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Hold JoJo's Hand Through Medicare/Medicaid Consumer-to-Consumer Education/Suppor

Started by Jojo, February 10, 2018, 03:36:59 AM

Jojo

Tonight I googled Medicare.  Wikipedia and a government site were informative, but I still have a lot of questions.  Does anyone want to hold my hand on this topic?

Why would anyone purchase long-term health care insurance, when everyone can get Medicare?  For instance, my mother purchased hers for years, but toward the time she was starting to think about needing it, she could no longer afford the insurance!  After all those years of unused payments.

She might have been better off enjoying her money (The payments were high), and just relying on Medicare?  Since that might be all she gets anyhow.  All that money down the drain, lining the pockets of aggressive insurance reps... And she might not be able to sustain the payments until the time she really needs the benefits.

So how bad is Medicare?  One of my friends gets torn skin in her groin, rendering life (let alone exercise or sex) risky and painful, with open skin all the time.  But her Medicaid covered estrogen, which fixed the problem.  But when she turned 65, Medicare would not cover her estrogen like her prior benefits had.  She was in tears all the time over it.

And what happens to old people who can't afford housing?  My retirement income might barely pay rent, but it won't pay even a fourth of the cost of a room in a retirement home.  And, what if I need assisted living?

I could probably get used to the inconvenient regimentation of a facility, but if I want the creature comforts of the home I rent, will Medicare pay for help?  Like many people, I like creature comforts that a facility just would not accommodate.

I know the Methodists take care of their retired Minister's in special, nice retirement homes.  Who pays for that?  Why would the church provide something that Medicare is already in place for?

I already down-sized, so Medicare isn't going to take any assets in my case.  But, will it confiscate my retirement checks?

When I worked at a retirement home, residents paid for their rent with personal checks.  But isn't some of the rent covered by Medicare?  I suppose I would have to pay some rent, but what would Medicare cover?

Who will have my interests at heart if my brain starts to go?  I don't have any decent family.  What if I can't speak for myself?  Many women with dementia lose the ability to talk sense.  They just rattle, "One to one.  One to one.  One to one..." and you have little idea what they so frustratedly are trying to communicate.  There are no flash cards, no picture books of ADLs, nothing to help understand what they need.  Unless you know them well, or knew them before the brain damage.  You'd think in today's day and age, every demented person would be given several photographic communication tools, where they could just point to an ADL to suggest what they need, whether it be food, a taxi, whatever.  Like picture books or flash cards.  At least for basic ADL stuff.  If I lose my speech, who will help me?

One guy came into my workplace the other day.  He was elderly, and needed to use the phone AGAIN.  His phone had been cut off due to billing, and he confided all his bills were on minimum payment plans.  He comes in all the time to use the phone, but shouldn't he know about the Obama phone, as well as food stamps?  I asked him if he had ever heard of our state's welfare agency, and he said he never heard of them.  Why isn't anyone helping this man?  He is perfectly pleasant.  I gave him their phone number and told him he probably could get a free phone from them.  But I felt I had to do it in whispers, since the manager evidently just keeps letting him use the phone without educating him on how he can help himself.  So, who is going to help me help myself when I am that old?  No one is helping him!  So, they won't help me?

Little Hater

You have to be 65, or in some cases, disabled, to receive Medicare. Medicare pays 80% of what are called Part B medical expenses (most anything but hospitalization and prescription drugs). Part A is hospitalization and Medicare pays 100% after a small deductible. If you qualify (generally less than 2K a month in income and 2K in assets other than your home, if any, Medicaid will pick up the 20% of Part B and usually pay your Part B premium. I qualify for both and went through a health crisis a year or so ago, with over three months in the hospital, and haven't paid a penny out-of-pocket. Medicaid is a state-by-state proposition, though, and if the funding isn't there neither is the coverage.

Old people who can't afford housing are screwed. We're dealing with that with a relative right now. Medicare won't pay for 'custodial care' like assisted living, period. They will pay for nursing home care that's deemed medically necessary. Medicaid will help with assisted living, but the patient essentially needs to impoverish himself to qualify (which, I guess, is as it should be). The facility my relative is going into (nursing home) provides all the 'creature comforts' she wants, anyway (save privacy).

