Hi, this is my 1st time to ask a question to this forum. I'm a "new" caregiver, of my 88 yr old dad, with dementia and he's now living with me as of 18 days ago. I learned recently that his VA benefits will unfortunately NEVER cover any form of assisted living or memory care, as his health issues were not caused from his 4 yrs of service. Their at-home healthcare would only kick in if he meets at least 3 ADL criterion, and he's not there yet. But for me, it's a part time job already (he can feed himself, but only if you put food in front of him as he has no appetite; he can put on his own clothes, but won't change them for weeks unless you put fresh clothes in front of him and you literally tell him to change his clothes, he won't brush his teeth unless you tell him to, etc). I also work full-time myself.
Long story short, given the above news regarding his VA benefits, the other option is Medicare. However, I recently learned in my research that he has a TEN YEAR penalty for not paying "Plan B". So roughly $23K penalty and double the monthly premium if he gets back on it. :'-( Also in my research, he only has "Plan A", and that won't cover assisted living, memory care or at home healthcare.
QUESTION 1: Does anyone know of, or can anyone point me to a service that helps pay for Medicare penalties for low-income elderly? He only receives one small SS check a month. PS: We're in the Denver area.
QUESTION 2: I'm completely unaware if Medicare Plan B (and beyond like Medicare Advantage, etc), would even fully cover these services I'm seeking. So I wonder - is it even worth it?
Thank you!
Doctor's services: Visits to doctors and other health care providers
Outpatient care: Care received outside of a hospital
Home health care: Services provided in the home
Durable medical equipment: Equipment like wheelchairs, walkers, and hospital beds
Preventive services: Exams, lab tests, and screening shots to help prevent, find, or manage a medical problem
Mental health care: Counseling and psychotherapy for mental health conditions like depression and anxiety
Counseling and behavior modification programs: Programs for obesity, smoking cessation, and alcohol misuse
Medical nutrition therapy services: Services for people with diabetes, kidney disease, or who had a kidney transplant in the last 3 years
Medicare neither pays for ALs or MC. These are private paid facilities. Neither does it pay for LTC. It pays for some in home with a Drs. order but that does not give you an aide for several hours. It covers rehab for 100% the first 20 days and 50% the next 80. These days are not guarenteed.
Medicare is a health insurance that pays 80% of what they feel is reasonable. The provider charges $100, Medicare feels $80 is reasonable, 80% of $80=$64. You owe the provider $16. If you have a suppliment, they pay the 20% of $16. A provider cannot ask for more than the $80 that Medicare feels is reasonable.
From how you describe your Dad, an AL does not have the ability to care for him. MCs, they have their shortcomings too. He may need Longterm care and if he has no assets, Medicaid may pay for his care. His SS and pension will also needed to be used for his care.
I suggest you may an appt with your County Office of Aging concerning what resourses are out there for Dad.
MediCAID is what you are speaking of. That has requirements Dad would easily fit into of mental and/or physical needs.
I would go to medicare.gov site and find out how to find a counselor/expert advisor.
None of us here, with the exception perhaps of Igloo, will have a clue how all this works. You need expert advice and for that I fear you need to go to the horse's mouth. You can also call 1-800-medicare and ask how to get advisor and advice regarding your concern.
Your father will be self-pay, or his SS go to the nursing home, with the government supplementing the rest via Medicaid. He can still keep a home and a car if he has these, but will have to be spent down otherwise to the rules for your own particular state. And should he have home, car, there would be Medicaid clawback (recovery) upon his death.
I wish you the best of luck here, but this sounds complicated, and I think you need an expert. I am hoping Igloo is out and about on the Forum, as she's the best I know to be able to give you some clue as to what's what. I can only wish you best of luck.