insurance, Medicare and Medicaid may pay for others. Often, there may be wait lists for senior apartments in these type of desirable communities – so planning ahead can be helpful. Some of our clients place their name on a wait list long before they plan to move, even years ahead of time.
For additional information about Cleveland area Continuing Care Retirement Communities, please contact our Care Coordinators. We are happy to provide support and guidance through each stage of the search and decision making process and help you determine the best plan for your personal needs and financial situation.
 

Medicare Demystified: Understanding Observation Status

by | May 12, 2016 | Aging, Cleveland, Elder Law, Medicare

Over the last several years, many unsuspecting seniors and disabled persons have been opening the mail to receive large bills for health care procedures and medications they assumed were covered during a recent hospital stay. Even worse, some patients have transferred to rehab after a hospital stay only to find out their skilled nursing care wasn’t going to be covered and they would be billed at a cost of over $400 per day for care they needed to recover from an illness or injury.
These situations are both a result of a technical, financial loophole in Medicare billing called “Observation Status” – and thankfully, as of August 2016 hospitals will be required to notify patients in writing if their stay is not going to be covered, so there should be less surprises in the mailbox.
But that doesn’t make the billing issue any easier to understand, and it doesn’t ensure that people who need hospital care will be able to afford it. Here are a few of the key points you need to know about Observation Billing, Medicare Part A/B coverage and Skilled Nursing Rehabilitation.
Outpatient Services – Covered under Medicare Part B (Outpatient Insurance) includes medical services that are typically performed in the community such as doctor visits, lab work, x-rays and some home health care.
Observation Status – If the hospital determines that they are “watching you” overnight or collecting information to determine an accurate care plan and diagnosis, then you are probably being admitted under “Observation Status.” This means that any medications and services provided for pre-existing conditions will likely be billed under Medicare Part B, probably at a much higher rate than anything you would pay if you were getting those same meds from a local pharmacy.
Inpatient Hospital Services – Covered under Medicare Part A (Hospital Insurance) and includes all hospital services, including semi-private rooms, meals, general nursing, drugs as part of your inpatient treatment, and other hospital services and supplies. This includes the care you get in acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, long-term acute care hospitals.
Qualifying Stay – This is the Medicare requirement that says in order for someone to have Skilled Nursing Facility (SNF) rehabilitation covered under Medicare Part A, he/she must be admitted to an INPATIENT hospital bed at midnight for three nights in a row. The tricky part is that if the hospital is billing your stay as OBSERVATION status, then you don’t qualify for the SNF benefit coverage.
How to reduce the costs of care:

  • If you are being admitted under observation status, ask the hospital staff if you can bring in medications from home. Cleveland Clinic and University Hospitals both have policies in place regarding this process. This can drastically reduce the expense of Outpatient/Observation Care because medication is often the highest part of bills that patients receive.
  • You also have a right to question your bill. Errors are not uncommon, and rates are often negotiable for patients who are willing to pay their bill in full. Don’t hesitate to contact our Care Coordinators if you need help navigating this process.
  • Finally, if you need rehab, but a SNF stay isn’t going to be covered, consider going to assisted living or supportive senior apartments where there is staff to help you. The cost of these will be lower than paying privately for a bed at rehab facility. Your doctor can then order Home Care services for nursing care, home health aides and physical and occupational therapy which can be billed under Medicare Part B at a much lower out-of-pocket cost that nursing home care.

There is still much work that needs to be done in order to avoid burdening seniors with the expense of care under the current Medicare guidelines and legislation has been put forth by Senator Sherrod Brown that would allow Observation Status to be considered a qualifying hospital stay for skilled rehab benefits. He presented this bill with the support of many Cleveland-area hospitals and nursing homes including Cleveland Metrohealth and Menorah Park, but the Improving Access to Medicare Coverage Act has not received the congressional support it needs to become law.