Differences Between Skilled Nursing and Long-Term Care Transcript

Speaker 1  00:00

No need to lose sleep over planning your Medicare coverage. Lisa Lauro and the team at Secure Money Health want you to get the best, most customized service when planning your Medicare coverage. In fact, Lisa wants to share her new book with you, The Ultimate Medicare Book. It’ll help you choose the right plan, understand your benefits and avoid common pitfalls. Go to mymedicarebook.com. That’s mymedicarebook.com.

 

Speaker 2  00:34

It’s time to secure all your health care needs, and we will really simplify the process. Welcome to Secure Health with Lisa Lauro.

 

Steve Sedahl  00:46

Hey everybody. Welcome in. This is Secure Money Health. My name is Steve Sedahl, joining me now is Lisa Lauro. Lisa is with Secure Money Health Radio. She is president of Secure Money Health, works in conjunction with Secure Money Advisors in the good gang with Brian Quaranta and the crew. Hey Lisa, how’s it going?

 

Lisa Lauro  01:02

Good, good. How are you?

 

Steve Sedahl  01:04

I am well, thank you. And so, Secure Money Health means that we’re talking Medicare. We’re talking, how can we help? You know, how does it? How can I get more connected to Medicare and learn more about it,

 

Lisa Lauro  01:17

Right, right. And especially, you know, with Secure Money Advisors. They, as they’re retiring folks, they really needed someone to help them with that, because Medicare can be a very confusing topic, at least, so I’ve heard. And so, you know, it’s one of those things where, you know, we try to be the guide, you know, the professional who knows exactly what to do and how to do it, right.

 

Steve Sedahl  01:40

And again, so, and your background is in Medicare, but your background is in financial planning, right? I mean, this is kind of how you got here.

 

Lisa Lauro  01:48

No, actually, my background is in education.

 

Steve Sedahl  01:52

Oh, education. That’s right, you taught for 20 years, yes, okay, and then you got into this because of family, right?

 

Speaker 1  01:57

That’s right, yeah.

 

Steve Sedahl  02:01

So in this position, you’re seeing Medicare and applying, or getting it and maintaining it, maintaining it. That’s where the, that’s where it kind of comes into play, and things change as we go. So, what we’re going to do in this segment is we’re going to talk about skilled nursing care, which is a big part of Medicare, and I know it’s a big part of a lot of conversations.

 

Lisa Lauro  02:23

It is. Skilled nursing is, is something that I think confuses a lot of people, and there are some rules that we need to follow with that in order to properly get skilled nursing care. So basically, for folks that are unaware, skilled nursing is medical care that’s provided by licensed professionals. So that could be nurses, it could be physical therapists. Doctors usually stop in at skilled nursing as well and make, you know, make sure that everyone’s doing what they need to be doing. But, and it’s usually, it could be at a facility, but it’s, it could also be at your home, where skilled nursing happens, because a lot of people want to be home. A lot of, yeah, a lot of people do want to be home, you know. But what people don’t realize is that there are three basic, like prerequisites that you have to meet before you get approved for skilled nursing. Okay, so it, and so those are, you need to have a qualifying hospital stay. So, you know that would require you to be in the hospital for at least three days. Okay, okay. The second one is that a doctor must certify that you need skilled care. So, it’s not just general help. It has to be medical care that only a professional can provide. And then the third one is that the care must be provided in a Medicare approved skilled nursing facility. So that’s the other one. So not every nursing home qualifies, so it’s important to confirm this ahead of time. So that that’s a key one, that people, you do have to go to a facility, even though people do want to sometimes be home, and it has to be an approved facility. So, they’re not all created equal.

 

Steve Sedahl  04:17

What’s the differentiator? I mean, are they, is it just that they’re qualified? They have to provide certain services? How do they become qualified?

 

Lisa Lauro  04:24

Yeah, you know, I don’t, that’s a question I do not know. Like, what? What makes one qualified and one not, you know? Or Yeah. So they’ve got the answer. They do have the answer, if you ask them. So it has to come, probably come down to the type of treatment, and, and, and, and also what that specific skilled nursing facility has to offer.

 

Steve Sedahl  04:47

So, with skilled nursing care, you’ve got a, you’ve got those three major things that you have to deal with. How difficult is it to get the approval process? What? What’s that like?

 

Lisa Lauro  04:57

So, I think the approval process once you’ve met the three criteria, I think after that, you’re okay, okay, you know, I don’t think that that’s, you know, but, but that’s, and I think that’s why they have this criteria. So that, they have it, you know, it’s pretty written in stone, that these are the three things you need to meet in order for that approval to go through.

