I do not think she’s eligible for a Medigap policy, but not sure if this is a life-changing event going from assisted-living to skilled nursing does anyone know if she could purchase a plan to cover the 20%? She currently has humana gold advantage plan. Thanks in advance!
If that’s what her situation is, I think it would be helpful for you to understand why AP totally suck for those in a NH. The Advantage Plans all do a very narrow network of providers that are in her Plan. And AP really best only work for those who can always & consistently go and see only the doctors / clinics/ hospitals in-network for her Advantage plan. For those in a SNF, going out of the NH to see outside doctors is realistically not at all feasible; plus likelihood of the MD who is the medical director of the SNF and the PT&OT and any other medical providers at her SNF being “in network” doesn’t exist. AP are totally Disadvantage Plan.
But if she is on Original Medicare and the right “gap” policy, then some if not all of her medical costs will be covered by health insurance. The tricky part is finding out which insurer has a gap aka a supplemental that fits best for where she is. I’d ask admissions & billing at her SNF which gap most of their residents have. That’s probably the easiest way to figure this out.
& something to be aware of….. should mom run out of $ to private pay for care in this SNF and so she applies for the LTC Medicaid program (it’s this specific Medicaid that pays for custodial care costs in a facility), she will end up being on 3 things: 1. Original Medicare as her primary health insurance 2. Medicaid as her 2ndary health insurance, and 3. LTC Medicaid for custodial care. She will become a “dual” for her health insurance. What most States do nowadays for “duals” that are in NH/SNF is they go on a MCO aka Managed Care Organization. The MD, PA, NP, PT, etc affiliated with her SNF will be also in the MCO. So btw Medicare + Medicaid + MCO all her health insurance costs are covered. And between her own Share of Cost of her income paid to the NH + the State LTC Medicaid daily reimbursement to the NH all her custodial costs are covered. The big player for MCO’s is Molina Healthcare.
If you think that fairly soon, mom will be applying for LTC Medicaid, as a suggestion, find out if this SNF participates in that Medicaid program and if they do which MCO is the one (or main one) their residents are on. If this MCO also does Medicare “gap / supplemental” policies as well, it might be easier to go with this insurer as her health chart and all its information will be easier to flow over later on.