Humana Medicare "Take Advantantage" Plan

VANITY

[tired&retired]

How can Humana change the coverage after the patient is admitted?

I logged into the indiviual account and printed the "My Benefits" in November when a close friend was hospitalized for a severe stroke. I have full medical and legal POA.

The "Plan Benefits" showed FULL PAYMENT Coverage for skilled nursing through day 100.

While she was admitted, they changed her plan to only cover 80% through day 100. With a $203 per day co-pay, that is a lot of money she doesn't have.

How can they change the plan during continuous admission?

In addition, they keep denying any payment saying she is not benefitting from the treatment. She clearly is benefitting based upon a team of medical specialists who ordered rehabilitation treatment and are evaluating her on a regular basis.

Five times now they denied coverage five times I appealed and won. They are doing this to everyone. United Healthcare is doing the same.

This week, I won the appeal on Saturday and Monday they denied payment again.

I feel bad for all the senior citizens who have lived one's in treatment and must fight for coverage. Humana is ripping off many people and Medicaid by forcing people out of coverage.

In this case, she must give up her home for rehab, thus she has no place to live after she improves and no longer needs care.

If she were an illegal immigrant, all this would be paid by the government.

Any advice is welcome as my blood is boiling, I'm that angry at the Medicare Advantage rip-off plans.

[Jim Noble]

If I keep working & having employer-sponsored health insurance past age 65 does that push my window out to the date my employer coverage ends?

Usually, yes. Some employers require you to have Medicare as your primary (mine doesn't), if so, activating Medicare Part A as your primary might trigger the Part B obligations/rules.

[Nailbiter]

medicare

[GnuThere]

This is exactly it.
A MCare Advantage company may issue blanket denials for all skilled nursing requests from a hospital on the first request for a patient, or at least refuse a significant percentage (hmm, perhaps a quota so as not to look suspicious?).

They very well know that in the time spent on an appeal or “peer-to-peer” doctor call required, a certain percent of patients will die or get better and go home, thus avoiding any skilled nursing payments. So the hospital eats the extra days, because they get paid by diagnosis code, not for the extra days needed to jump through hoops.

[oldeguy]

I am going to give you a verbatim list from a United Healthcare booklet, “A Simple Guide to Medicare”, and I would recommend that you pick one of these up or go to Medicare.gov for more information.

Basically, you have a seven-month enrollment period for Medicare (IEP). It begins the month you turn 65, the 3 months before, and the 3 months after. It begins and ends a month earlier if your birthday is on the first of the month.

You may be able to delay enrollment if:
1) The employer has 20 or more employees
2) The employer provided health insurance is considered “credible”
3)The employer doesn’t require the covered spouses to enroll in Medicare at age 65 in order to remain on the employer’s plan.

You must also get a certificate of “credible drug coverage” from the plan administrator. You must have this documentation to avoid a Part “D” penalty if you plan to delay enrollment.

I hope this helps. There is a lot of information available from Medicare.gov that will help you avoid some of the pitfalls of enrolling at the wrong time.

[TropicanaRose]

Great, thank you!

Mine doesn’t either.

[TropicanaRose]

Great, thank you!

1 & 2 apply. My current plan is a grandfathered pre-ACA plan that may not be considered credible as it does not cover preventative care, but other plans are offered that would likely be considered credible & could switch to one of them before my 65th birthday.

My employer-sponsored plans are so much better & cost so much less than Medicare that combined with the flexibility of the job has me thinking I should work there as long as I am able.

[oldeguy]

"My employer-sponsored plans are so much better & cost so much less than Medicare that combined with the flexibility of the job has me thinking I should work there as long as I am able."
That is probably wise, but keep in mind that the credible coverage also applies to the prescription drug plan. You can find all of that information on the Medicare.gov site.