When choosing a Medicare plan or buying supplemental insurance, make sure you understand what is covered and tailor your plan and insurance to your specific needs and circumstances.
One way to avoid mistakes is to learn from the experience of others. Here’s an opportunity to learn from one of my clients.
I have a client whose husband was in a Skilled Nursing Facility (SNF). When asked how she was paying for his care, she said that Medicare and her supplemental insurance were paying for it. This seemed like a reasonable explanation since Medicare will pay for the cost of care in a SNF, if her husband had a 3-day stay in the hospital prior to entering the facility, and if he continued to need skilled nursing services. However, I knew that Medicare would only pay the full cost of care for the first 20 days; after that, Medicare would pay part of the cost for an additional 80 days, with a $148.00 copay per day.
My client’s husband stayed in the facility for the full 100 days. Time passed and a bill came from the SNF. When the bill was substantially more than my client anticipated, I called the SNF and learned the following: My client did not have Medicare and a supplemental insurance; instead, she had a Medicare Advantage Plan. Medicare Advantage Plans fall under Medicare Part C and include some types of managed care plans to provide Medicare benefits. There are four different plans available under Medicare Part C. Each plan has advantages and disadvantages in the services and coverage offered. We learned that while some supplemental insurances will pick up the copay for care in a SNF, the plan that my client had did not completely cover her husband’s care.
When buying Medicare supplemental insurance, make sure you understand what it covers and tailor your insurance to your specific needs and circumstances. If you need help understanding Medicare, SHIBA (Senior Health Insurance Benefits Advisors) provides free assistance in understanding the complexities of the Medicare program. You can contact SHIBA at 1-800-488-5764 or go online at www.shiba.idaho.gov. An attorney experienced in handling Medicare and Medicaid questions can also help you.