Understanding Your Senior’s Coverage Plan

by Lois Etienne on December 29, 2010

in Insurance

Senior-Mother-And-Boomer-DaughterQ. 84-year-old mother, who has been in excellent health all of her life, recently fell and spent several days in the hospital following hip surgery.  She’s now coming home and my family and I are trying to work through the medical healthcare maze.  Can you help?

Most families don’t know what Medicare or private insurance covers until they need it, says Lois Etienne of of Home Instead Senior Care.  Following, from the Web site www.familycaregiving101.org, sponsored by the National Family Caregivers Association and National Alliance for Caregiving, are tips to help.  Refer to the site for a more complete list:

Know What Your Insurance or Managed Care Company Is Responsible for Covering

  • If your loved one has been hospitalized, insist on being consulted by the discharge planner about the care plan before decisions are made.  Explore all the options, not just the one the discharge planner recommends.
  • Find out what your insurance company will approve for your loved one’s care, why, and for how long.
  • Try to get one person from the insurance or managed care company (a case manager) assigned to your loved one’s case and make sure that person fully understands the patient’s condition so that the correct home care services and equipment are provided.

Identify and Use All Available Resources

  • Get to know your local pharmacist, who is an excellent and readily available resource.
  • Discuss your options with people outside of your network who have experienced your situation.
  • Have friends and family help with some of your managerial chores – sorting out bills, reviewing insurance policies, etc.  Do not let bills pile up.
  • Consider hiring respite help, such as Home Instead Senior Care, which employs CAREGivers to go into the homes of seniors to help with companionship and non-medical tasks.

Be Assertive About Your Rights

  • You can say no if hospital discharge planners want to send your loved one home and you feel you are not prepared to provide the necessary care at home. Be flexible but firm as you negotiate a feasible plan.

If someone tells you “Medicare (or another insurance plan) won’t pay for it,” don’t stop there.  Check it out yourself through your State Health Insurance Assistance Program, the Medicare Rights Center at (212) 869-3850 or online at www.medicarerights.org, or through another independent source.

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