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?

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.

Suze Orman, ugh!

Dear Mr. Robbins, Thank you for answering my query on that $100,000.00 investment in an annuity. Your full explanation was an enlightenend expose of the practice of selling annuities. No, the agent did not disclose his commission to me. He did say that Aviva would pay him, and nothing would be subtracted from my deposit into the annuity. He also mentioned that it would be a safe investment, sent me copies of Suze Orman's endorsement, and told me that this annuity would not be subject to the peaks and troughs of the market......nothing to ride out.
I'm glad that I did not engage. As for interest rates, what can I say? Returns are down today ( 08/02/2011). Inflation is a slow burn....will rise of course.
Somehow I'm not too worried. Thank you again for sharing your great knowledge!

Well thank you, Jeannie, and I'm glad that you have the understanding to know that people are different, coming from various backgrounds, education, and experience. I don't know what your financial situation is now, but you say that you've "been there, done that". I hope life holds promise for you. They say that money doesn't create happiness, and that is absolutely true. Because I was married to a very wealthy man, I am in a comfortable position right now. Before his death, I took care of him with the help of one other family member. We did it with extraordinary love and compassion. No task was too difficult nor too demanding. I woke every morning with the joy of being able to take care of him. He passed away in October of 2009. I did not know it at the time, that so much wealth had been left for me. I am almost ashamed. I want to give it away, not to "charities", but to those truly in need. I want to pass on my experience of caregiving to others...mostly through education. Some of the commentary on this site is bothersome. I do not understand it. The middle class puzzles me. I simply HAVE to begin to understand that Medicare/Medicaid etc. is the way to go for so many people. I want to say, "Just write a check, and be done with it", but it doesn't work that way. My hope is that we can eliminate mental illness....the underlying cause of so much distress and crime.. If I can ease the pain of just one person, I'll be fulfilling my own purpose.
Best wishes to you, Jeannie, and may you find peace and true contentment, a blessing in itself. May you continue to be kind to others as you have been to me.

N1k2R3:
I'm so glad you didn't get taken in by that annuity nonsense. Unfortunately the CFP Board allows CFP's to sell commissioned products...however commissions must be disclosed. I'm curious, where you told that the agent would make between 4 and 12% commission if he/she sold you that annuity?
General rule for all investing: If it sounds to good to be true, it surely is. In your case you were being offered the equivalent of a 7.2% interest. I'm sure you were told the annuity was a "safe" investment. So let's look at the interest rate on what used to be the safest investment on the planet.
As of today, 8/2/11 the interest rate on a 30 year US Treasury is 4.07%. So you were being offered an interest rate 43% higher than a 30 year Treasury.
On top of that they were promising you a 10% "bonus"...they were going to add $10,000 to your $100,000. Sure beats a toaster!!
And on top of that, the agent was going to earn between 4% and 10% of the $100,000.
Does this seem like a viable business deal to you? Of course not! Good for you for stepping away. Have patience. Interest rates will soon be soaring, unfortunately, so will inflation.
By the way...no offense taken.

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?

Well, I stand corrected. First, I didn't know that there was such a thing as tiertiary coverage in healthcare. Second, we are all very fortunate to have the expertise of Mr. Robbins on this site. He gives us the straight stuff, whereas all of us tend to give examples out of our own lives of people we know....."my mother....my aunt.... "etc. I do, however, having researched this issue, still say, that one has to qualify for Medicaid. Those qualifications remain in place in this state-sponsored, state-paid-for program. They are as follows: Age 65 plus, but now always., Disability, Financially at or below the line requirement. Medicare is a different ballgame.

Since most of us here are 65 plus, and receiving Medicare with a supplemental coverge to pay the additional 20% that Medicare does not pay, we are all in different financial situations. Hopefully we also have Medicare Part D to pay for drug and medicine coverage. (They take the premiums out of the S.S. check every month). I personally do not know ANYONE who is a " Dual Eligible". Nor, do I know anyone who is a Medicaid recipient......the financial qualifications preclude most of us from qualifying. So there!
As I said in my opening statement, I stand corrected. I hope that the 93 year-old "recovers", and none of us will become financially eligible for Medicaid.....As they told Arthur, "you don't know how to be poor".

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.

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!

The Medicare/Medicaid/private insurer situation depends to some degree on whether the applicant is under or over age 65 and what services are being applied for.
Those under 65 applying for Medicaid who are disabled must wait two years after disability determination to qualify for Medicare. They may be covered by Medicaid alone in the interim but once eligible for Medicare, Medicare will be primary.
Those under 65 who are NOT disabled will not be eligible for Medicare until they are 65 but still may qualify for Medicaid.
Those over the age of 65 do not need to be determined "disabled". Most will already have Medicare in place and as I stated earlier, Medicare is primary.
It is possible to have private insurance AND both Medicare and Medicaid.
Example: For those over the age of 65 Medicare will be primary. Most also have a Medicare Supplement from a private insurer which will be secondary. Medicaid will then be tertiary. For those over 65 receiving Medicaid and NOT in a nursing home I always recommend a that a Medicare supplement insurance plan be in place (not an HMO or "Medicare Advantage Plan" by the way).

