Are you talking about the 20% that Medicare does not cover after the first 20 days of rehab after a qualifying hospital stay? Be aware that the MAXIMUM number of days that Medicare will cover at 80% is 100, meaning that you will only be paying the 20% for an additional 80 days, tops. After that, it's private pay, until you have another qualifying hospital stay.
If this is about finding one to work in tandem with MediCARE, you need to clearly find out if they are on "original" Medicare or if instead they are on a Medicare "managed care" type of plan as whatever secondary or supplemental must be on a approved secondary participant list for the specifc medicare primary insurance.
If your elder is right now in the hospital & about to be discharged to "rehab" OR is already in rehab, your not going to find a secondary policy as most require a 30 -90 day minimum window for any coverage to be in force.
As an aside in all this if they are currently in rehab, I'd suggest you clearly speak with the PT & OT working with them as to their progress. Every day there's some sort of measurable "progress" update done. If their health chart is edging towards a "plateau", you need to start thinking about just where they go after rehab. Often the initial 20 day 100% Medicare rehab benefit is just window-dressing as they likely aren't going to ever get better, so they plateau day 21 & off Medicare BUT they need to stay at the NH as they cannot return to their old life, return to living at home. If this could be your situation, you kinda need to use those first 20 / 100% medicare days or day 21-100 / 80% medicare days to get finances together, see an elder law atty if need be and do a medicaid compliant spend down ASAP to get them eligible for Medicaid. So they can transition from a Medicare rehab bed to "Medicaid Pending" bed at the NH. It can get quite overwhelming.....
Glo - it really should be moms finances paying the copay. Moms not yours, or other family if paying her copay puts you at financial risk. If mom just doesn't have the $, then she can apply for Medicaid. Medicaid will pay her room & board costs at the facility with Medicare & Medicaid co-sharing covering the medical costs. Her Blues will need to be "suspended" during this period - there should be a specific form from bcbs for this. SUSPENDED not cancelled. It's going to be pretty paperwork intensive & someone at the billing office at the rehab place is going to have done this before & can help you. You do need to try to make sure that moms PT, OT or any others doing her "gait training" participate in Medicaid as well as BCBS - often they are independent vendors to a rehab facility (so not staff) & bill independently & do not participate in medicaid.
I think she should be Medicaid eligible until the house actually sells. It's an exempt asset for Medicaid, so it doesnt HAVE to be sold, slthough upkeep, taxes and insurance are always an issue.
Babalou is right, the house is an exempt asset. Mom can be either "Medicaid pending" or fully medicaid eligible & own her home as Its an exempt asset by & large for Medicaid in all states. It is only the month in which mom actually gets the actual hard$ proceeds from its sale that her assets go over 2k so she becomes ineligible that month & stays ineligible till she does a spend down.
Personally I think you should mull over IF you want to deal with & do the VA A&A paperwork or just forget a&a & only do the VA $90 allowance. VA A &A is tricky on that it pays IF there isn't another primary payor. The semantics is confusing...but here's how it's been explained to me....Say mom is in AL and it's 3k a mo; mom gets $1800 VA A&A plus her SS of 1k; so mom pays out of pocket $200 and between the 3 her AL is totally & easily paid. Mom gets worse & now needs a NH & it's 6k a mo, mom jumps from $200 to needing $3200 a mo. The $ just isn't there so mom qualifies for medicaid. Now once mom becomes eligible & on Medicaid, it will become her primary & will pay all her room & board costs plus between Medicare & medicaid all health providers costs get fully paid. VA will decline to continue to pay the A&A once medicaid eligible as they are no longer either a primary or secondary. Once on Medicaid, VA A &A stops BUT VA now pays a $ 90 personal needs stipend.
You still with me? Now here is where it gets sticky....medicaid will retro payment to day 1 of the application and pay the NH several back months of payments at NH Medicaid reinbursement rate set by your state. It could be way less than mom paid as a private pay resident. The NH will need to return the A&A payments as VA wants the $ back from mom. If you are personally paying the gap -which is $3200 in the example - you want the $ paid to you - like check written to you - not mom as you dont want it coming up as "income" for mom and needing to go into her bank account as its written out to her. Comprende? You are going to need to be very ocd on records on all this as the timing by medicaid, VA is not synchronized. if mom should die while all this is getting rebalanced, it gets quite complex.
Sometimes it's just easier to apply for Medicaid; to have in place a plan on how to spend down ASAP the proceeds from house sale so that all clears bank account within 1 or possibly 2 bank statements, so mom can requalify for Medicaid. If moms state places a lien on property, then at act of sale the medicaid costs to date get paid from proceeds of the sale. Most states don't do this. I'd see an elder law atty to see what's what for yiur state and what mom could use the house $ for - like paying a preneed no cash value funeral & burial; a better wheelchair beyond what medicaid would ever pay for; dental care or even get set up a special needs trust account for mom, etc that is totally medicaid compliant. If yiu do this, remember Mom has to get all done & cleared ASAP so she can be ok for Medicaid the same month or the next month as the house closing ideally. You want to have realtor set closing on the first of the month.
