20 Day Skilled Nursing Reset by Changing Maps Plans?

keith365

Super Genius
119
I have a woman who has qmb, who will soon have to pay $150/day for skilled nursing. We know that the insurance company will pay the first 20 days. Could she get a new 20 days by switching companies?
 
I have a woman who has qmb, who will soon have to pay $150/day for skilled nursing. We know that the insurance company will pay the first 20 days. Could she get a new 20 days by switching companies?

No, that's regulated by Medicare, not the insurance company. Remember, the Supplement will only "supplement" what Medicare approves and pays.
 
No, that's regulated by Medicare, not the insurance company. Remember, the Supplement will only "supplement" what Medicare approves and pays.

I believe OP is referring to MAPD, not Medigap.

I find it interesting that the MAPD does not cover in full days 21-100. Is this normal exposure on MAPD plans in general? Curious.
 
To the best of my knowledge the answer would be YES..............

MOOP is for medical and TROOP refers to Part D

BTY....what is her MOOP?
 
If you live in Ohio, and you are entitled to Qualified Medicare Beneficiary (QMB), the State of Ohio thru QMB pays all "covered" Medicare expenses including the per day copay. Is she on Medicare or an MAPD plan. Most MAPD plans mirror Medicare's coverage for skilled nursing home stays. Is there a Dual Eligible SNP in her county? She should be on that. Not much value to MAPD for someone eligible for QMB, unless they are on a DE SNP.
 
Last edited:
Back
Top