The LTC Medicaid Process

People over the age of 65 are more likely to be readmitted than younger patients, and readmission can be more serious for seniors.Readmission after an illness or injury is a serious health issue for seniors. However, it is important for seniors and their loved ones to remember that in many cases, readmission is avoidable and can be prevented with a thoughtful post-hospital care plan.Nearly one-fifth of all Medicare patients in the United States who are discharged from the hospital end up returning within 30 days.  There are many reasons seniors may need to be readmitted to the hospital, but healthcare agencies are focused on finding ways to reduce these numbers and educate patients about how to have a healthier recovery at home.For many seniors, this means having a quality caregiver that can help them overcome some of the main preventable causes for returning to the hospital. Consider the following:Medication is critical: Some seniors need assistance taking medication in the right amount on the correct schedule. When you consider that, on average, seniors with chronic conditions fill 50 different prescriptions annually, it is not difficult to imagine how someone could get confused when a new medication is added to their regimen. Caregivers can not only remind seniors to take medications as prescribed, but they can also help seniors keep a list of those medications and their dosages so the information is readily available for healthcare professionals. Managing medications is one of the best ways a caregiver can help seniors during their recovery.Follow up visits prevent readmission: A full two-thirds of patients readmitted to the hospital would have avoided that trip if they had seen their physicians within two weeks for follow up. The reasons for not following up vary but can include transportation difficulties and forgetting to make or keep appointments. Hospital staff can aid the senior by setting up appointments for the individual before discharge, but getting to the appointment can still be a challenge. In addition to a host of uplifting care services, caregivers can provide transportation to appointments and keep track of any post-care visits.Discharge plans only work when implemented properly: Having a discharge plan for the patient before he or she leaves the hospital can be crucial for recovery, but it can be difficult for seniors and their family members to focus on the plan during the stress of the illness and discharge. Caregivers can help the senior follow the instructions and will connect with family or other approved individuals when there are problems or change in condition during recovery. They can also help explain the information or ensure that the appropriate person is notified if the older individual has questions about his or her course of treatment. This takes the stress off the family and the patient so he or she can focus on recovery.Having a helping hand during recovery can ensure positive outcomes and a return to an active, engaged life. Family members, friends and neighbors are often willing to serve as a post-hospital recovery caregiver, but there is professional help available for those that dont have someone nearby to assist them. For long-term recovery, those who have the assistance of friends and family can benefit from a professional caregiver to provide respite care and support.Comfort Keepers Can HelpComfort Keepers caregivers can help with encouragement, support and assistance with daily living. And caregivers can encourage overall health through meal planning, grocery shopping, meal preparation and activities. Our custom care plans focus on physical and mental health and wellness activities. Our goal is to see that clients have the means to find the joy and happiness in each day, regardless of age or acuity.To learn more about our in-home care services, contact your local Comfort Keepers location today.ReferencesRelias. What you need to know about readmission among seniors. Web. 2016.American Hospital Association. Examining the drivers of readmissions and reducing unnecessary readmissions for better patient care 2011 AHA Policy Research. Web. 2011.Robert Wood Johnson Foundation. Ten things you should know about care transitions. Web. 2013. 

Congress recently made significant changes to Medicare's Part D prescription drug benefit as part of the Inflation Reduction Act. While some changes aim to help seniors afford their medications, others may have unintended consequences.On the positive side, insulin costs are now capped at $35 per month for Medicare beneficiaries. This has already provided relief for many seniors with diabetes.Starting in 2025, out-of-pocket Part D drug costs will be capped at $2,000 annually. Seniors will also have the option to spread these costs throughout the year through the new Medicare Prescription Payment Plan. These changes can benefit seniors who rely on multiple brand-name medicines or have fixed incomes.However, awareness of the new payment plan is low. Medicare could do more to inform seniors about this option, which requires opting in. Seniors should consider contacting their Part D insurers during open enrollment if they would benefit from spreading out pharmacy costs.The law's drug price negotiation provision has led to some unintended effects on drug development. At least 36 research programs and 22 experimental drugs have been discontinued as a result.Part D premiums have also increased. This year, standalone Part D plans were set to cost 21% more on average compared to last year. Many seniors switched to lower-cost options as a result. The number of available plans has decreased by about 25% since 2020.Some insurers have moved certain medications to tiers requiring higher out-of-pocket costs, restricting access to previously covered drugs. New rules like step therapy requirements have also been implemented, potentially making it harder for patients to access drugs their doctors recommend.It's important for seniors to understand these changes and their potential impacts on drug access before Medicare's open enrollment period begins in October.  Contact Carleen Lachman, Independent Insurance Specialist at 724-571-4688 to learn more.  

Health insurance jargon can be the hardest to understand for consumers. Thats why you have a broker who goes to work for you and explains your policy options with clarity. However, not all brokers work ethically. You may not have an insurance broker who values you and may not elaborate on your policy limitations. The omission of these limits is illegal and should result in the termination of that broker. In contrast, the insured typically doesnt take legal action, and the broker makes his or her desired commission.This is not to say that all health insurance brokers operate in this zone of immorality. Just as with any profession, there are good and rotten eggs. Your moral compass and ability to judge a persons intention is a significant factor people can typically smell a sleazy salesperson. Below, are the most common limitations obscurely mentioned in health insurance policies. This information should adequately equip you for when you are asking questions of your broker.Heres a screenshot from the summary of the benefits of an insurance carriers product:*Note these limitations do not exist in all policies. Ask your broker.The list of benefits above is towards the end of the policy summary. Most people are interested in seven factors when it comes to their health insurance:Deductible/coinsurance/max out of pocket, doctor visits/specialists/urgent care, the network, prescription coverage, preventative/wellness coverage, emergency room fees, and ambulatory services. If your insurance broker goes over those seven things, this is how the policy would look and sound:Choice of $500-$10,000 deductible/max out of pocket (1 million in coverage)Choice of 70/30, 80/20, or 100/0 coinsuranceUnlimited $25 copay to doctor, specialist, and urgent carePHCS Network (PPO)$50 copay for annual wellness/preventative checkupER subject to deductible and coinsuranceAmbulatory services (above) $500 per transportMost people would agree that those seven things sound fantastic for health coverage. You have all your daily doctor needs taken care of and one million dollars in coverage, right? Wrong, let me show you a scary breakdown if you had an appendectomy while being covered by this policy.On average, the Fair Price for an Appendectomy lies somewhere between $7,000 and $25,000 (may vary due to zip code). If there are complications, it could be upwards of $35,000 or more. Heres a breakdown of the services and their estimated costs. You can always check on any surgery, and its price by visiting Healthcare Bluebook.Hospital Services for a 2-day admission, itll cost roughly $9,700.Physician Services the fee for procedure and routine postoperative care costs around $1,400.Anesthesia the price for an average surgery time of 1 hour and 15 minutes costs about $750.This cost adds up to the lower end of about $11,000 for an appendectomy. If you look above at the example policy, youll see that for the entire coverage term an appendectomy will be given a $2,500 coverage benefit. Even though your plan has a deductible, coinsurance, and max out of pocket; theres a specific limitation for appendicitis. With this knowledge, the insured will be left an $8,500 bill as an out of pocket expense! Keep in mind; these numbers are on the low end with no complications.Of course, its always better to have health insurance instead of going uninsured. With insurance, that remaining $8,500 for the appendectomy may negotiate to a lower bill. Policygenius.com does a great job explaining the functionality of network negotiated rates. Without insurance, you would be paying the almost full retail price for your medical surgery, which is a terrifying thought!