why medicare

Why Medicare

When it becomes necessary to enter your loved one into an Assisted Living Facility it is almost impossible to anticipate all the financial impacts of such a long term living arrangement.

In this mellieu of decisions to be made it may not be evident that the type of insurance a loved one has can impact the level of services available to that loved one in a residential care facility. The insurance carrier of choice when one lives in a Residential Care Facility for the Elderly (RCFE) should be Medicare as the primary. Medicare is accepted by all hospitals, nursing homes and most importantly by independent practitioners who will provide services at the RCFE on an outpatient basis. The easiest example of this is a primary care physician. With Medicare the resident can be seen in the comfort of the facility. In the case of Kaiser as the primary this would not be possible and the family would need to get the loved one to the primary Kaiser Doctor. This applies to Dentists, and Podiatrists, as well. Pharmacy is another area of concern for Kaiser or other HMO primary payors. Kaiser requires 90 day supplies and they must be ordered from Kaiser. They do no put these meds in bubble packs which creates a counting nightmare for the facility who receives all the rest of their meds from one pharmacy delivered monthly to the facility in bubble packs with every day of the month accounted for and not delivered in bottles.

Switching from an HMO or Medicare Pledge plan back to Medicare as a primary payor can be done anytime during the open enrollment period (Oct.1- Jan 31). It can also be done more immediately if the loved one moves from a lower level of care to a higher level of care; say for example if they move from home to a facility. This one time exemption is allowed any time during the year. In the case of a couple, one half of the couple can stay with the HMO while the other can switch back to Medicare as their primary Payor.

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