What if you're not quite sick enough (according to insurance standards ) for nursing home, but too sick to be cared for at home?

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carol1948 Asked September 2014

What if you're not quite sick enough (according to insurance standards ) for nursing home, but too sick to be cared for at home?

My friend has been living in my home for 16 mos. her condition has deteriorated drastically in that time. Has been in hospital 6 times in last yr. Went back in 3 weeks ago, and still there. I can no longer care for her at home, but she does not have Medicare as her primary and choices are very limited. It looks like we may get her into rehab . I want her in a safe place. would anyone have a suggestion ? I am 65 and my friend is 62. I am her legal guardian . She has Multiple Sclerosis and dementia. I took care of my husband who had Parkinson's and Dementia until he passed away 2 yrs. ago. So I have an understanding of her physical needs . I don't know where to turn. Her family is not involved and will not help. Any suggestions would be greatly appreciated.

Skilled Nursing Facility

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score 0 · Answer 1

I have Blue Options which is a group plan with my former employer who continues to cover me, my wife and our two boys.

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score 0 · Answer 2

cmagnum, which Blue Cross plan do you have ?

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score 2 · Answer 3

Thanks everyone, I gathered all the advise and I have been in touch with social worker today. We are making progress. You are right ba8alou, blue advantage is a medigap plan. I finally met with a nursing home admissions co-ordinator today. She told me how to go about changing the insurance to a better plan for my friend. I also have the papers to start Medicaid ( the insurance won't change until Oct. 1st ) The nursing home is dealing directly with social worker and Blue Cross. They think we may get rehab approval by tomorrow. I appreciate all the input, it was so nice to hear from people who really wanted to help ! Thanks !

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score 0 · Answer 4

People on disability go on medicare automatically and is treated as primary. I'm on disability and that is how it worked for me. I have another health insurance policy with BCBS, but it is treated as secondary.

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score 0 · Answer 5

Persons on disability are eligible for Medicaid. In some states it is automatic; in others you have to go through the application process. This is definitely the route for you to pursue!

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score 0 · Answer 6

According to my Googling, Blue Advantage is a medigap plan. One of our insurance gurus needs to weigh in here.

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score 0 · Answer 7

Yes, she's very lucky to have you! But don't let them discharge her until you have this straightened out. Much easier to get someone into a facility from a hospital than from home. Remember, they can't force you to take her home.

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score 0 · Answer 8

Hmmm. I thought that Medicare was always the primary. What is she in the hospital for? And does she have Medicaid? It seems that getting her on Medicaid would be beneficial. Unless Blue Advantage is actually a Medicaid plan?

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score 0 · Answer 9

She has been on disability for about 17 yrs. She has insurance called Blue advantage . Hospital explained that Blue Cross is primary and Medicare is secondary , which seems to be the problem. If they refuse Rehab, I don't know what to do next. I have a sick feeling right in the pit of my stomach !

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score 0 · Answer 10

Talk to the social worker about getting her qualified for Medicaid. Is she on disability?

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score 1 · Answer 11

Carol, did your friend get on disability when she was no longer able to work? That eases the way for getting Medicaid.

Getting social services involved in determining options is a very good idea.

Your friend is lucky to have you on her side!

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score 1 · Answer 12

I appreciate the input . I will check all options. Thanks, Carol

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score 2 · Answer 13

Have a meeting with the social worker and discharge coordinator about rehab possibilities. Even though she is under 65, she should be on Medicare NOW, and receiving monthly checks, due to her disability. Apply on line for her at ssa.gov.

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score 3 · Answer 14

That she's in the hospital is a good thing from the standpoint of finding her adequate alternative care. If you talk to the Social Services Department, I'm confident they can walk you through some alternatives for her.

If she can private pay for a while, she'll have more options.

Get Social Services involved immediately if you haven't already done so.

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What if you're not quite sick enough (according to insurance standards ) for nursing home, but too sick to be cared for at home?

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