Medicare/Supplement/Medicaide

[GreenSky]

Just found this on medicare.gov and it seems like medicare should pay according to this if hospice ordered the care.


Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility. If the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.

Let me suggest you find an expert on hospice. It's an unfortunate situation to be in.

Rick

 

[missgingerbgb12]

Thank you for your help.

 

[midwestbroker]

Hospice will not pay for room and board when it comes to care in a LTC facility, the same as they will not pay for the client's mortgage should they be living at home.

Respite care is used when a hospice patient is being cared for at home and there is a need (usually up to 5 days) where the family needs a break, the family can place their loved one in a LTC facility and the hospice provider can bill Medicare for the room and board. If memory serves, this can happen once per hospice benefit period (the go 90 days, 90 days, then every 60 days there after).

If they were on a skilled nursing bed (Part A benefit in a LTC facility) and go on hospice care, they will usually come off their Part A benefit and will be responsible for the cost of the room and board on their own. This is where I judge the LTC facility is suggesting the Medicaid spend down which can be back dated to the time of the application for room and board reimbursement.

Hope this helps...

 

[yogooglethis]

It was the long term care policy that the agent sold her when she first went on to medicare. I am not sure what one it was though. She went on hospice because there is nothing else they can do for her and basically just waiting to dye but from the way I understand if she would have refused hospice and medicaid, would medicare and the supplement still have to pay. I will look into the type of policy she had. Thank you for your response.

I don't think anybody can make her drop her med supp or life policies.some states will even pay the medicare supplement premiums for people on medicaid.Medicare pays almost everything for hospice services wherever needed including the nursing home facility charges for short stays under the Respite benefit ,if that is where the Hospice team determines the care is needed.Perhaps the nursing home staff that is helping her with her ICP Medicaid application to cover the facility charges for the days after hospice ends, if that happens, is recommending cashing in Life policies and transferring cash values to a burial trust for medicaid spend down reasons but dropping a med supp doesn't help with this.

http://www.medicare.gov/Pubs/pdf/02154.pdf


If the LTC policy had met the qualifications for State Partnership benefits I would definitely not have dropped it until further investigation especially if as others have suggested the policy had additional benefits such as a waiver of premium benefit.


Missouri Partnership for Long Term Care

 

[missgingerbgb12]

Hospice will not pay for room and board when it comes to care in a LTC facility, the same as they will not pay for the client's mortgage should they be living at home.

Respite care is used when a hospice patient is being cared for at home and there is a need (usually up to 5 days) where the family needs a break, the family can place their loved one in a LTC facility and the hospice provider can bill Medicare for the room and board. If memory serves, this can happen once per hospice benefit period (the go 90 days, 90 days, then every 60 days there after).

If they were on a skilled nursing bed (Part A benefit in a LTC facility) and go on hospice care, they will usually come off their Part A benefit and will be responsible for the cost of the room and board on their own. This is where I judge the LTC facility is suggesting the Medicaid spend down which can be back dated to the time of the application for room and board reimbursement.

Hope this helps...

Yes, this is what is going on. My question is how do we stop this? By bringing her home or refusing hospice. I also suggested that I would buy her life insurance policy instead of letting the funeral home keep the whole thing. I was told if she had refuse hospice medicare should still cover since she is still on dyialsis. I thought she could stay in the skilled facility for 90 days on medicare but we are being told she can only stay for 18 days on Medicare.

 

[wln417]

You might want to try calling your local Council on Ageing. (E or no e? I don't want to look it up.)

 

[missgingerbgb12]

Thank you , I am going to be researching how to get this LTC policy reinstated. If anyone knows of any thing that would help I would appreciate it as I am going to get my step mothers power of attorney and I also believe because she had a stroke she was not able to make correct decisions on her behalf and her daughter may have made the wrong move. Does anyone have any advise?

 

[goillini52]

Thank you , I am going to be researching how to get this LTC policy reinstated. If anyone knows of any thing that would help I would appreciate it as I am going to get my step mothers power of attorney and I also believe because she had a stroke she was not able to make correct decisions on her behalf and her daughter may have made the wrong move. Does anyone have any advise?

You need to call the company the policy is with and see what they say about reinstating it. I think most companies have a provision to prevent accidental policy lapse. John Hancock for instance may reinstate a policy within 5 months of termination if the policy lapsed because you didn't pay your premiums due to physical or cognitive impairment.

 

[missgingerbgb12]

She is getting both hospice and nursing home care for now. She is also on dyalisis for now which is confusing because she is choosing life and death at the same time.

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Also, she had a stroke and they did not make her cancel her LTC policy but her daughter did not think it was doing any good and felt ripped off so she canceled it in December.

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Also, I also do not understand why Medicare is not paying because she is in hospice, they should cover according to medicare rules but the nursing home says no.

 

[GreenSky]

Also, I also do not understand why Medicare is not paying because she is in hospice, they should cover according to medicare rules but the nursing home says no.

Medicare only pays for skilled care. I don't believe someone in hospice would be getting anything other than custodial care.

Rick