Why Traditional Medicare is Best for Treemont Assisted Living in Houston Residents
In discussions over the past month with Treemont families and residents, I realize there is much uncertainty regarding whether residents have Traditional Medicare vs a Medicare Advantage Plan. Everyone over age 65+ has Medicare. If you would like us to do a
“quick check” on which Medicare coverage you have, please call or email me with 3 pieces of information:
Name of Senior
Social Security Number (SSN)
Date of Birth
Treemont is advocating Traditional Medicare with a supplemental plan for resident age 75+ for the following reasons:
• Traditional Medicare provides the Maximum Flexibility to choose one’s doctors, hospitals, rehab, center, nursing home, home health care and hospice providers without going through the intermediary of an “Advantage Plan” case manager. We had a recent 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 Health Care Center. 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. Approvals are automatic. 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. Executive Director Rodney Brooks and his team keep an eye on Independent Living residents. If there seems to be a change in a resident’s health, Rodney looks to Senior Allegiance to do an evaluation/assessment. The simple truth is that Senior Allegiance Home Health only takes Traditional Medicare. Being on Traditional Medicare also makes it easier for us to get residents the care for which they are qualified. Below is an example of a Treemont resident who is switching to Traditional Medicare. The resident currently pays for:
- 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, we can often get you qualified for baths or other services which do not qualify on a “stand alone” basis for Medicare payments..
Please call us 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 by Treemont. We have attempted to obtain contracts with other insurance plans, but we have been turned down by insurers who say their current network is sufficient and they are not adding any new providers.
Cost Comparison. Traditional Medicare may cost more upfront per month ($104 base cost), but it permits you to stay on Treemont’s Continuum of Care Campus and permits the team to provide the care you or your loved one needs. If you switch to Traditional Medicare, you will typically want to purchase a supplemental plan. 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.
As the Dec. 7th deadline draws near, I encourage you to understand what your current Medicare Plan is, and understand if we are within your network of providers. We urge you to also understand what your co-pays are, and deductibles are before you have a health setback and need to use your insurance plan.
Marketing Manager/Owner Lisa Witt will be on campus on Monday, December 5th. She is also available by phone at 505-797-8735 to discuss your Medicare options. We are happy to check which Medicare Plan you have so you choose with all the facts in hand. For Treemont residents, If you would like the opportunity to discuss your insurance coverage options with a knowledgeable Treemont staff person, please sign up at the Front Desk with Mariana.