Are you sure you want to exit? Your progress will be lost.
Who are you caring for?
Which best describes their mobility?
How well are they maintaining their hygiene?
How are they managing their medications?
Does their living environment pose any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
Which best describes your loved one's social life?
Acknowledgment of Disclosures and Authorization
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment. You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
✔
I acknowledge and authorize
✔
I consent to the collection of my consumer health data.*
✔
I consent to the sharing of my consumer health data with qualified home care agencies.*
*If I am consenting on behalf of someone else, I have the proper authorization to do so. By clicking Get My Results, you agree to our Privacy Policy. You also consent to receive calls and texts, which may be autodialed, from us and our customer communities. Your consent is not a condition to using our service. Please visit our Terms of Use. for information about our privacy practices.
Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
Remember, this assessment is not a substitute for professional advice.
Share a few details and we will match you to trusted home care in your area:
I'm not sure if I understand the question but when my Mom was in this situation we continued these payments. The ltc facility paid the premiums out of Mom's monthly social security and pension income, all if which went directly to them. I never gave it much thought...just figured there may be a benefit for the facility if the insurance continued to be paid. My only concern was that Mom was given the care she needed and that she was comfortable and content.
Ask Medicaid in your state what their requirements are regarding prescriptions and if you should still be paying the premiums for Medicare or to Medicaid.
When in a nursing home and receiving Medicaid long-term care benefits the recipient required to have a Medicare Part D Rx plan. The recipient will automatically be enrolled in the "Low Income Subsidy" program (LIS) and can switch between Part D plans at will. If the recipient does not choose a plan one will be chosen for him/her at random. The premium is paid by the state and the maximum premium amount allowed varies by state (you can search for "low income subsidy premiums by state" to find your state's maximum allowable premium - do not choose a plan with a premium higher than this amount). Rx deductibles and co-pays are also paid for by Medicaid. I always recommend asking the nursing home which plan to choose since they will be responsible for navigating pharmacy needs.
With respect to Medicare supplements, a Medicaid recipient may keep a Medicare supplement and the premium can be paid from the recipients income before Patient Responsibility is paid to the nursing home. You must receive approval for the premium payment from the Medicaid agency. The only negative consequence to retaining the supplement is that the premium may reduce income that can be diverted to the community spouse if there is one. Otherwise, since there is no other negative consequence to retaining a Medicare supplement and, depending on the state, perhaps some advantage, I generally recommend keeping the supplement.
Thanks, Ralph! We're going to be in that situation hopefully sooner or later with a Medicaid application pending and a supplemental insurance policy paid from Mom's survivor annunity from Dad's federal retirement. The supplemental has paid prescription costs with the exception of a co-pay. Mom is currently in a LTC facility.
We're working to have Mom Medicaid eligible by Nov 1st.
At what point would Medicare part D take effect? Would any of that be retroactive and cover prescriptions costs from the point at which she became Medicaid eligible or is this a totally separate situation that takes effect later with no retroactive period?
Reason we're asking is that we need to know if we should pay the pharmacy costs with the remainder of her funds going to the LTC facility while waiting for Medicaid to approve.
Part D takes effect the month of Medicaid eligibility. The applicant may have to private pay until the enrollment in Medicaid goes through at which point the Medicaid recipient will be sent a check to reimburse for premiums paid.
Let's clarify: You said that mom has supplemental coverage that includes prescription costs except for a co-pay. Are you looking to drop the supplemental Rx coverage (not the supplement itself) and substitute Part D or are you looking for Part D to cover the co-pays not covered by the supplemental Rx coverage?
I don't believe you can have Rx coverage from a private plan AND Part D but I am not sure. Perhaps the business office at the facility can give you the answer to whether you can have both plans simultaneously. If they are not sure, or you want to double check, 1-800-MEDICARE does a great job answering questions of this nature.
I do know, however, that most states will allow the Medicaid recipient to pay for recurring unreimbursed medical expenses from their income BEFORE the nursing home is paid. In Florida, this is called the "Uncovered Medical Expense Deduction" and is based on the expenses of the last six months and is re-evaluated every six months. So, if you wanted to keep the supplemental Rx, which you might want to do if, for instance, if the supplemental formulary has drugs that the Part D plan may not, you could have the co-pays covered by mom's income with no penalty to her. (Part D for a Medicaid recipient falls under the "Low Income Subsidy" (LIS) program. The premium is paid by the state and each state has a maximum premium they will pay for an LIS plan. Because these are generally the lower cost plans, it is possible that the formulary may be limited in some respects. I suggest asking the facility which Part D plan they recommend for their Medicaid recipients as they will have to administer the program. You can then go to Medicare.gov and check the formulary of the plan against your mother's Rx needs.)