 

Steve Sedahl  05:20

So now you’ve been approved, and you’re in a facility. You’re getting skilled care. What about cost? Is there, is there cost involved?

 

Lisa Lauro  05:28

Yes, and cost is a big thing. So Medicare, your original Medicare, your Part A and your Part B, covers skilled nursing for the first 20 days, okay, 20 days. 20 days. And then from day 21 to 100 then you would be on the hook for a, Medicare will pay a percentage, and then you would have to pay, and the way it is this year for 2025 it’s 214 a day for days 21 to 100.

 

Steve Sedahl  06:05

$214?

 

Lisa Lauro  06:06

$214 a day. Now that would be if you only had A and B. Now, if you pair that A and B and you have a supplemental plan, plan G or Plan N, those plans pick up that $214, a day for days 21 to 100.

 

Steve Sedahl  06:27

And so, and this is, this is traditional Medicare. This is not, we’re not talking Advantage here.

 

Lisa Lauro  06:33

No. So, right, okay, yeah, that’s, that’s Original Medicare paired with Plan G or N, you would, your 20 day, 21 day to 100 is covered, because those plans kick in on the Advantage side, that $214, a day is not covered, and so, that’s a big one. When people say, what are the pros and cons? That’s one of the things that we need to talk about in our meetings that people don’t realize is that skilled nursing from day 21 to 100 you would have to pay on an Advantage plan that $214 a day.

 

Steve Sedahl  07:10

Wow, wow. Yeah, you’re right. People don’t I mean, I think there’s so much that people don’t know, but you’re all about the education, and that’s what this show is all about, right? Getting the word out just to help people understand and teach people that Medicare doesn’t have to be as complicated as it seems,

 

Lisa Lauro  07:26

Right? And I think the big thing is just having a guide. When you have somebody that does this every day and walks you through the process, it’s priceless, because these are the little things that you wouldn’t know to even ask, right?

 

Steve Sedahl  07:43

You know? Because, I mean, I think when, when you get to the point where you know, you’re, you’re getting older, and you’re a couple, and things start to, you know, go wrong. You don’t think about this stuff. You’re thinking about, I want to care for my spouse. I want to, you know, I want to take care of myself, right?

 

Lisa Lauro  07:58

Right. Yeah, so the folks that are on, sorry to interrupt; the folks that are on Medicare Advantage plans, I always tell them, we’ll just, you know, make sure that you’re aware of that 20 days and, you know, maybe that’s something you want to consider putting a little kitty aside that you, you know, if you because basically, the skilled nursing, oftentimes is, you know, people that have a hip replacement or a knee replacement or something like that, and they have to go in rehab, so hopefully they’re well enough within that 20 days to go home and finish their rehab at home. But, you know, that’s to be determined.

 

Steve Sedahl  08:35

Well, let’s say it doesn’t go well, and you’re not getting better, and it’s time to stay in a long, you know, getting into long term care. We need to be there longer. Where does this fall? Where does this fit into all of that?

 

Lisa Lauro  08:49

Well, long term care is different from skilled nursing. Completely, two different things. People think they’re the same, but it’s not. So that’s a totally separate policy that somebody would have to get, and then perhaps that, that’s where that long term care would kick in, but, but it’s not considered the same as skilled nursing, and it’s its own separate thing.

 

Steve Sedahl  09:15

Okay, so is that not even a consideration? Medicare in general doesn’t cover long term care.

 

Lisa Lauro  09:21

It does not. No.

 

Steve Sedahl  09:22

And again, those are the kinds of conversations that you have with folks. What are some of the other things that people are surprised to hear when it comes to skilled nursing?

 

Lisa Lauro  09:31

They are surprised to hear that there is criteria that they have to meet. I think, sure, you know. But I think the hospital also knows that, like, Okay, well, this, this person just had a knee replacement, so they are going to need to stay here for three days, make sure they’re stable, and then we can send them over to the skilled nursing for their rehab. So hopefully everybody is in, you know, but I would say –  I’m trying to think if there’s any other surprises. Another thing that, custodial care, people confuse that as well. So custodial care is, you know, when you need somebody, that kind of goes along with the long term care, where you need somebody to come into your home and take care of you, and so that, that gets paired with the long term care, people seem to think that that’s also part of skilled nursing, and it isn’t. So that’s another thing that I think a lot of people are surprised by.

