Hello. I have a few questions. My father is only 66. So I hope you all can answer my questions. He suffered a massive stroke a few days ago and we have since found out he has no insurance coverage. He is under sedation so my older sister is handling all decisions. We are wondering how we would go about getting his Medicare coverage since he cannot do anything himself. Is this legally allowed? What steps do we have to take to make sure he gets the coverage he needs and is due because he has reached the age of 66. Please advise we are open to all help in this matter!!
The social worker at the hospital should give you guidance.
How is your father after his stroke? Is he able to talk? Prognosis good?
Prior posters gave great info above. Has your dad worked long enough to be eligible for Medicare? I am not sure but I think it’s 10 years of work and having paid into the system.
Or maybe his spouse worked and he is eligible through her if she worked?
Did your dad have a doctor he saw prior to his stroke? They may have insurance info as well.
Gather up his paperwork as you’ll need it to apply for Medicaid/Medicare.
Good luck!
CMS - centers forMedicare & Medicaid- has lots of info on their website. Medicare is a federal benefit so if dad goes onto Medicare, it’s valid across the US.
HOWEVER - & this is very important - since Medicare dies NOT cover all costs, there will be a “gap”; so most on Medicare end up getting either an advantage or a supplemental plan and these vary by state / city or region within your state. If you dad is going to need lots of care, some of the gap plans will be of little to no use to him. I’d suggest you speak with the MD who is the lead hospitalist for his care as to what the next year is apt to look like. Take notes or run your phone to record. Then speak with social services / social worker at the hospital as to who to connect with for gap plans that the hospital participates in.
Some plans, like Humanas “ silver sneakers” are low to no cost but best for the over 65 healthy & fit. Others are like an HMO is that coverage is limited to MD, PT, etc that are within the hospital system or it’s affiliated vendors. I haven’t had to yet deal with wading through gap plans as still on spouses employer coverage but I think they can can use preexisting conditions to not allow enrollment. If so, dad may have limited choices.
And then there always medicaid if dad is eligible. If it is looking like he is going to have horrendous health care costs, if it we me, I’d forget looking at the gap stuff and get his income & assets such that he is eligible for Medicaid. As between Medicare & Medicaid (aka he would be a “dual”) almost all health care costs will be covered.
Another thing just occurred to me, is there a reason why dad did not while he was still 65 file for Medicare to start when he turned 66??? I think it’s supposed to be done 4 mos before 66th birthday. There is a penalty for late enrollment, I think it’s a permanent penalty too. But if he was incapacitated, maybe it could be waived? That’s a CMS question.
Does dad get SS? If so, he should have gotten all sorts of letters regarding Medicare & gap plans. Or did dad work off the grid, so no SS?
OR is there a issue that dad does not himself have enough work quarters existing so that he cannot qualify for Medicare? If that’s the situation, he can buy into Medicare but it will cost way way more than the $ 135 mo payment that gets taken out of SS checks for Medicare Part B right now. If this is the situation then it might be either he pats to join Medicare, or goes ACA or Medicaid. Hopefully if he goes ACA, your state took Medicaid expansion under ACA.
GOing to be oodles of paperwork and overwhelming. Whomever is dpoa or going to be dads health care point person needs to stay organized. Focus on the future as much as possible. Good luck.
As the wife of a stroke survivor, I wish you and Dad the absolute best and a speedy recovery.