What Are Skilled Nursing Facilities?

All of us have strong memories of visiting the “old folks’ home.”  Whether grandparents, relatives, or friends, we recall the smells, linoleum, long hallways, and institutional dormitory rooms.  “Old folks’ homes” or nursing homes fall under the category of Skilled Nursing Facilities (SNF).  Medicare covers skilled nursing facilities within limits.

Patients go to the SNF after surgeries to recover, from illnesses to heal, and from injuries to recover and strengthen.  Skilled Nursing Facilities are for temporary treatment, not long term residential care or custodial care, like memory care.  Other facilities, like senior living communities, assisted living, or senior care centers describe other types of facilities that assist seniors.

A skilled nursing facility provides highly skilled professionals, such as occupational therapists, physical therapists, registered nurses, speech therapists.  The advantage of an SNF is these professions are available 24 hours a day for the patients.  The level of care is very high but short term.

Post-Acute & Skill Rehab Services

Skilled Nursing Facilities are institutions that provide post-acute skilled nursing care and rehabilitation services.  People sometimes confuse skilled nursing care with nursing home care because most of the time skill nursing usually takes place in a nursing home location.  Medicare, however, doesn’t pay for “nursing home care”.

Medicare covers skilled nursing facilities within specific parameters.  Nursing home care is for individuals who have reached a point in life when they can no longer perform activities of daily living.  This is referred to as custodial care.  In other words, they cannot bath, feed, and dress themselves.  Medicare will not pay for those services to be provided exclusively.

Skilled Nursing is for after surgery or acute illness, for example, hip surgery for a fractured hip or a stroke.  A skilled nursing facility admits patients for a short period of time after being in the hospital to aid in their healing and/or rehabilitation.  Hospitals are incredibly expensive, and a skilled nursing facility can provide the necessary treatment at a lower cost.

Medicare Criteria For Skilled Nursing Facilities

The tricky part about skilled nursing facilities is admittance.  A skilled nursing facility requires patients to meet certain essential criteria for admittance and for Medicare to pay.  This is the complex checklist:

1. The patient must be admitted to a hospital as an “inpatient” for at least three consecutive days, not including the day of dismissal. She can’t be in the hospital for “observation” for it to count for Medicare to pay.
2. Medicare mandates patient admittance to the skilled nursing facility within 30 days of discharge from the hospital. If problems arise later—past 30 days—the patient cannot go to the skilled nursing facility and have Medicare pay for it.
3. Only a skilled nursing facility can provide the type of care necessary for the patient’s recovery.   A skilled nursing facility would provide intense physical therapy for a hip injury or occupational therapy after a stroke. Going to the physical therapist’s office a couple of times a week would not be sufficient in those cases.
4. A doctor, or appropriate medical professional, must certify that skilled nursing care is required for recovery.
5. The patient must be treated for the same condition for which she was in the hospital.

There are nuances and exceptions to some of these rules.  The list gives you a good idea about how skilled nursing fits into your Medicare health insurance.  The Omaha, NE area has many quality Medicare certified facilities, and  You can find them on the Medicare.gov website.

Sheep get sheared.  They follow the other sheep into the pen, down the shoot, then in to the hands of the shearer and are fleeced.  The ram is a alert.  He doesn’t go with the flow he leads the way and butts heads when he is force to go where he doesn’t want to go.

How do people pick their Medicare supplement plan and company?  They talk with their buddy on the left and their buddy on the right.  ‘They both can’t be wrong.’  Everyone says Plan F is “the best.”  “I never have to pay anything”—no co-pays.  That’s great!  Sign me up.  That is the thought process of the sheep.  Insurance companies love it.  Insurance agents love it.  Plan F is the most expensive plan in all kinds of way.

There are ten possible Medicare supplement plan types that an insurance may offer–A–N.  In reality, they usually only offer 4 or 5.  Plan F is the most popular as well as the most expensive.  Insurance companies and agents like that because it brings in the most money and pays the highest commission.  But is it the best for a client?

Plan F does cover all the deductibles and co-insurance that Medicare doesn’t cover.  That is nice, but you pay a price for that convenience.  It raises the question whether Plan F is the best.

Is there an alternative?  How about Plan G?  Plan G is very close to Plan F.  The difference is that you pay the Part B deductible of $147.  It is a one-time annual deductible.  Once you pay your Part B deductible of $147, for let’s say a doctor’s visit, you are done for the year.  Everything else will be covered 100% which is similar to a Plan F.  So why plan G?  Because the premium is lower—quite a bit.

Let’s do some simple math.  Let’s say that a plan F is $150 per month for a 65 year old male and a plan G is $110 for the same person.  The difference is $40 per month and $480 per year less for the Plan G.  Subtract the $147 Part B deductible, and you are still ahead $333.  Putting it another way, you are paying $333 for the convenience of having the insurance company pay your Part B deductible so that you don’t have to write a check IF you go to the doctor or have some other procedure.  Multiply that times 10 years and you are at $3,330.

The second and more important consideration about Plan G is that the rate increases are smaller and less frequent.  Yes premiums go up because medical costs go up, but the unusual reality about Plan G policy holders is that they generally do not go to the doctor or emergency room as frequently as Plan F policy holders.  There is something about the $147 deductible that causes people to pause and think.  ‘Is this really medically necessary?’  The result is that, because Plan G policy holders do not over use medical benefits to the extent Plan F policy holders do, the claims and cost are not has high.  Consequently the rate increases for Plan G’s are fewer and smaller than Plan F.  Plan F is the best?

Don’t be a sheep.  Don’t follow the herd.  Stop and look at the different plans.  Ask yourself the hard question in light of the facts whether Plan F is the best.  Do some analysis, and you will save money in the short, long, and longer run.

