My Grandma (87) broke her shoulder and is at skilled rehab for the first time. If she needs to become a resident, do we keep Blue Cross 65?

First of all, you never pay for anyone elses stuff but your own. Call the Blue Cross place and find out what their ruling is. usually that would come out of your grandmothers finances. check with an Elder attorney as they would know all about that kind of stuff and be able to help you with that. wishing you luck

social services, head of hospital, blue cross, SCAN, Medicaid, etc. lawyer. etc. her attorney, CPA, etc.

In Massachusetts, people are allowed to keep their supplemental insurance and the premium amount is subtracted from the amount of their SS that goes to the nursing home so that the Blue Cross can be paid. Perhaps your state does the same. The liaison in the business office at the rehab/nursing home should be able to answer that question. In order for her to stay as a Long Term Care resident, she will have to medically qualify and she will need to be assessed to see if she is eligible to stay in long term care. If she has any extra assets, they can be used to prepay for funeral expenses before she goes onto Medicaid. Here in Mass. they also allow a burial account at a savings bank. That money cannot be withdrawn until the owner of the account dies. A death certificate must be produced. If she does apply for LTC Medicaid, you will also need to know of any life insurance policies that she may have. An elder law attorney can give you a list of what needs doing. Even if she doesn't qualify to stay and is instead sent home, now is a good time to learn about this process so that you aren't blindsided later. There is a lot to understand and it's good that you are thinking about it now.

Imho, you may want to retain an elder law attorney.

Medicaid will allow your grandmother to keep her insurance. But once she is in LTC on Medicaid, she probably won’t need her BCBS policy anymore, all her medical expenses should be paid between Medicaid and Medicare.

Be careful about "spending down". See an eldercare attorney for estate planning.

Is she in a nursing home or assisted living? In Ohio most AL facilities don’t accept Medicaid unless the recipient has been a resident for 2 years? That includes Memory Care units in AL facilities.

My mother lives in a LTC facility in NYS and is on a Medicaid spend down to qualify for Medicaid to pay for her living there. She has a supplement plan to go with Medicare and the cost of Medicare and the supplement come off he income before the amount of the spendown is figured. Check with Social services about this. While they are busy they are very helpful. Once she is on Medicaid they will cover her medical expenses after Medicare pays but she will need a part D plan to cover her drugs. Medicaid told me they actually prefer clients keep their supplemental insurance since it saves them expenses.

My 98 year old mother has BCBS Gold which is a supplemental and she is grandfathered into the plan, once it is cancelled she would never get it back, BCBS does not offer this type of plan any longer. the policy cost almost $900, and covers everything after Medicare. Be careful about canceling her policy until you get the facts. I would call Medicaid and discuss it with them but I would speak to the supervisor and It would not hurt to call Medicare as well to clarify things.

1) I agree with Ricky6's comment - you might be getting ahead of yourself
2) As others noted, a legitimate expense like supplemental insurance would likely be allowed.

Your description of your grandmother's condition doesn't necessarily lend itself, yet, to requiring NH care. Usually one needs to require specialized nursing care to qualify, especially when using Medicaid. She could recover sufficiently to be released to home care. If you jump the gun and cancel, it could end up MORE expensive for her.

My mother tore her rotator cuff when she was in her 80s. She had the surgery done, did well with home PT and managed to live alone in her own place for many more years. She, like your grandmother, had many of the same "issues" (age-related decline, arthritis, osteoporosis, and urinary tract infection.) In addition, she had significant hearing loss, Mac Degeneration and bad knees.

Even after developing dementia, she would NOT have been a NH candidate. We probably could have gotten her into one, as self-paying clients, but NHs are MUCH more expensive than AL or MC. Thankfully she had SS plus a good pension left from my dad, some other funds and the net from the sale of her condo to pay for a good MC place and also cover all her other needs.

I do agree, the BCBS plan she had was very expensive (Fed plan), however I kept it as it covered so much more than others. Just the cost of Mac Degeneration treatments made it worth keeping! She used to use ambulance transport for UTIs (I chastised her for this as it takes services away from others who need it, but her response was that her insurance pays for it, which it did, mostly.) She had stopped driving at night, but could have gone to her doc during the day, instead of tying up an ambulance and then spending HOURS in the ER for this!

