July 27, 2018

Your Advocacy

By Kathy Nitz
GolderCare Solutions

Benefits: Insurance, Medicare and Public Entitlements

It is all so confusing!

Normally when we go to the hospital, we are facing a health crisis and who is paying for it is not the first thought in our minds. We just need to feel better and interacting with the healthcare staff is primary. However, money is a primary thought of the healthcare facilities. You know when you go to the doctor and check in, the first question they ask is for a copy of your insurance card and a check for the co-pay. When you register at the hospital, the first thing they ask is about your insurance – not you.

When we are talking about long term care, the rules of the game change significantly. It is a common misconception that health insurance will pay for the nursing home. Not so. Let’s talk about the different options for payment and some of the rules.

Insurance. Medical insurance pays for medical care. While long-term care in a nursing home is often thought of as medical care because there are nurses and nursing assistants, it is not covered by medical insurance. Sometimes short-term rehab can be covered under certain circumstances with certain insurance policies. It is important to know what your policy covers and when. Never assume.

Medicare. Medicare is a federal health insurance. Medicare is changing and the rules keep changing circumstances. There is the traditional Medicare Parts A & B, drug insurance which is Part D and then the replacement or advantage plans which are Part C. It is important to know what you have and how they pay and when. When discussing long-term care, it is a common misconception that you automatically get 100 days of nursing home care under traditional Medicare. Not always. There are qualifications that must be met, and you need to be aware of those qualifications. Part C Medicare comes in all sorts of policies with different companies. Know what you have and how they pay. Bottom line, Medicare is not an option for long-term nursing home care.

Public Entitlements. Medicaid. Medicaid will pay for long-term care. Medicaid is a federally funded program that is controlled by each state. Each state has its own rules and regulations. We are very lucky here in the Quad Cities area that we have fine facilities in both Iowa and Illinois from which to choose and take advantage of the state’s rules that most benefit us. However, the states do not make it easy to get qualified. Medicaid is a benefit that you are “entitled” to once you meet the qualifications. The states make it so complicated and put up so many hoops to jump through that often people give up and don’t receive the benefits they deserve.  I happen to be at a nursing home last night when one of the families came in. They were thrilled that they got their Medicaid approved in just 18 months!!! They didn’t even look at the numbers to know if it was a right decision. Can you imagine dealing with the State for 18 months just trying to get your loved one the benefits to which they are entitled?

When facing long-term care for a loved one, you need to have the advice of an independent advocate that can look at your options and help guide you to your best solution. There are so many considerations that “one size does NOT fit all”!  Although many insurance people know a lot about insurance and what to sell you, they don’t know all of the many pitfalls of long-term care and Medicaid of which to be cautious. It takes an advocate to pull all of the aspects together and know which is right for YOU.

Please consider joining us at our August Empowerment Series, Benefits: Insurance, Medicare and Public Entitlements.  Learn about how understanding your insurance and entitlements can help optimize your savings options and add quality of life.  Wednesday, September 12, 2018, 10 to 11:00 A.M. – GolderCare Solutions Education Room, 1900 State Street, Bettendorf (across from Waterfront Convention Center next to Hardees).

Kathy Nitz is Lead Benefits Advocate for GolderCare Solutions. She uses her wealth of knowledge and experience in benefits planning to help seniors and those who are disabled. You can reach GolderCare Solutions Unlimited, LLC at (309) 764-2273.

Filed Under: Community, Health & Wellness, News, Retirement

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