Manage your money - we can help.

Rehab Nurse Shares Insight: Medicare/Advantage/Medicaid Part 2 of 3

The following is a summary from a nurse who worked many years in a Rehab facility. This is not to be interpreted as professional counsel, but seen through the eyes of medical professional giving account of their experience as such.

[Erin] Well, we know that right now we’re in open enrollment for Medicare and do you have anything you want to input on that?

[Ilona] Yes, (this is) coming from a nurse that has been in a rehab setting familiar to the history of having or needing a rehab stay. So I would say the biggest thing is to do your homework. With Traditional Medicare you can go to whatever doctor you want. You will need a supplement and those can be costly. With a managed care it might be a little bit less expensive, but there might be stipulations. You may get this – You may not get this. You may get equipment. You may not get equipment.

You may be able to go to a specialist, but you need the doctor to write a letter saying why you need to go to a specialist. So it could be time consuming to get that authorization -and- also you need to check with your Primary Physician. (Suppose) if you decide to take Humana HMO you may need to call up your doctor and say “do you take Humana HMO?” And they might say, “Well, yeah, it says on our website that we do take it. If we’ve met our quota for Humana HMO patients and (i.e.) – right now we are not taking them (patients).”

So be very, very specific. Everybody will say they’re taking it, but when you get down to the nitty gritty, well, they’re only going to take ten because Humana (experientially) Humana really doesn’t pay that well and we can only afford to take ten patients.

[Erin] Wow, this is a lot of insight – this is behind the curtain kind of information. This is real life working, scenarios.

[Ilona] And you have to remember that all these flyers and information you’re getting from all these insurance companies that they are selling; part of this is sales. So you to need to do your background checks. Say you are snowbird and you’re buying insurance (elsewhere) up in New York somewhere and you come to Florida. Make sure you check that you have coverage in Florida, make sure you have coverage in Charlotte (your residential) County, get down to the details. Some people’s insurance will not follow them out of state or out of county. So you have to ask all those questions to make sure you know (that) when you sign up for your insurance, they will cover wherever you go. If you travel out of state, out of county, and exactly what it covers or where it covers. They don’t tell you those kinds of things.

[Erin] There’s just so much to be aware of and so much to plan for. In the event someone has an issue where they go in and they’re going to require Medicaid, you know, if they don’t have the funds or availability. Is there a liaison in that instance at a rehab facility? Are there people, I mean when you walk in that can (help) I can’t imagine being thrust into this and not having a plan (thought out process). What’s your Hail Mary? You know, what do you do if you walk in the doors and your spouse whatever is in urgent care and needs these things, and you haven’t done your homework, is there any sort of lifeline or something that someone can call upon?

Share this post