Why Traditional Medicare is Best for Treemont Senior Living in Houston Residents
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We recommend Traditional Medicare for seniors 75+ for the following reasons:
- Traditional Medicare provides the Maximum Flexibility to choose one’s doctors, hospitals, specialist, rehab center, nursing home, home health care and hospice providers without having to be restricted to limited providers that are in-network. Plus you and your healthcare professionals make the decisions on progress, not an unseen case manager paid by the Advantage Plan. Treemont Health Care Center (HCC) had a situation where a resident waited an extra 4 days in the hospital while their Advantage Plan approved their insurance so they could transfer to Treemont’s nursing facility. Advantage Plans also require approval every 7 days for you to stay in a nursing/rehab setting. That would not happen under Traditional Medicare insurance coverage, pre-approvals are required. You choose where you want to go with maximum flexibility.
- Treemont Likes to Keep an Eye on Treemont Independent Living Residents and we can best do this if residents have Traditional Medicare to best utilize the resources that are part of our continuing care campus. Executive Director Rodney Brooks and his team keep an eye out for changes in a resident’s health. Rodney looks to Senior Allegiance to do an evaluation/assessment as Treemont has a Preferred Provider relationship with this home care entity. Senior Allegiance Home Care takes Traditional Medicare. Being on Traditional Medicare also makes it easier for us to get residents the care for which they are qualified. According to Rodney, he has come across situations where care is very much needed, but they couldn’t locate a competent provider that would accept their Advantage Plan—a challenging and frustrating situation that he never wants find residents in.
Below is an example of a Treemont resident who switched to Traditional Medicare. The resident previously paid the following out-of-pocket costs for Personal Assistance Services:
- Restorative therapy at $25/session at 3 sessions/week = $300/month.
- Bath assistance at $10/bath, 3 sessions/week = $120 month
- Total monthly out of pocket is $420.
- If you qualify for a Medicare home health episode, often baths and other services, such as managing medications, can be included as part of the episode which would not qualify on a "stand alone" basis for Medicare coverage.
Senior Allegiance can often get you qualified for baths or other services which do not qualify on a “stand alone” basis for Medicare payments.
Please contact me, Lisa Witt, at LisaW@TreemontHC.com to ask about your specific care needs and if you would qualify for Medicare Home Health visits.
Treemont Health Care Center (HCC) takes Traditional Medicare and has a contract with Humana Advantage Plan. Some insurers will allow care at Treemont Health Care Center on a case by case basis but, even when allowed, this often results in delays for residents and substantial additional paperwork with possible delays. As with Senior Allegiance, the HCC has attempted to obtain contracts with other insurance plans, but have been turned down by insurers who say their current network is sufficient and they are not adding any new providers.
Cost Comparison. We no longer see the cost savings, with Medicare Advantage Plans now implementing co-pays similar to those of Traditional Medicare. Plus you can’t get a Medicare Supplemental (Medigap) policy with an Advantage Plan to cover unexpected medical costs.
Traditional Medicare allows full access to Treemont’s Continuum of Care Campus and permits the team to provide the care for you or your loved one based on their needs. If you switch to Traditional Medicare, you will typically want to purchase a supplemental plan also known as Medi-Gap plans. One quality plan is AARP Plan F (about $240 per month for 80+ year olds.) which is a United Healthcare plan. Naturally, you need to select the best option for your family, considering co-pays, deductibles and likelihood of high care needs.
**SPECIAL INCENTIVE to Sign Up for Traditional Medicare** - If you sign up for Traditional Medicare or stay on Traditional Medicare, Treemont will provide the following incentive. When a resident has a rehab/nursing home stay at Treemont Health Care Center, Traditional Medicare pays for the first 20 days of care at no cost to you. On days 21 to 100, you will have to pay a daily co-pay of $167.50 (2018 rate) for your care, and you continue to pay the rent on your independent living apartment. If you are on Traditional Medicare in Treemont’s Health Care Center, your independent living rent will be waived during days 21 to 100. (If you are part of a couple, your $500 second person fee will be waived.) This is only available for residents on Traditional Medicare, NOT for those on a Medicare Advantage Plan.
As the September 15 to December 7 Medicare enrollment period draws near, I encourage you to take the time to understand what your current Medicare Plan (Traditional Medicare or Medicare Advantage Plan) is, the benefits it provided, and understand if Treemont and Senior Allegiance are within your network of providers.
We urge you to also understand what your co-pays and deductibles are before you have a health setback and need to use your insurance plan. Please do your research and make the choice that works best for you! If you have questions, please call Lisa Witt at 505-797-8735 or via LisaW@TreemontHC.com to discuss your Medicare options. We are happy to check which Medicare Plan you have so you choose with all the facts in hand. You may also speak with Janie at the Front Desk. Give her your contact information and the best time for Lisa Witt to call you.