One of all common phone calls I receive at your workplace is when someone's parent is admitted to hospital. In this time for many crisis, answers are not easy to come by.
How does their insurance coverage work? What does Medicare pay? Once the parent which is discharged, what happens, where do they go, how is it purchased, what are our products? What do we never will if mom or dad may have to go to only a bit of Nursing Home? How do we pay for it?
This confusion is expected whenever a senior health care system can be a very confusing and overwhelming trends. The first thing to set up is to understand the walls for today's system.
In 1983, Congress created the Prospective Payment System. This is important because when a person 65 and assend is admitted to a basic hospital, he is assigned just one of 473 Diagnostic Related Groups (DRG's). This makes a difference because Medicare compensates the hospital a flat dollar amount to the DRG assigned to anyone.
Let me give an example. Say that your dad is admitted to the hospital with lung problems therefore , the DRG is four gatherings. If my father is sweet discharged in three length of time, then the hospital makes one day of profit. If dad is discharged in five days a hospital loses money and cannot bill the patient to get this one extra day.
Back in the previous, I remember when my grandfather open for the hospital and the nurse asked him if he felt good to go home almost like he didn't, he could stay things to consider extra days until glistening felt better.
Today, it's all about the money. Once a patient is no longer getting better or significant, in other words, is regarded as "stable", then the patient is discharged to either home or a Medicare certified Nursing Home or treatment facility.
In order for Medicare having to pay rehab care the patient was likely in the hospital for several consecutive days (72 hours). Followed by, no later than thirty day period after discharge from the hospital, be admitted to a extremely Medicare certified nursing herbal.
If these criteria so far met, then for 2010, day's one through twenty from the rehab facility are purchased 100% by Medicare. For days twenty one through one hundred, your co pay holds this year is $137. 00 every day.
From day 101 only to beyond, regardless of your problem, you are responsible for all of the facility costs.
Keep in mind, that in order to the present reimbursement schedule to currently, you must either receive better or getting more serious. Like the hospital, if you're deemed to be steady, you come off their own Medicare reimbursement schedule and need to pay for all costs.
In California, most patients will appear of Medicare reimbursement in the field week three and inside begin private paying from this point forward. The business office will show you when this is expected materialise.
If the facility has now long-term care beds, then the patient may also stay in the same facility. But if the option is strictly short-term vehicle repairs or rehab, then somebody else must find another facility or go back home.
How does the patient's health insurance fit into this? Contingent on what type of plan when the senior patient is on. Is it a Medicare supplement plan or PPO, or could it be a Medicare Advantage plan as the HMO?
Medicare supplement insurance, also called Medigap, is private health insurance designed to supplement Health-related. A premium is recompensed this coverage which will be age rated.
There are typically twelve standardized Medigap directives, A through L. In a number of states, you can trip any doctor or facility that accepts Medicare without the benefit of pre-authorization. Under plans J through J, days one through twenty are completely bought by Medicare. For days 21 years old through one hundred, the Medicare co-pay for 2010 is $137. 00 which is covered by the Medigap policy. From day one hundred one and past years, the patient is responsible for the full cost.
For Medicare Advantage plans being an HMO like Secure Capabilities, SCAN and Kaiser, the patients can have a co-pay from day 12 of $100. It is the greatest check the benefits booklet or call somebody service department.
If someone goes to some facility without going to the hospital first, then that you need to private pay from the first day.
Once the patient heads off Medicare reimbursement, if in case qualified, Medi-Cal will help to pay for Nursing Home costs. If going to the facility directly from room, then, if qualified, Medi-Cal may help to pay for Nursing Home costs from the first day.
Please consult with a Medi-Cal specialist for more information and the exact procedures.
Copyright 2010 by Karl Kim
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