[Fredslist] RENATTO - Medicare, Medicaid, and what YOU should know

[Raj Goel]

Gotham,


  1.  THANK YOU - the responses & advice I received was helpful & heartwarming.


  1.  Here's what I have learned in the past 24 hours.



  1.  When you're taking care of elderly or ill family members, you should have the following information handy:
     *   Their FULL LEGAL NAME
     *   Current address
     *   Date of Birth
     *   Social Security #
     *   Email address & password
     *   Bank account numbers, login username, passwords, secret questions and answers



  1.  Medicare, Medicaid, Private Health Insurance, Dental & Vision insurance
     *   policy numbers,
     *   contact phone numbers,
     *   policy coverage dates,
     *   policy benefits,
     *   policy limits
     *   Where coverage OVERLAPS, where you have JOINT coverage and where 1 plan ends and another begins
     *   (yes, this is a LOT of confusing information)



  1.  EVERYONE speaks in jargon and code.  WRITE DOWN the jargon they use and ask what it means.


As for my father-in-law, here's a quick synopsis.

He's 65+ and has

  *   Medicare PART A (Hospital care)
  *   Medicare PART B (Medical care)
  *   Medicare Part D (Prescription coverage)
  *   He also has MEDICAID (which is for people with limited income)
  *   MEDICAID MANAGED Long Term Care (MLTC) with HealthFirst
  *   (that's 5 different plans before we touch vision & dental...)

His MEDICARE benefits ran out because he has been in hospital+rehab for more than 100 days

The VERY SCARY Skilled Nursing Facility Advance Beneficiary Notice of Non-Coverage (SNFABN) form is simply Medicare telling the facility they won't pay for him anymore and the facility needs to apply to his secondary insurance.  That means Medicaid and healthFirst.

Now, we're waiting for HealthFirst to tell the nursing home what benefits and for how long they will cover him.

The summary is the result of 4 hours on the phone with 5 different instutituons.

Important Phone Numbers:

MEDICARE - Federal  800-633-4227
MEDICAID - New York State - 800-541-2831
Medicare LONG TERM CARE OMBUDSMAN 800-342-9871
HEALTHFIRST - 866-463-6743

I hope this helps someone.


EDITORIAL:

The ENTIRE MEDICARE  PARTS A, B, D (oh wait, Medicare PART C eliminates the need for Parts A. B. D) + Medicaid + MLTC system is designed to confuse, frustrate and annoy people.

There's no reason why the elderly, the infirm and those without copious free time should have to call 4-6 organizations and THEN stitch together the answer.

A sane country would replace this bureaucratic maze with a simpler system.  But because we are Americans and we don't want to see our neighbors benefit, we have built this enormously complex bureaucracy from hell.

--Raj

Rajesh Goel, CISSP
cell 917-685-7731
raj at brainlink.com<mailto:raj at brainlink.com>
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