402-614-3389; [email protected]

Most people show up at the steps of Medicare without any idea about how to buy Medigap insurance.  If they have health insurance company A at their work, they call up health insurance company A and buy their Medigap insurance from company A.  They don’t shop, and most pay more without getting more.

Amateur Or Professional?

A few years ago, a friend of mine told me that he was going to finish off his basement himself.  His wife wanted it done because she was going to host her large family for Thanksgiving that year. Tom thought he could save some money by doing it himself.  

He figured out a design, went to the hardware store, and bought some lumber.  It sat there for several months because he got busy with coaching the kids, work, and other projects. His wife got on him because there was a deadline. He started the project, but because he wasn’t an experienced carpenter, he made a few mistakes. The mistakes started adding up. 

Mistakes are expensive. The deadline was looming. Finally, he called in a professional. The basement was done in six weeks, just in time for Thanksgiving.  He also realized that the basement was much nicer than what he could have done.

What does this have to do with how to buy Medigap Insurance?

How Do You Find The Lowest Price?

A true insurance professional will show you how to buy Medigap insurance at the lowest cost for the coverage you want.  He will have the knowledge and experience to better serve you than doing Medigap insurance yourself, visiting with a friend of a friend who does Medigap insurance part-time, or talking to someone in a call center thousands of miles away. 

The benefits of working with an experienced and independent local Medigap insurance professional are that he or she understands the laws and regulations around Medicare in that state and county.  The Medicare Handbook is over 150 pages. It takes a while to absorb all the regulations, and that is just from Medicare.  Each insurance company has its underwriting guidelines, policies, and procedures. In other words, buying Medigap insurance is complicated.

And all of these organizations are run by humans, and humans make mistakes—lots of mistakes.  Have you ever had an insurance company make a mistake that affected you?  I’ve seen a few, and an experienced Medigap insurance agent can quickly and easily help you resolve snags that inevitably will arise when you’re trying to figure out how to buy Medigap insurance.

How Do You Buy Medigap Insurance With So Many Choices?

Showing you how to buy Medigap insurance means shopping for Medicare supplements and plans for you. In Nebraska or Iowa, there are over 30+ insurance companies offering hundreds of supplements, 20 Medicare Part C Advantage plans, and 28 Medicare Part D prescription drug plans, which all interact with Medigap insurance.  

That is a tremendous amount of information, and prices and information are not easily available to persons not licensed and appointed with Medigap insurance companies. A truly independent agent will be able to show you all the plans and pricing, not just one company with a few plans or a handful of cherry-picked companies. Using sophisticated software, he or she can line up the Medigap insurance plans in your area down to the zip code, showing you how to buy Medigap insurance.

A Plan G is a Plan G

A dirty little secret that most people do not know is all the Medigap insurance plans are the same.  By law and regulation, the plans are exactly the same.  

“It’s important to compare Medigap policies since the costs can vary between insurance companies for exactly the same coverage . . . .”  The Official U.S. Medicare Handbook: Medicare & You

A Plan G is a Plan G is a Plan G.  The only difference is the price.  An independent Medicare insurance broker should be able to line up all the Plan G’s and Plan N’s in a row from the least expensive to the most for you to see. How to buy Medigap insurance should be straightforward.

Lowest Price vs. Biggest Brand

While brands are not unimportant, saving money is more important.  Some companies trade on their name.  You pay more, but the Medigap insurance you buy does not cover anymore, pay any faster, or do anything extra.  

There are other things to consider when you think about how to buy Medigap insurance.  You will hopefully be using Medicare for twenty or thirty years.  Picking a Medicare plan is not like getting a tattoo. It is not a one-and-done thing. Each year Medicare makes changes in rules.  Medigap insurance policies go up in price because of age or rate increases. The insurance companies are constantly adjusting plans based upon Medicare, markets, inflation, pharmaceutical companies, etc. 

Medigap Age & Rate Increases

How to buy Medigap insurance should also consider the history of age increases to the policy and rate increases.  For an insurance company to stay alive, not to mention be profitable, it must be able to adjust its prices.  The two ways an insurance company adjusts are through age and rate increases.  An independent Medicare insurance broker should be able to show you the age increases.  In other words, what will your Medigap insurance policy be at 66, 67, 68, etc.  

An independent Medicare insurance agent should also have access to the history of rate increases.  Some companies will increase their rates each year a little bit.  Other companies will wait a couple of years.  Those increases can be quite large.  Either way, the price will go up.  While past performance does not guarantee the future, you still get an idea of how any insurance company handles prices and inflation.  With inflation over 4% this quarter, prices will definitely be going up.  

How To Buy Medigap Insurance?

An experienced and independent agent lives in this world and can guide you through the changes to supplements and plans that are most beneficial to you. She can shop Medicare supplements each year and show you how to buy Medigap insurance at the lowest price.

New people are constantly recruited to sell Medigap insurance.  Some last a few days, a few months, or a few years.  Most do not last at all.  The Medicare rules are confusing and unforgiving.  Insurance companies follow strict underwriting guidelines and are constantly changing prices.  Do you really want to do it yourself or entrust yourself to an amateur?

A Professional Will Show You How to Buy Medigap Insurance

The insurance companies will not give you a discount for going direct.  When you do that—and the insurance companies love that—your agent is now whoever answers the 800-number you call.  You will speak to a different person each time.  That person may be in the insurance industry for two days, two months, or two years.  You’ll never know.  Or would you rather have an experienced and independent local insurance professional who will be your advocate for the next twenty or thirty years, to help you learn how to buy Medigap insurance?  He can show you how to buy Medigap insurance at the best price for you.