 

Steve Sedahl  10:25

Well I’ll tell you what: a lot of your questions could get answered, folks with the book that Lisa has written. It’s called The Ultimate Medicare Book, Simplifying Medicare So You Can Make Confident and Informed Decisions. That book is available for free. All you have to do is go to medicarebookoffer.com medicarebookoffer.com. Sign up, and that book will get sent to you. Comes in a beautiful gold envelope, and, you know, as long as you’re there, ask for Mar, ask for Brian’s book as well, you know, because that’s a great book on retirement in general. Coupled with this book, you’ve got yourself really a sort of an encyclopedia done in two books.

 

Lisa Lauro  11:01

That’s right, you know, that’s such a good point to make Steve, you know, because Brian does not charge for his book either, and it is a wonderful resource for folks that are, you know, getting ready to retire, and even a little bit before that, because you kind of need to plan for it, don’t you?

 

Steve Sedahl  11:19

Right Oh absolutely, yeah. And I do think…

 

Lisa Lauro 11:21

So both books are good.

 

Steve Sedahl  11:22

Yeah. So we’re talking about the, The Ultimate Medicare Book. And this is, I’ve read it, and it’s, I mean, it goes by quick, but boy, there’s good information in there. It’s just like, what we’re doing here on the show, except that you’ve got it, you’ve got a reference copy.

 

Lisa Lauro  11:36

Right, right one you can highlight. I like to highlight stuff and earmark and get back to it, you know. But it is a, it is a very good reference to have on hand.

 

Steve Sedahl  11:50

Folks, if you want to get a head start, give us a give us a call right now. It’s 724-293-6653. 724-293-6653, give us a call. Visit securemoneyhealth.com, securemoneyhealth.com to learn more, don’t forget medicarebookoffer.com and we need to take a quick break. When we come back, we’re going to continue the conversation here on Medicare. We’re going to talk about special enrollment periods. Should be interesting. We’ll be right back with Lisa Lauro right after this.

Secure Money Health with Lisa Lauro. My name is Steve Sedahl. Lisa’s president of Secure Money Health; works in conjunction with Secure Money Advisors. You are a licensed agent specializing in health insurance for retirees, the Boomers, people like me. She is the one who helps make Medicare make sense and you certainly do a great job of that. This is, this is something we’re going to get into here we’re talking about special enrollment periods. And a special enrollment period is a specific time in the, you know, in annual enrollment, which goes from October to December. Well, okay, let’s, let’s clear this all out. Lisa, what are we talking about special enrollment period, and who’s affected and why?

 

Lisa Lauro  13:18

Yeah. So, with, these special enrollment periods are specific to folks that are on an Advantage plan. Okay? So, yep, it’s specific to that and, and basically, you know, these are things, basically that are like life events that happen where someone has to make a change to their plan. So, so you know, and because otherwise you know, normally, you cannot make a change to your Advantage plan unless it’s the annual enrollment period, which is between October 15 and December 7, right? Well, those, yeah, right. So, what happens when you suddenly move mid-year, or, you know, something happens; there’s these, that’s where the special election or special enrollment period comes in. So let me just name a few and see if people identify with that. So, first one is moving to a new location. So, with these Advantage plans, you have to live in the service area. So, if you were to move out of – and the service area is usually your county – so if you were to move out of the county into another county, then you would have to switch your plan. Now, oftentimes, if you’re saying, you know, if you just go from one county to the next, and you’re close by, the same plans are usually offered, but you just have to go through the proper protocol to be in that plan for that specific service area, sure. So it’s just a matter of paperwork…

 

Steve Sedahl  14:52

I just went through it. I got a letter from Medicare said, “Hey, we got to know where you live.” And it turns out I’m about 50 feet in a different county, and they just wanted to confirm that everything’s cool, everything’s the same. But again, you’re right. It’s just…they need to know.

 

Lisa Lauro  15:06

And did you get that squared away?

 

Steve Sedahl  15:07

I did. Yeah, absolutely

 

