Are we at risk of losing Medicare if my dad was released from rehab and we do not provide him with the full-time caregiver the doctor prescribed? - AgingCare.com

Are we at risk of losing Medicare if my dad was released from rehab and we do not provide him with the full-time caregiver the doctor prescribed?

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Dad, age 93 ready for release from rehab hospital to home with 90 year old mom, but p/t will only approve it if we have 24/7 caregiver in addition to mom (she is not able to handle it alone in pt opinion). If we do not have that 24/7 in place and something happens to dad while home, are we at risk of losing medicare coverage?

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No, Medicare coverage will not be "lost".
Hospitals and Skilled Nursing Facilities are under new Medicare guidelines with respect to discharge in an attempt to reduce "recidivism". This includes specified recommendations and followup. He may not be discharged if the conditions recommended are not in place.
As suggested above, if the recommendation is that Dad should be supervised 24/7, that is what should be provided. If such care is unaffordable or not practical at home, then a long-term nursing home placement should be considered until such time as he has recovered sufficiently to be safe at home.
Of course this may never occur (full recovery), and at 90 and 93, an alternative to home may be the best bet, i.e., assisted living.
Presuming this is NOT affordable, consider assisted living expenses versus all of the expenses maintaining them at home (taxes, insurance, food, transportation, utilities, etc.).
Between their combined income, Medicaid community benefits that may be available (what state do they live in?), and possible Veteran benefits if Dad was a vet, you may indeed find assisted living a viable alternative.
Check out:
Medicaid home and community benefits.
Veteran benefits.
If you can be more specific with respect to their financial and medical situation (and disclose what state they are in), I can be more specific as well.
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Ralph has some very good advice and this is his specialty. Looking into all options if a good idea. Thanks for the tips, Ralph!
Carol
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It’s difficult to answer your question without some additional pieces of information, like which state you live in and which type of Medicare coverage you have; basic Medicare, Medicare Advantage or a Medicare Supplement.

But, here are some general rules that apply to your situation:
1. Your father’s eligibility for basic Medicare coverage – also called “original Medicare” – is primarily based on his citizenship and the length of time that he paid Medicare related payroll taxes. If he worked for at least 10 years and paid payroll taxes that hole time, he should get Medicare Part A for free and Medicare Part B for $115 per month. That $115 premium is usually deducted from a person’s monthly social security check. There are always exceptions with Medicare, but these rules and prices apply for most people.

2. I’m not aware of anyone’s Medicare coverage being cancelled for any reason, except in instances of fraud. Although, again, there are always exceptions with Medicare.

If I’m reading between the lines of your question correctly, I’d assume you’re more concerned about whether or not your Medicare coverage will cover the cost of a professional caregiver, if they’re not the caregiver prescribed by your father’s treatment center. And, again, this will likely depend on what type of coverage you have, what state you live in and whether or not the caregiver services you wish to select are covered by The Center for Medicare and Medicaid Services, or by your father’s ancillary Medicare insurance, if he has any.

If you have supplemental insurance – Medicare Advantage or a Medicare Supplement - the best advice I can give you is to contact the insurance company directly and explain the situation. They should be able to tell you if your desired caregiver would qualify. But, the issue should not affect basic Medicare eligibility. Worst case scenario, you still have Medicare but pay for the caregiver out of your own pocket.

For more information on your specific problem, I would encourage you to speak to Medicare at 1-800-MEDICARE.
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No, he will not lose Medicare because of this.


p.s. Jeannie, get real.
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Congrats on having a great doctor who wrote that Rx. This way when you apply for home health, the agency has something to work with to off set costs! The doc is just recommending 24/7 because he either feels that Dad requires it or that mom will need the help to care for him. It also alerts the family to the severity of the situation. You can not loose benefits from NOT utilizing Medicare however there is usually a small window for this opportunity. Contact your Area on Aging (AoA) to see what benefits they may be able to provide and state Dads age and condition and that he has an RX for 24/7 care. And check on what Ralph said- he gave good advice.
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I don't know if you at risk of losing medicare coverage (hope someone else will know that) but you are at risk of losing Dad. If the professional assessment is that he needs constant supervision/care, what would prevent that from being provided?

Is cost the concern? Is Dad on Medicaid? Would he be eligible? Have you discussed with pt how this 24/7 could be made possible?

Is it Dad's stubborn resistance to in-home care that is the stumbling block? Would it help to present this as something to help Mom, who cannot cope with all the responsibilites?