It's probably unreasonable to expect there to be flying squads of government do-gooders running around helping people like your old guy, but as you mentioned, programs exist to help out. Someone (you?) needs to point him to the proper agencies.




Uncle Duke

Quote from: Jojo on February 10, 2018, 03:36:59 AM
Tonight I googled Medicare.  Wikipedia and a government site were informative, but I still have a lot of questions.  Does anyone want to hold my hand on this topic?

Why would anyone purchase long-term health care insurance, when everyone can get Medicare?  For instance, my mother purchased hers for years, but toward the time she was starting to think about needing it, she could no longer afford the insurance!  After all those years of unused payments.

She might have been better off enjoying her money (The payments were high), and just relying on Medicare?  Since that might be all she gets anyhow.  All that money down the drain, lining the pockets of aggressive insurance reps... And she might not be able to sustain the payments until the time she really needs the benefits.

So how bad is Medicare?  One of my friends gets torn skin in her groin, rendering life (let alone exercise or sex) risky and painful, with open skin all the time.  But her Medicaid covered estrogen, which fixed the problem.  But when she turned 65, Medicare would not cover her estrogen like her prior benefits had.  She was in tears all the time over it.

And what happens to old people who can't afford housing?  My retirement income might barely pay rent, but it won't pay even a fourth of the cost of a room in a retirement home.  And, what if I need assisted living?

I could probably get used to the inconvenient regimentation of a facility, but if I want the creature comforts of the home I rent, will Medicare pay for help?  Like many people, I like creature comforts that a facility just would not accommodate.

I know the Methodists take care of their retired Minister's in special, nice retirement homes.  Who pays for that?  Why would the church provide something that Medicare is already in place for?

I already down-sized, so Medicare isn't going to take any assets in my case.  But, will it confiscate my retirement checks?

When I worked at a retirement home, residents paid for their rent with personal checks.  But isn't some of the rent covered by Medicare?  I suppose I would have to pay some rent, but what would Medicare cover?

Who will have my interests at heart if my brain starts to go?  I don't have any decent family.  What if I can't speak for myself?  Many women with dementia lose the ability to talk sense.  They just rattle, "One to one.  One to one.  One to one..." and you have little idea what they so frustratedly are trying to communicate.  There are no flash cards, no picture books of ADLs, nothing to help understand what they need.  Unless you know them well, or knew them before the brain damage.  You'd think in today's day and age, every demented person would be given several photographic communication tools, where they could just point to an ADL to suggest what they need, whether it be food, a taxi, whatever.  Like picture books or flash cards.  At least for basic ADL stuff.  If I lose my speech, who will help me?

One guy came into my workplace the other day.  He was elderly, and needed to use the phone AGAIN.  His phone had been cut off due to billing, and he confided all his bills were on minimum payment plans.  He comes in all the time to use the phone, but shouldn't he know about the Obama phone, as well as food stamps?  I asked him if he had ever heard of our state's welfare agency, and he said he never heard of them.  Why isn't anyone helping this man?  He is perfectly pleasant.  I gave him their phone number and told him he probably could get a free phone from them.  But I felt I had to do it in whispers, since the manager evidently just keeps letting him use the phone without educating him on how he can help himself.  So, who is going to help me help myself when I am that old?  No one is helping him!  So, they won't help me?

Every community/town/county has an office that specializes in assisting senior citizens weave their way through the maze of issues you've mentioned.  The level of assistance available varies, some are very hands on, others do little more than provide referrals.  In Ohio, these offices are known as "Council on Aging," and is a quasi-governmental agency.  If you cannot find the equivalent organization in your area, a call to your county government center or state (not federal) representative should get you their contact information.   Call them to make an appointment to learn what services they offer and how they can assist you with specific issues/questions.

A couple of other things. 

You can also look into a Medicare Supplemental insurance policy - the monthly premiums do not seem to be too bad.
As mentioned above for some things  Medicare covers 80%. For my 90+ year old Mom it makes financial sense to have it  to help with that 20% that is not covered but of course everyone's situation is different.