Lisa Lauro  15:08

Perfect. Okay, so yeah, so it’s pretty easy to do, but you do have to follow the proper, proper protocol there. So, moving is a big one. If you lose employer coverage or union coverage, or you decide to retire. So for folks that are past the age of 65 and stayed on the group insurance for whatever reason, it suited their needs at the time, and now they’re ready to go ahead and get on to Medicare and onto it, perhaps an Advantage plan, that would be a special enrollment period, so you have to actually use a special code on your application, and so that was, so losing other coverage is one. Plan changes. So, if your plan, your Medicare Advantage plan, makes a significant change, dropping one of your doctors, or ending coverage in your area, you can switch to another plan. That’s another one. Perhaps you now have a chronic condition. So chronic conditions could be: you’re diagnosed with diabetes or congestive heart failure or COPD. There are special Chronic Needs Plans that a lot of people are unaware of, and so you might get a letter in the mail. I had a client just yesterday email me and say I got a letter in the mail that I am now eligible to be on a Chronic Needs Plan. So, you can make a switch mid-year for one of those. And then, you know, other life events could include living abroad and then moving back home, so that that’s another one. But there are many, many special enrollment period, uh, what are they called? Like, not rules, but different types of codes that they can use, so there’s different, different topics that might apply to you based on the situation, but it’s, they’re usually life changing events,

 

Steve Sedahl  17:10

Sure, and again, I thought that was interesting, that the special needs or chronic conditions that, nice to be able to, you know, have some consideration there, that yes, Medicare will adapt if I need these changes.

 

Lisa Lauro  17:23

Yeah, yeah, that’s a good point. Steve, you know, people don’t realize that, but yes, there are certain conditions that would qualify you and then those plans are better suited for you for whatever your needs are. So, it is a nice consideration.

 

Steve Sedahl  17:38

So, let’s see what’s, so, how does it work? So, how does a SEP work?

 

Lisa Lauro  17:45

So basically, depending on your situation, you may get a letter in the mail that says, hey, you know, you need to switch your plan. And then you would go to someone like myself, you know, come see me, and we’ll, we’ll find a new plan that’s going to be available to you in your new area, or if, that’s if you’ve moved if, but if you’re retiring: people that are retiring, I usually tell them to start three months beforehand, because, depending on the situation, you know, there’s different ways that you need to go about it, especially if you’re outside of your initial enrollment period, which is the seven months around your 65th birthday. So, plan ahead is a big one with these.

 

Steve Sedahl  18:32

So Lisa, when, when, I’ve signed up for Medicare, and you know, I’ve been going along for a few years, and I did it. I didn’t sign up with you. Can I still call you and will you help me?

 

Lisa Lauro  18:45

Oh, yes, absolutely, yeah, you don’t. There’s no, there’s no prerequisites here.

 

Steve Sedahl  18:51

Okay, I think that’s important. People probably go, I have to, I have to be a client, or I have to be this. But no. I mean, if you’ve just got concerns about Medicare, you need help, sort of changing things and you don’t know where to go, Lisa’s your call.

 

Lisa Lauro  19:04

Yes, absolutely. That’s, I really pride myself on being a good educator in this field, and so I’m always willing to help and happy to walk people through this process. There’s one other thing though that I neglected to mention and that is a timeframe. So, with the Special Election Periods, you have usually two months from the date of the qualifying event. Okay, so, there is a window of opportunity of which you need to make that change, and if you miss out, then you would have to wait until the annual enrollment period, and you might be without; so very important to take note of that two month window.

 

Steve Sedahl  19:53

What else do we need to look out for? What are some other red flags, if you will? Let’s see, So documentation? What do we need? I mean, does that?

 

Lisa Lauro  20:00

Yeah, you do need, yeah. So, you do need documentation. You sometimes, you have to prove, you need proof of the life event. So, you might need a letter from your employer that you’ve lost coverage. Because, otherwise, here’s another thing, there’s a penalty to not sign up for Part B. So, if you might, you need that letter from your employer to prove that you’ve had credible group coverage. Now you no longer have it. You need to jump on the Advantage plan or on a Medigap Plan.

 

Steve Sedahl  20:33

And again to, because, if you miss that sign up period, and you, and you don’t sign up for Part B, you’re going to be fined essentially the rest of your life!

 

Lisa Lauro  20:43

Right, right. There is a fine. You will be.

 

Steve Sedahl  20:47

Not essentially; you will be. You’ve got to pay more than everybody else.

 

Lisa Lauro  20:49

Right, right, yeah,

 

Steve Sedahl  20:50

I don’t like that idea. So it’s completely avoidable.

 

Lisa Lauro  20:55

I don’t either. It is avoidable, but you have to know what you need to know, right? So,

 

Steve Sedahl  21:00

Okay, so we talked about limited options. Yes?

 

Lisa Lauro  21:04

I don’t know if we touched on that, but you do have some limited, depending on your situation. There are some limited plans, maybe in your new area. So that’s something to, you know, you have to look and see what’s available to you that that might suit your specific circumstances as well.

 

Steve Sedahl  21:21

So I’m thinking, you know, there’s this, this alternate enrollment period, and, you know, I’m not really happy with my… so I’m just gonna go in there and change it because I can. Or can you?

