Medicare Experience So Far

My mom has Interstitial lung disease and 5 % breathing capacity due to scarring. She was in the hospitial 2 weeks and medicare initially turned her down to go to rehab. The pulmonologist called United Healthcare to do a pier to pier review in which her Pulmonologist told the medicare Dr that she was unable to go home and take care of herself. ( cannot walk, bath or open a water bottle) Medicare denied this appeal from the Dr. So we did a family appeal and they granted her 2 weeks in rehab. After 10 days of rehab the case worker communicated with medicare to tell them she needed more time. DENIED! My sister appealed over the weekend and was granted the appeal. Medicare just called to tell us that they are turning over the appeal and it is DENIED and her release date is tomorrow. My mom is staying and paying!!!! These are all facts and not opinion, fortunately mom has a little savings to take care of herself. This has been my experience with government healthcare and I am keeping my opinions to myself, with the confidence that I do not need to write it out. I hope that we are unlucky, but fear that is not the case.

Sorry to hear that and thanks for sharing.

Won't be surprised when we see euthanasia offered as an alternative.

no es bueno

Dangit man

This sounds like a situation where they’re rationing care which is necessary and reasonable in both private and government healthcare. Can you look into another avenue to get care such as home care? It may cheaper for Medicare which could result in approval.

It’s hard to get the full picture because your grammar is terrible and there’s private details you shouldn’t share.

My experience is that if Medicare denies it, the Doctor's office plucked it up. Luckily I just call rhe VA and I am back in business.

People like to dump on the VHA because it’s evil government healthcare, but they’ve been great to me. I Just had ACL reconstruction surgery through them and the experience was smooth.

Going thru the same thing

Yall are both in many of our thoughts and Prayers gentlemen.

If United Healthcare is involved, it is not Medicare. It is a Medicare replacement.

Sorry about your mom.

Really sucks that such a good family is being run through the wringer. Ramsey your mom is still in our prayers.

It really sucks that Medicare is putting a few bucks ahead of someone's well being. I had a similar experience with private insurance.

That has to be real tough to deal with, prayers sent!

Sorry you are still having troubles Ramsey. Your mother is in my daily prayers.

Depends on which carrier you use.

It sounds to me like she has a Medicare supplement policy with United. If that is the case then Medicare is the primary insurance and typically would pay for 80% and United is the supplement and typically would pay for the other 20%.

It must be Medicare who is refusing the rehab -

Sorry about your sweet Mom Ramsey.

Medicare is great........till it's not. it gets very confusing.

X3 Sorry to hear this Rams

My mom had a stroke back in 2020 and United Healthcare would only approve 1 week of rehab. It was absolutely infuriating trying to deal with them. I do not envy you sir.

Our frustration has been the process. When 3 Drs tsking care of a patient communicates to Medicare that the patient needs another week and there is no way she can go home. They denied it anyways.

Ramsey, Does she by chance have Medicare Advantage or regular Medicare plus a United Healthcare supplement?

I'm curious because I've been on regular Medicare plus a supposedly good supplement for just over a year and luckily haven't even used it except for one ear exam. When I was signing up everyone I consulted told me do not get Medicare Advantage. Even my regular doctor's office strongly hinted that message as well. I think they have to be careful what they say.

More than likely it is a Medicare Advantage plan and not a Medicare Supplement plan. Different rules for the two different plans.

This is most likely a medicare advantage plan through united healthcare. Those are really decent plans up front but they suck for some things, and rehab must be one of those things that they suck at.

Regular medicare does have a limit to rehab as well, but with regular medicare if the dr requests it, it is done. There will be co-pays and 20% that isn't covered (possibly secondary insurance will, many times it doesn't), but medicare is actually pretty decent with end of life type care. The medicare advantage plans are not typically good for end of life care, and I have said for along time they are generally good as long as you are healthy but if you are a sick person (Interstitial lung disease is not a healthy person) then a advantage plan is not for you.

I am sorry for the problems your mom is having ramsey. One option, not a poopular option, but if she doesn't have much money or assets, is to let her get medicaid as well and then she can use that coverage or it can at least help. Some hoops to go through to get that, but it may help. Of course then you are dealing with medicaid facilities and those aren't always the nicest, let alone the best...

Mom is part of Teacher Retirement (TRS) she is on Medicare Advantage that is managed by United Healthcare.

Like a Ladybird deed?

Most likely this is the case - I have posted here many times about Advantage plans - premiums are either very little or nothing and the plan is great until you file a claim - sorry to hear you are going through this

Sorry to hear this issue. My wife is also retired from TRS and in the same plan. And I will be also in 3 years.

I don’t know what that is…

A "Lady Bird" deed is a nickname for an enhanced life state deed. It is named after Lady Bird Johnson, because allegedly President Johnson once used this type of deed to convey some land to Lady Bird.

The MEDICARE ADVANTAGE PLAN is a supplement plan. If possible get out of it at the first possible second.