Ms. Gibbs: You may know three people on Medicare and Medicaid concurrently, however, as Mr. Robbins just stated, these people, called " Dual Eligibles" must quality for Medicaid FIRST. These requirements are stringent: 1) Financial Eligibility, 2) Disability, 3) Age of 65 plus. After qualification for Medicaid has been met, then and only then, may they also ( that's why I said it was rare), qualify for Medicare. Medicare becomes their primary insurer, and Medicaid is secondary. If they have a private insurer, and they are paying monthly premiums to this private insurer, then Medicaid is wiped out, keeping Medicare..
You Do see the reason for all of this, don't you? No state should carry anyone financially capable of paying for their own insurance while taking offerings from Medicaid.

In fact it is safe to say that virtually everyone over the age of 65 who is receiving Medicaid is also receiving Medicare. They are known as "dual eligibles" whereby Medicare is their is their primary "insurer" and Medicaid is secondary.

N1K2R3 My mother, 91, was in a nursing home for transition care for a broken arm. In spite of her age, she was expected to fully recover, and she did. My 96 yo aunt is in a nursing home now recovering from a hip replacement. She is doing splendidly and is not only expected to recover but to be able to be more active than she was before. Old people do recover from things, depending, of course on what the things are. It is not an unrealistic question to ask about a 93 yo man. Is he expected to recover to the point where 24/7 care won't be needed, or is that expected to be an ongoing need the rest of his life? Realistic question in my mind. Not one that deserves a sarcastic comment.

I personally know three people on Medicaid and Medicare concurrently. It never occurred to me that that is rare. How on earth you know that "of course" the man in question is not only not on it but doesn't qualify for Medicaid is a mystery to me. I'd rather ask than assume.

We certainly don't have to agree with each other on these discussion boards. A diversity of answers is often useful. But I would hope we could be respectful of each other, whether we agree or not.

(I believe the wording of the question has been edited since I responded.)

Ms.Gibbs: I had to print your comment for my own record, so that I could answer your question intelligently. Here it is: First, cqleich asked, " If we do not have that, ( constant supervision/care ) 24/7 in place and something happens to Dad while home, are we at risk of losing medicare coverage?" Your comment:
"Is Dad on Medicaid?".....my comment to you: Of course not, he doesn't qualify.
Medicaid is a state-sponsored program with low, (very low) income requirements and additional disability, not sickness. One does not usually have Medicare and Medicaid, although it is possible (rarely).
Your comment: "Is this 24/7 recommendation for a limited time, until Dad fully recovers? Or is this the likely state of things indefinitely?" My answer to you: He's not going to "recover". He's 97.
Mom is 90. These people have all they can do to take care of both Mom and Dad and keep their sanity. Let Medicare provide for them both. They will not lose Medicare. Hopefully they have a Supplemental Plan, and continuous S.S. checks for each of them until the day they die.

Mr. Robbins, Thank you for that thorough explanation of the term, " Financial Planner" . I see that you have CFP after your name, so therefore you are one!
It appears that most of these planners want to sell Annunities. I must have been asleep in Econ class the day that they taught Annuities, for there is a lot that I do not know. The offer by a CFP to me was: "Put up $100,000.00 into an annuity. I'll add $10,000.00 to that. In return you will receive $600.00 per month which is taxable at the rate of Ordinary Income. ( Normal Distribution). If you live long enough, the $100,000.00 will be eaten up by distributions. If you die before that, your contribution will be part of your estate" . p.s. I still do not know what the term Annuitized means.
Question: Why would I give up $100,000.00 to a guy when I could keep it in a low-yield CD, or Series I Bond, or better yet a low paying Money Market Account?

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

N1K2R3, was your comment addressed to me? If so, I'm curious about what part of my answer did you think was unreal? No offense taken, but I meant the answer seriously and I'm wondering what part of it you reacted to.

Thanks for that clarification, Ralph. I receive all kinds of offers for "financial planning" and "retirement planning," often including a "free" meal at a restaurant where the seminar is being held. It is good to know about the Certified Financial Planner (R) designation.

Evelyn is right that one must be careful if seeking assistance to apply for VA Pension programs. However, I would take exception to the term "financial planners" being used in the broad sense.
The fact is that most who are offering "free" services in the private sector are insurance agents who are seeking to sell high commission annuities. This is problematic on two fronts.
First, there is an automatic conflict of interest when a person offering services is compensated solely by the sale of a product.
Second, the fact is that most who need this benefit have absolutely no use for an annuity and, the purchase of same, can cause serious problems if the elder is seeking Medicaid benefits simultaneously or at a later date.
I would avoid insurance agents offering to assist with this type of planning as most simply have no idea what they are doing. I spend a lot of time undoing these mistakes and it is very, very costly to the client.
Anyone can call themselves a "financial planner".
However, to earn the Certified Financial Planner (R) designation one must go through rigorous examination, scrutiny, and continuing education.
Moreover, CFP's are required to act in a fiduciary capacity with respect to their client's affairs. This is the highest standard of conduct proffered by statute and a responsibility that no one in the profession takes lightly.
Although I am a Certified Financial Planner (R), I do not sell financial products, I do not invest client money, and I earn no commissions. My services are offered on a flat fee basis.
There are many non-lawyer planners who operate the same way and do an excellent job assisting families with these complex matters.
Naturally, such advice should only be sought if needed. If assets and income pose no problem with benefit approval for either Medicaid, VA, or both, then certainly take Evelyn's advice above.
What is unique about the VA in particular is that their stated mission is to assist veterans in receiving claims, not denying claims. My experience has demonstrated to me that this is true and the VA does a great job at every level.

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!

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.

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.

No, he will not lose Medicare because of this.


p.s. Jeannie, get real.

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?