This week, I received a shocking text message from one of our clients I would like to share. You may never know when you or one of your family members will experience a life changing medical diagnosis.
Toni: I need to put together a 24/7 home care recovery plan after a liver transplant. The surgery is over a year out, but I would appreciate some tips on Medicare and how to plan for this event. Thanks in advance — a Toni Says client. (name withheld for confidentiality)
This text made me realize most people are not prepared for a life-changing medical need such as a transplant.
Luckily, my client has a Medicare Supplement allowing him and his doctors together to pick which rehab/ skilled facility he will use while recuperating after he qualifies medically to have rehab/skilled nursing services.
In the Medicare and You handbook, it discusses transplants and immunosuppressive drugs. It states that “you must have Part A in place at time of the covered transplant, and you must have Part B at the time you get immunosuppressive drugs. You pay 20% of the Medicare approved amount for the drugs and the Part B deductible applies.”
The handbook also states, “If you’re thinking about joining a Medicare Advantage Plan (like an HMO or PPO) and are on a transplant waiting list or believe you need a transplant, check with the plan before you join to make sure your doctors, other health care providers and hospitals are in the plan’s network.
“Note: Medicare drug plans (Part D) may cover immunosuppressive drugs if they aren’t covered by Original Medicare. In other words, be sure you have a complete Medicare Part D planning consultation before you enroll in a specific Medicare Part D plan to be sure that the Part D plan chosen covers all of your transplant drugs.”
If your Part D plan does not cover all of your transplant prescription drugs, then who will pay? You will.
Regarding my client’s question about Medicare paying for 24/7 at-home care while he is recuperating from his liver transplant, I didn’t have good news.
Medicare pays absolutely nothing for at-home while recuperating from a transplant or any illness. Medicare will pay for home health visits if there is a doctor’s order and it meets Medicare requirements.
Medicare will only pay for rehab or skilled nursing. If you do not meet Medicare’s qualifications for skilled nursing, you will pay 100% of the cost out of your pocket
I’ve informed him to begin speaking with what is called at-home provider services and his church about getting their help with round-the-clock help at home to help his wife. If he has a long-term care policy, it may pick up some costs.
In today’s financial climate, America has new long-term care options to maximize the 401K capabilities and get more bang for your 401K dollars.
If you are still confused and would like to discuss your specific Medicare circumstances either email info@tonisays.com or call 832-519-8664 and the Toni Says® team can help you.