Once she went onto hospice, following the first stroke, I made the decision to drop it for next year. The eye treatments were long and taxing on her, so I stopped those. Hospice wouldn't cover her regular meds, so I made sure to order what might be needed to cover the next few months, after checking online to see how much they would cost buying them elsewhere and it was MUCH less than the cost of the insurance! We wouldn't be doing any major life-saving treatments at that time, so there was no justification for continuing the insurance at that cost. She was over 97 then. I didn't even get to fill out the form they sent to me to cancel it. She had a second stroke and passed before the end of the year.

Your grandmother, on the other hand, could live for many more years and require treatments for who knows what. Medicare and Medicaid don't cover everything. Once on hospice, if it went that far with your grandmother, they don't cover anything other than comfort care, except maybe UTI or other infections, simple stuff. If she gets any treatments or medications now, you'd have to weigh the cost of the insurance vs anything that might happen after canceling it. Those would be self-pay. Once canceled, she wouldn't likely be able to get on that plan again, and have to sign up for something with less coverage.

Also, not familiar with this plan. Premium costs plus deductibles, co-pays and out of pocket expenses would all have to be considered. Mom's plan was federal and expensive, but covered just about anything you could think of! I don't recall ever paying anything other than a couple hundred for several months of PT while in MC.

Find a good elder lawyer, they will have all the answers...family doesn't have to pay anything... you're not responsible for her bills..

JoAnn29 - It's not entirely true that the family "is not made to pay anything." It depends on the policy of the nursing home as well as the family's asset situation.

Some nursing homes, such as county-run ones, will accept Medicaid-only paying patients, but many private ones will not. Either families, or their remaining assets, are expected to make up the difference.

You can have both Medicare and Medicaid. It's referred to as a "dual-eligible" person.

Is the Blue Cross through her former employer - or is it a Medicare Advantage Plan or Medicare Supplement Plan?

Don't drop the Medicare Advantage/Supplement just yet - because you could be paying huge out-of-pocket expenses if you do this.

Use the spend-down money to pay for the supplement until she qualifies for Medicaid.

In our state, when we applied for Medicaid for my brother in law we listed his Medicare supplement insurance as an expense. The DHS deducted that amount from his income in their calculation of what he needed to pay for his cost of care at the nursing home. I'd double check with your state's DHS and see what they'd advise based on their policies. Brother in law was paying for prescription drug plan, deducted from his social security, but after he went on Medicaid that got paid for through an "extra help" program for people on Medicaid. Of course the extra $$ from his social security went for his cost of care, but it's fair.

I would put those questions to the institutions where she will be going.

I would also check with all her Insurance Co.

Don't be in a hurry as you might cancel it and she'll end up in a terrible place.

You said you needed to downsize the amount of money in her Bank account, I suggest you do this while paying her Insurance.

Talk to lawyer in her state. He/She can give you the best advice.

I've been told by Medicaid that once we use up all of our person funds for my husbands care at his memory care facility, that he can apply for Medicaid, which will take all of his social security money, minus $50 allowance fee, to pay for his care at the nursing home. Then the nursing home will charge me that balance that the ss money doesn't cover. I will not be able to pay that big amount. I'm curious where JoAnn 29 got her information about the family not made to pay anything towards a persons care who now is on Medicaid. Please help. I have an appointment with our attorney next week but I don't want to spend big dollars on attorneys. Thank you.

You need to have a meeting with your State’s Dept of Human Services, or an Elder Care Lawyer, PS: you also may be jumping the gun in regards to to your Grsndma’s healthcare. Talk to the doctor, maybe she could be released with home health care which is payable by Medicare.

Your profile says:

"I am caring for my grandmother mary, who is 87 years old with age-related decline, arthritis, osteoporosis, and urinary tract infection."

So, are you 65 and grandmother is 87? Makes a difference in the answers to your question. Thanks!

THANKS !

From what I understand, that some States allow the secondary insurance and there is an adjustment in the cost of her care to compensate for it. In my state, they allow you to drop your secondary once Medicaid becomes into effect. Family is not made to pay anything towards a persons care who now is on Medicaid.

Someone will pipe up with more info.