 

Lisa Lauro  21:30

No, no, there’s no SEP for buyers remorse, right? So, so when you make, when you make a change, it’s really important that you kind of know what you’re doing. So, if you make that change in the middle of your annual enrollment period, there is an open enrollment period if you find like, maybe your doctor wasn’t in network, or the plan isn’t suiting your needs, you can make a switch during the open enrollment period, but you do during these SEPs. You have to really be sure that the plan you’re choosing is the right plan for you.

 

Steve Sedahl  22:06

But I mean, in the in the scheme of things, this, the special enrollment periods really are a good thing because it can solve a lot of problems if, because life happens, we know this right?

 

Lisa Lauro  22:18

Exactly, life does happen, and that’s what it’s there for. You know it’s there so that you know no matter what happens, you know different twists and turns, little curve balls that are thrown at you. You have this, this opportunity to take advantage of making a change while you can, and especially during that two month period.

 

Steve Sedahl  22:37

Well, speaking of taking advantage, let’s take advantage of a book that you can get for free, The Ultimate Medicare Book. Lisa wrote the book, and it is chock full of great information, pretty much like we’re doing on the show. But again, it’s going to be able to, you’re going to be able to reference it, highlight it, and mark it, and it really becomes a great Bible. And wouldn’t, you can get that by going to medicarebookoffer.com, medicarebookoffer.com. Pretty much put in your name, and Lisa’s going to send you that book free of charge. And it’s a hard cut, not a hard cut, but it’s a, you know, it’s a book. It’s a real book. It’s not like a, you know, PDF.

 

Lisa Lauro  23:12

Right, right. You’re going to actually get a physical copy. It used to be a PDF because we were in the process of ordering them, but now we have actual books on hand, and they’re really nice.

 

Steve Sedahl  23:23

Yeah, they are. It’s nice. It’s and again, again, along with these, along with Right Track Your Retirement – those two books combined, that’s a, that’s a great resource. And folks, I want you to give us a call if you need, if you wanted more information. 724-293-6653. 724-293-6653. Lisa, boy, this goes by so quickly. Hard to believe. (It sure does. Sure does.) So, tell you what we are going to we are going to say so long for this week or come back next week. We’ve got a lot more to talk about in the coming weeks.

 

Lisa Lauro  23:57

That sounds great. Steve, have yourself a wonderful week.

 

Speaker 2  24:00

Investment advisory services are offered through Foundation’s Investment Advisors LLC, an SEC-registered investment advisor. The content provided is intended for informational and educational purposes only. The views, statements and opinions expressed herein are those of the individual speakers and are not necessarily those of Foundations and its affiliates. The information contained herein does not constitute an offer to sell any securities or represent an expressed or implied opinion or endorsement of any specific investment opportunity offering or issuer. Any discussion of performance or returns is not indicative of future results. Any discussions of specific strategies are for informational purposes only, and have been provided to help determine whether they may be appropriate for your specific situation. If applicable, the primary goal in converting retirement assets into a Roth IRA is to reduce the future tax liability on the distributions you take in retirement or on the distributions of your beneficiaries. Each individual investor situation is different, and any ideas provided may not be appropriate for your particular circumstances. Comments regarding a particular client’s experience may or may not be the same as another client’s experience, and is not an indication that any client or prospective client will experience the same or a higher level of future success or performance. Foundations only transacts business in states where it is properly registered or is excluded or exempted from registration requirements. Registration as an investment advisor is not an endorsement of the firm by securities regulators, and does not mean the advisor has achieved a specific level of skill or ability. Nothing herein constitutes a recommendation that any security portfolio of securities or investment strategy is suitable for any specific person. No legal or tax advice is provided. Please review your retirement tax and legacy planning strategies with a legal or tax professional before transacting or implementing any strategy discussed herein. Any comments regarding safe and secure investments and guaranteed income streams refer only to fixed insurance products. They do not refer in any way to investment advisory products. Rates and guarantees provided by insurance products and annuities are subject to the financial strength of the issuing company, not guaranteed by any bank or the FDIC. This is not endorsed or affiliated with the Social Security Administration, any federal Medicare program, nor any US government agency, if applicable, we do not offer every plan in your area, and contacting us at the phone numbers provided herein will direct you to a licensed insurance agent. Any information we provide is limited to those plans we do offer in your area, please contact medicare.gov, or 1-800-Medicare to get information on all of your options. All rights reserved.

 

Outro  26:09

Coach P Radio.