There also might be some assistance available if the person in question is a Veteran.  There is probably a Veteran's Service Officer in the County Offices that can offer advice.   My Dad was bed ridden the last few years of his life and needed a great deal of hands
on care. Which between my Mom and myself we were able to handle - up until my Mom was diagnosed with stage 3 cancer.
There was no way I could take care of both of them.  Fortunately as a WWII veteran my Dad was eligible for one of the state veteran nursing homes - the monthly bill was many thousands of dollars.  The VA paid a portion, the state paid portion, his long term insurance paid portion, his pension paid portion and I covered the rest.  I hated that Dad had to go there but there was no other choice and it was very nice facility that took excellent care of him until he passed at age 93.  Per his wishes, he was buried at sea by the US Navy from the very type of ship he served on - for which there was no charge. So if there is a veteran involved make sure you visit your local VSO and ask some questions.   

BTW - My Mom's treatments were successful and she's basically fine now.   :)


Uncle Duke

Quote from: Walks_At_Night on February 10, 2018, 09:43:56 AM
A couple of other things. 

You can also look into a Medicare Supplemental insurance policy - the monthly premiums do not seem to be too bad.
As mentioned above for some things  Medicare covers 80%. For my 90+ year old Mom it makes financial sense to have it  to help with that 20% that is not covered but of course everyone's situation is different.

There also might be some assistance available if the person in question is a Veteran.  There is probably a Veteran's Service Officer in the County Offices that can offer advice.   My Dad was bed ridden the last few years of his life and needed a great deal of hands
on care. Which between my Mom and myself we were able to handle - up until my Mom was diagnosed with stage 3 cancer.
There was no way I could take care of both of them.  Fortunately as a WWII veteran my Dad was eligible for one of the state veteran nursing homes - the monthly bill was many thousands of dollars.  The VA paid a portion, the state paid portion, his long term insurance paid portion, his pension paid portion and I covered the rest.  I hated that Dad had to go there but there was no other choice and it was very nice facility that took excellent care of him until he passed at age 93.  Per his wishes, he was buried at sea by the US Navy from the very type of ship he served on - for which there was no charge. So if there is a veteran involved make sure you visit your local VSO and ask some questions.   

BTW - My Mom's treatments were successful and she's basically fine now.   :)

Glad to hear your Mom is well.

Great point about the veteran aspect.  At least here in Ohio, the county Veteran's Services has a liaison with the Council On Aging who coordinates the activities of the two agencies.  I dealt with them for my Dad, the two agencies worked very well together to coordinate and not duplicate necessary activities.

Jojo

Sorry to hear about your loss.  But I'm glad his end time went as well as it did.  Amazing about your mom.  It's so confusing that some people are expected to get help from family, but there are entitlement programs, too.  (If state funding is in place, like he said).

Glad you have recovered from your health crisis and that the financial part of it worked out the way it's supposed to.

I appreciate the information on how the gaps in coverage work out. We do have an organization to help people.  It will be a while before I am 65, but I already have a lot (like more than 4) quality of life issues so if I make it to 65, I will probably have a lot of medical concerns.

I'm not considered a veteran, but I meet them frequently.

Thank you for opening my eyes to the likely combo of Medicare and Medicaid.  If i understand you right, neither cover most residential facilities.  With no family and and a very ugly low-income rental market here (very high cost, very sketchy quality), I would be much safer in a facility.  Unless I marry or something.

I'll check out the costs of supplemental insurance.  After all, people must think it's better than Medicaid, or they wouldn't put out the payments.

I feel a lot more informed about the process now, so thank you for putting the topic into regular language.  I hear people grumble about Medicare, and I've worked for a lot of healthcare providers who put down Medicaid.  But I think they all took Medicare. 

Thank you for your help.  I wonder how many other people are overwhelmed and confused.  It sounds like Medicare comes through for medically necessary services.  For me, the biggest out-of-pocket expense, then, will probably be palliative, OTC, herbs, things like that.

I suppose the success in one's Medicare depends on having a good doctor?

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