The Sandwich Generation . . . Helping Your Aging Parents
by Carol Abaya, M.A.
for release January 28, 2000
Are you juggling doing errands for your aging parents, your children, yourself and working at the same time? Are you tired, stressed out and upset that your once vibrant parent is now frail and needy?
Do you feel alone? Rest assured you are not alone! The Sandwich Generation is dedicated to the 50 million Americans who may have elder/parent care concerns and/or responsibilities.
More About Medicare
Question: My parents live in Illinois and spend two months during the winter with us in Arizona. They are thinking of changing to a Medicare HMO and don't know if they'll be covered in Arizona. Need information.
Answer: All Medicare Health plans must pay for "emergency" and "urgently needed" care, without prior approval, anywhere in the United States, even if you are out of the plan's service area.
You should check with the plan to see if they cover other services, and importantly how they define "urgently needed" care. Emergencies, e.g., a heart attack, fall, accident, are easier to define.
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Question My father, 76, had a stroke and needs extensive physical therapy. We've been told by the therapy company that Medicare will pay for only $900 worth of therapy a year. He will need a lot more. This limitation isn't fair.
Answer Yes, for services provided by an independent Medicare-Certified Physical Therapist, there is a $900 cap. However, if therapy is provided by a hospital on an out-patient basis, there is no cap. In both scenarios, your father has to pay the 20% co-payment.
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Question: My mother, 81, has had chronic high blood pressure for years and recently had a mini-stroke. She was in the hospital and now goes to her doctor quite often. We just received a bill from him for $1,750, which he says we owe him. My mother has a limited income, and this is a lot of money. We've tried talking unsuccessfully to the person in charge of billing, and she says, "You owe us. Pay us." Should we pay?
Answer: Hold off paying until you get satisfactory answers to questions and carefully review the Medicare statement received by your mother. This statement will detail the claims, the services provided, the charges, the amount approved by Medicare and the amount paid to the doctor.
Your mother always has a 20% co-payment, based on the amount approved by Medicare - and not the amount charged by the doctor.
You need to ask if the doctor "accepts assignment." If the doctor does not, then he can only charge you 15% more than the approved amount. This means your mother only has to pay the 20% co-payment and the other 15%. On a $100 bill, for example, the maximum your mother has to pay is $35.
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Response to previous article. A reader wrote to remind me that a three day hospital stay is required before Medicare will pay for skilled nursing home care. Yes, a three day stay is required. However, if the hospital tries to force you to leave before the three days are up, you and your doctor can file an appeal with Medicare and/or your state Medicare review agency. In the meantime, you can't be forced to leave the hospital - so you gain that critical time.
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Do you have a question? Send it in. Although letters cannot be answered individually, appropriate letters will be answered in this column whenever possible. Letters may be edited. Send letters to Ms. Carol Abaya, c/o Name\Address of YOUR newspaper or e-mail her at SandwchGen@aol.com.
Carol Abaya is an international-award-winning journalist and creator of the unique magazine The Sandwich Generation: You & Your Aging Parents.
NOTES TO EDITORS: text = 480 words; other material = 160 words
We would appreciate it if you would include the "Globe Syndicate" bug at the end of the column.
©2000 by Globe Syndicate, all rights reserved.