If this is a lower value house, it may not be all that much $ to push through in 2 or 3 weeks & easily doable imo.
Also if you or other family have fronted costs to make the house sellable, if you want to be reinbursed for those costs, you need to have some sort of contract with mom as to this before closing. You cannot be just reinbursed as it comes across as gifting and can place a transfer penalty by Medicaid on mom. The info on the sale of the home to the penny is recorded so the state has all details. It's a lot to think about, try not to get overwhelmed.
When my Mom was in rehab Medicare only paid 100% for 20 days after that it was 50% up to 100days. Her supplimental paid a small amount. She paid about $150 a day. The billing department should tell you this upon entering the rehab. Medicare does not pay for longterm nursing care.
If your elder is right now in the hospital & about to be discharged to "rehab" OR is already in rehab, your not going to find a secondary policy as most require a 30 -90 day minimum window for any coverage to be in force.
As an aside in all this if they are currently in rehab, I'd suggest you clearly speak with the PT & OT working with them as to their progress. Every day there's some sort of measurable "progress" update done. If their health chart is edging towards a "plateau", you need to start thinking about just where they go after rehab. Often the initial 20 day 100% Medicare rehab benefit is just window-dressing as they likely aren't going to ever get better, so they plateau day 21 & off Medicare BUT they need to stay at the NH as they cannot return to their old life, return to living at home. If this could be your situation, you kinda need to use those first 20 / 100% medicare days or day 21-100 / 80% medicare days to get finances together, see an elder law atty if need be and do a medicaid compliant spend down ASAP to get them eligible for Medicaid. So they can transition from a Medicare rehab bed to "Medicaid Pending" bed at the NH. It can get quite overwhelming.....
If mom just doesn't have the $, then she can apply for Medicaid. Medicaid will pay her room & board costs at the facility with Medicare & Medicaid co-sharing covering the medical costs. Her Blues will need to be "suspended" during this period - there should be a specific form from bcbs for this. SUSPENDED not cancelled. It's going to be pretty paperwork intensive & someone at the billing office at the rehab place is going to have done this before & can help you. You do need to try to make sure that moms PT, OT or any others doing her "gait training" participate in Medicaid as well as BCBS - often they are independent vendors to a rehab facility (so not staff) & bill independently & do not participate in medicaid.
Personally I think you should mull over IF you want to deal with & do the VA A&A paperwork or just forget a&a & only do the VA $90 allowance. VA A &A is tricky on that it pays IF there isn't another primary payor. The semantics is confusing...but here's how it's been explained to me....Say mom is in AL and it's 3k a mo; mom gets $1800 VA A&A plus her SS of 1k; so mom pays out of pocket $200 and between the 3 her AL is totally & easily paid. Mom gets worse & now needs a NH & it's 6k a mo, mom jumps from $200 to needing $3200 a mo. The $ just isn't there so mom qualifies for medicaid. Now once mom becomes eligible & on Medicaid, it will become her primary & will pay all her room & board costs plus between Medicare & medicaid all health providers costs get fully paid. VA will decline to continue to pay the A&A once medicaid eligible as they are no longer either a primary or secondary. Once on Medicaid, VA A &A stops BUT VA now pays a $ 90 personal needs stipend.
You still with me? Now here is where it gets sticky....medicaid will retro payment to day 1 of the application and pay the NH several back months of payments at NH Medicaid reinbursement rate set by your state. It could be way less than mom paid as a private pay resident. The NH will need to return the A&A payments as VA wants the $ back from mom. If you are personally paying the gap -which is $3200 in the example - you want the $ paid to you - like check written to you - not mom as you dont want it coming up as "income" for mom and needing to go into her bank account as its written out to her. Comprende? You are going to need to be very ocd on records on all this as the timing by medicaid, VA is not synchronized. if mom should die while all this is getting rebalanced, it gets quite complex.
Sometimes it's just easier to apply for Medicaid; to have in place a plan on how to spend down ASAP the proceeds from house sale so that all clears bank account within 1 or possibly 2 bank statements, so mom can requalify for Medicaid. If moms state places a lien on property, then at act of sale the medicaid costs to date get paid from proceeds of the sale. Most states don't do this. I'd see an elder law atty to see what's what for yiur state and what mom could use the house $ for - like paying a preneed no cash value funeral & burial; a better wheelchair beyond what medicaid would ever pay for; dental care or even get set up a special needs trust account for mom, etc that is totally medicaid compliant. If yiu do this, remember Mom has to get all done & cleared ASAP so she can be ok for Medicaid the same month or the next month as the house closing ideally. You want to have realtor set closing on the first of the month.
If this is a lower value house, it may not be all that much $ to push through in 2 or 3 weeks & easily doable imo.
Also if you or other family have fronted costs to make the house sellable, if you want to be reinbursed for those costs, you need to have some sort of contract with mom as to this before closing. You cannot be just reinbursed as it comes across as gifting and can place a transfer penalty by Medicaid on mom. The info on the sale of the home to the penny is recorded so the state has all details.
It's a lot to think about, try not to get overwhelmed.
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