Look up Enhanced Life Estate Deed. And whatever you do don't trust websites with free or $19.95 deeds. If you want to go this route call up a title company that you may use because they are the one that has to issue a title policy. Ask them for the attorney that they recommend to write this deed that they will underwrite.

This works in Texas now, but the future isn't guaranteed. It is a Medicaid planning tool to keep a home, and possibly other property, immune from MERP, Medicaid Estate Recovery Program.

Almost amateur info here, but from what I've learned is that the vast majority of nursing home residents are on Medicaid. To get there they have to "spend down" their assets to a low minimum. Their homestead, minimal funds, maybe a car, is exempt.

I know of families that received a letter from Medicaid VERY SOON after the passing of a Medicaid recipient. It went something like, "Sell this home now and send us the proceeds."

If that home had been put into this Enhanced Life Estate Deed beforehand it bypasses probate. I think at 12 midnight of the passing the heir of that home is the owner, zip and done.

Don't let Google send you down some rabbit hole of BS ads for cheap useless docs. Just call a title company, tell them what you are interested in doing, and what attorney do they recommend. And whatever you do, don't even call a so-called "Medicaid Planner." I sat through a session of a BS presentation. They basically played a shell game that ended with them selling me an annuity.

Luckily, we never even got to to the point of needing Medicaid in the first place.

Not true at all. A medicare advantage plan is a medicare replacement with very defined enrollment and dis-enrollment times. It is also not what is known as a medicare supplement, or secondary insurance to medicare. When you sign up for a medicare advantage plan you do not get to use regular medicare for that enrollment period (usually one year) and you have to comply with the policy terms of the advantage plan.

Many times there are very easy to find disadvantages for medical advantage plans (yes, it is kind of funny considering the name) and most of those will come in the very expensive things that cost medicare a lot of money where the advantage plan limits coverage of those things. These plans originated as a way to save money for the govt by getting people off regular medicare and these plans heavily market with lots of gimmicky things to attract people to enroll, but they feel the pain when they get really sick. The worst of it is when the people don’t have a choice because something like the teachers union tries to save money on healthcare costs by giving crappy plans. Sorry ramsey and ramsey’s mom

No, it is not a standardized Medicare Supplement plan. The standardized plans are plans A through J and if it is a standardized plan no manner who the company is that sold it or what state it is in the coverage is the same only the premiums will vary. With a Medicare Advantage plan what the plans offer can vary between the companies.

The difference with a Standardized Medicare plan is that when a claim is submitted it is submitted to Medicare first and then it is submitted to the Supplement company and you will receive a “EOMB” explanation of Medicare Benefits With a Medicare Advantage the clams is submitted to the MedicRe Advantage company and not to Medicare and you will receive a letter from the Advantage company showing how much went towards your deductible and how much they paid.

Advantage plans will have stuff like Silver Sneakers which is discounted gym membership and other gimmicks. A true Medicare Supplement plan doesn’t have any of that crap and is pretty simple if Medicare pays the plan pays.

I may be wrong on this but it is my understanding that what the insurance companies did was they went to Medicare and said hey we have this Advantage plan that we want to sell and it will cost you Medicare less. So no claims are submitted to Medicare and in return Medicare pays to the Insurance companies the Medicare premiums for the Medicare beneficiaries. This way the cost to Medicare is lessened and therefore the insurance companies say what benefits are payable.

I don't deal with much Medicaid as a health administrator, but from my understanding, it's where the person needing coverage deeds their assets to a family member to hide it from Medicare. It makes it look like they don't own as much.

Called him out on grammar and now this lol.

If you are ever in need of Medicaid the first thing you need to is get in touch with a Elder Care Lawyer they know all the ins and out of Medicaid. There is a five year look back period that Medicaid will do to see if monies have been given away or property has been transferred and this can keep a person from qualifying for Medicaid.

A spouse is allowed to keep a residence, a vehicle, their retirement plans, Social Security, and so much savings. However, the splice can not keep their spouses retirement plans, Social Security, and transfer monies that was in their spouses name into their name to qualify their spouse for Medicaid. Yes you have to spend down to a certain level and if a person is single Medicaid may come after property to pay for their care after the person has died.

It’s my opinion that that is fair. Why should the Federal Government ie the taxpayers be on the hook for the care of a individual if there is property that can be sold to pay for their care? I don’t understanding the thinking that mom or dad’s house or land should be passed down to their kids of other family members instead of being sold to pay for their care and putting the taxpayers on the hook for it. Yes it would suck to have to sell property that had been in the family for generations but on the other hand why should the taxpayers be responsible!

I do fully understand the cost of taking care of a person in a nursing home and in my wife’s situation it would be anywhere from $5000 to $6000 a month and that does not include her meds, insurance, or clothing care. Also we would be responsible for providing the furniture for her room.

my MIL is in assisted living now and it runs around 7K a month for everything - thankfully we got a LTCare policy on her years ago and it is now paying out like a slot maching

There's nothing wrong with my grammar. Even ran it through a checker to be sure.....