My 85 year old dad has been hospitalized for 3 times in last 55 days with sepsis. He was transferred to a Skilled Nursign Facility from the hospital 2 times. Needless to say that the SNF care is not working. I have been informed by the doctor that the Medicaid (United Healthcare)/Medicare is not permitting him to receive the care he needs. My dad has no income and lives independently. How can I get the needed care for my dad when he is discharged from the hospital? I am very concerned and will appreciate any information from this forum.
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Once you choose to be on an advantage plan you are stuck. You need to find out if he is on one of those and what they cover. You can change but not for any reason and not at any time. Typically you can change during open enrollment period only. I was told that you can not go from an advantage plan to supplemental plan once you make that choice unless you are cancelled for certain reasons. You need to find an insurance agent that specializes in Medicare, then they can help you understand what you are facing.
No insurance is going to pay for him to be in a facility where he lives. Except a LTC policy and that boat has sailed.
Are his doctor's saying he is ready to go home? Has it been determined that he has base lined, meaning he isn't improving any further? These are important factors for you to know when you call his insurance, he can give them permission to speak with you.
It sounds like he is in need of a nursing home and that is not covered by Medicare or medicare supplemental or Medicare advantage, that is long term care insurance, self pay or Medicaid.
Difficult to be figuring all of this out while your loved one is in need, I feel for you, I went through it and it motivated me to make sure my affairs were in order so I would not put anyone through this.
My mom was on Medicare with a supplemental policy, so that might Have made a difference in her case. She had been in the hospital for surgery, got a severe infection, but still discharged to a SNF for rehab. Blood had to be drawn twice a day, specialized antibiotics given. SNF didn’t have the ability to process/handle that. They handled the transfer to a LTAC. A lady from church also ended up in the same LTAC after a major stroke, when the nursing home couldn’t handle her Medical needs & family didn’t want her in hospice.
In in my area, there’s not many LTACs, so depending on your location, you might have to travel to a larger city.
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