Question
QUESTION: My Mother is 89 she has medicare part A&B and had AARP supplemental for years then this jan. 2010 she switched from AARP to Humana Gold HMO because AARP was so expensive. She had Humana less than a month then fell broke her hip was hospitalized for 3 1/2 days then sent to a Healthcare rehab. Wont Humana pay for so much of her stay then medicare pick up the rest of the bill.
ANSWER: Hi Bill
Humana HMO is the only payer. It is Medicare.
Medicare has two payment systems. She had original Medicare when she has the AARP.the bill went to Medicare, Medicare paid it's part, the AARP paid the rest.
When she switched to Humana, she went to the Advantage system. Medicare pays Humana a set amount each month to Humana, whether she uses it or not. and humana is responsible for her care. In short, Medicare, prepays.
She is entitled to all her benefits under either program. While the premium is cheaper, if she has a lot of office visits, she may end up paying more in co-pays.
John
---------- FOLLOW-UP ----------
QUESTION: They told me at the rehab where mother is that the first 7 days were no cost then the next 32 days were $100.00 a day then after 32 days it was no cost again, does this sound right to you. Thanks Bill
ANSWER: Hi again
It does not sound right, however I do not have enough information to give a good answer.There is an outside possibility they might be right depending on the time line of events. Too complicated to be done on line. Contact SHIP and request to have a counselor to assist you in checking out the time line and finding an answer. You can find the phone number in the center of the back cover of MEDICARE AND YOU 2010 she received in October, or get a copy at the local Social Security office. Or you can go on Medicare.gov===locate and click on Find the SHIP number in your area=====then click on the State she is in.
Hope this helps.
John
---------- FOLLOW-UP ----------
QUESTION: Well i have tried calling SHIP i left a message 2 days ago they have never called me back but i called Humana and they told me that Mother is only covered for the first 7 days by Humana. The thing that gets me is it seems if she only had Medicare it would pay for the first 20 days and therefore she is being punished by paying for medicare part B and Humana.
Answer
Hi again
Keep trying on the SHIP line.
Getting a time line is kind of hard to do by e-mail. Look in MEDICARE AND YOU 2010 and read about Benefit periods. I have a hunch she is in a rather long benefit period that will continue until she has not been out of hospital or a skilled nursing facility(SNF) for a period of 63 days. She had used up 93 days if SNF 100 day coverage earlier in the benefit period and therefore only had 7 days of eligibility left.
John