Is this 24/7 recommendation for a limited time, until Dad fully recovers? Or is this the likely state of things indefinitely?
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Ralph above has wonderful answers. If dad is a veteran, contact the veterans admin. or go on line and check out VA aid and assistance program. They will give you the qualification requirements and they can provide financial assistance for both dad & mom (as his wife) for care inhouse or in assisted living. There is money there and if he is a veteran he deserves to received funds from the VA for his care now. Call the VA or check with your county to see if they have someone who works for the VA through them. They will walk you through every step of the application and they do not charge. Be aware however, that there are some companies that will tell you they can assist you to fill out VA forms - but many are finanacial planners and will also try to get you to invest money in their company - just be aware of that. You should not have to pay anyone to assist you to fill out VA forms. Also check with your local Council on Aging. Good luck!
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Sorry, N1K2R3, but the people I know were on Medicare long before they needed (became eligble for) Medicaid. I am on Medicare myself. Everyone I know over 65 is on Medicare. Most of us also have supplementary insurance. If we are all lucky we'll never need Medicaid. But if we do need it (and you might be surprised how soon a retired person can become very poor if paying for long term care and astronomically priced drugs), then the fact that we are already on Medicare is not relevant.If you work, money is being taken out of your paycheck for Medicare. You will be eligible for Medicare automatically when you reach the appropriate age (right now, 65). "Dual Eligibles" are not at all rare -- or not any more rare than Medicaid recipients. We are each entitled to our opinions, but this is a matter of fact. You most certainly do not have to qualify for Medicaid before you are eligible for Medicare!
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To N1K2R3 - you stated above that "after qualifications for Medicaid have been met, then and only then may they also qualify for Medicare". You also state that "one does not have Medicare & Medicaid although it is possible-rarely". My mom was 88 when she passed away - she was on Medicare from age 65 - the last few months of her life she encountered numerous health concerns after a broken hip. She was in a ALF the last month of her life, and it was then that I was going try to get assistance for her from Medicaid, (which she would qualify for) anticipating that she may need to be transferred to a nursing home. So she along with many of her friends would have been on both programs. You also state that "a person is on Medicaid because of a disability, not sickness". Well because of mom's "sickness" she had become "disabled" and now needed assistance dressing, bathing, getting around, etc. You also stated that "of course he's not going to recover - he's 97". I agree with jeannegibbs that "it is not unrealistic to ask if he is expected to recover". jeannegibbs was right in asking that question wondering what the doctors had determined by his health not his age! I have taken line dance classes from an instructor in her 90s - yes she's the instructor and can put alot of young ones to shame with her energy and good health. Just because someone is a certain age doesn't mean they won't recover. When my mom was in the hospital I was called on two seperate occassions by doctors telling me that she wouldn't make it through the night. The next day (both times) I was called by the hospital social worker telling me she was fine & was being transferred back to rehab. Needless to say, after getting the news the day before, I argued with the social worker that they must have the wrong patient. Well they didn't - mom made a complete turnaround and surprised everyone! Then when she went to the ER with a hole in her colon, 3 doctors told me she had a few hours to live - she was transferred to Hospice and was there 4 days - and that was with no fluids or food. What I'm trying to say is that age doesn't matter, illness doesn't matter - no one knows - only God! To RalphRobbins - I'm sorry if I offended you in my previous post when I mentioned that financial planners tried to charge a fee and only wanted you to invest money for assisting in applying to the VA. I went to a few of these so called "seminars" and although I found out then that they weren't "financial planners" - unfortunately that is what they called themselves and tried to get people to invest in their companies. I see that you are a Certified Financial Planner (unlike they were) and I commend you for what you do, and in no way was that comment towards you - a true professional. I think we are all extremely fortunate to have RalphRobbins writing on these posts - I read his comments on many subjects/posts and he is always excellent on explaining many aspects of the situation in a true professional and helpful manner. Thank you Mr. Robbins, for your great wealth of information that you share with all of us.
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Actually, N1K2R3, I do know how to be poor. Been there. Done that. I'm glad you don't and haven't. Maybe that explains why I know people on Medicaid and you don't.

In any case, you have a wealth of experience as a caregiver to offer here. You can share those experiences, offer encouragement, caution others about what didn't work for you, and generally extend a helping hand. You don't need to be an expert on medicare and medicaid or any other technical topics to make a huge contribution here. Share what you do know, what you feel, what you believe. I just ask that you not disrespect the statements (or in this case the questions) of others.

Truce?
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