Thanks, Ralph. Sorry to get back to you so late. Really appreciate your answer.
In summary, we'll likely keep the secondary insurance coverage through the retirement annuity survivor benefit and would then add Part D, if required, on top of that. According to what our state has posted online, it looks having Medicare Part D, Medicaid, and other insurance is a legal possiblity for which they account.
The big question is now that we're in official limbo status...Medicaid pending and now eligible since the beginning of November, do we have to pay the pharmacy bill? The question doesn't apply this month because they didn't send us a bill. Next month they probably will and we'll owe them. Should we pay the pharmacy or should we wait for Medicaid once it approves?
Sounds like a quick call to 800-MEDICARE might be in order, and we really appreciate that advice.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
With respect to Medicare supplements, a Medicaid recipient may keep a Medicare supplement and the premium can be paid from the recipients income before Patient Responsibility is paid to the nursing home. You must receive approval for the premium payment from the Medicaid agency. The only negative consequence to retaining the supplement is that the premium may reduce income that can be diverted to the community spouse if there is one. Otherwise, since there is no other negative consequence to retaining a Medicare supplement and, depending on the state, perhaps some advantage, I generally recommend keeping the supplement.
We're working to have Mom Medicaid eligible by Nov 1st.
At what point would Medicare part D take effect? Would any of that be retroactive and cover prescriptions costs from the point at which she became Medicaid eligible or is this a totally separate situation that takes effect later with no retroactive period?
Reason we're asking is that we need to know if we should pay the pharmacy costs with the remainder of her funds going to the LTC facility while waiting for Medicaid to approve.
Part D takes effect the month of Medicaid eligibility. The applicant may have to private pay until the enrollment in Medicaid goes through at which point the Medicaid recipient will be sent a check to reimburse for premiums paid.
Let's clarify:
You said that mom has supplemental coverage that includes prescription costs except for a co-pay. Are you looking to drop the supplemental Rx coverage (not the supplement itself) and substitute Part D or are you looking for Part D to cover the co-pays not covered by the supplemental Rx coverage?
I don't believe you can have Rx coverage from a private plan AND Part D but I am not sure. Perhaps the business office at the facility can give you the answer to whether you can have both plans simultaneously. If they are not sure, or you want to double check, 1-800-MEDICARE does a great job answering questions of this nature.
I do know, however, that most states will allow the Medicaid recipient to pay for recurring unreimbursed medical expenses from their income BEFORE the nursing home is paid. In Florida, this is called the "Uncovered Medical Expense Deduction" and is based on the expenses of the last six months and is re-evaluated every six months. So, if you wanted to keep the supplemental Rx, which you might want to do if, for instance, if the supplemental formulary has drugs that the Part D plan may not, you could have the co-pays covered by mom's income with no penalty to her.
(Part D for a Medicaid recipient falls under the "Low Income Subsidy" (LIS) program. The premium is paid by the state and each state has a maximum premium they will pay for an LIS plan. Because these are generally the lower cost plans, it is possible that the formulary may be limited in some respects. I suggest asking the facility which Part D plan they recommend for their Medicaid recipients as they will have to administer the program. You can then go to Medicare.gov and check the formulary of the plan against your mother's Rx needs.)
In summary, we'll likely keep the secondary insurance coverage through the retirement annuity survivor benefit and would then add Part D, if required, on top of that. According to what our state has posted online, it looks having Medicare Part D, Medicaid, and other insurance is a legal possiblity for which they account.
The big question is now that we're in official limbo status...Medicaid pending and now eligible since the beginning of November, do we have to pay the pharmacy bill? The question doesn't apply this month because they didn't send us a bill. Next month they probably will and we'll owe them. Should we pay the pharmacy or should we wait for Medicaid once it approves?
Sounds like a quick call to 800-MEDICARE might be in order, and we really appreciate that advice.