Medicare You've Worked For (Part A of Medicare)
Have a listen to learn:
- What Medicare Part A is
- The three different groups that qualify for Medicare Part A
- What Medicare Part A covers and what it doesn’t cover
- How much Medicare Part A costs
- How Medicare doesn’t have any networks or referrals for any physicians or medical facilities and what that means for Medicare patients
- How Medicare Part A covers 60 days of hospitalization and what happens on day 61 and beyond
- What happens when you keep working after age 65 and the associated insurance implications
- The options individuals who don’t qualify for Medicare still have
- The services BenchMark Physical Therapy offers for Medicare patients
- The most common kinds of ailments BenchMark sees in Medicare patients
- The kinds of clients Parkwest Physical Therapy sees each day
- Tips for how seniors can succeed with physical therapy activities
- What “wrinkles on the inside” means
- How recovery care is the favorite product that Nick offers and why
- And more!
“If an individual has worked 40 quarters or 10 years and paid into Medicare, traditionally via payroll taxes, then they will automatically qualify for Part A. They will receive Medicare Part A on the first day of the month of their 65th birthday with one exception: if their birthday is the first day of the month, they get it the month prior.” — Nick
“In a nutshell, Part A of Medicare is hospitalization insurance for individuals on Medicare.” —Nick
“Keep in mind that Medicare is a nationwide program. So, Medicare beneficiaries, whether from California, North Carolina, Michigan, to Florida all have the same program.” —Nick
“As we get older, our system just doesn't do what we tell it to do. Our brains try to tell our body what to do, and it doesn’t react the way it did when we were in our teens.” —Matt
“Physical therapy is a commitment. It's a time commitment. It's a financial commitment. It’s a lifestyle commitment.” —Matt
“I think the biggest hurdle for a lot of people is that it's so new. You're doing things that you've never done before. Everybody's gotten their routine, and some of the older population, they've been in that routine for 50, 60, 70 years. And so, turning things in a different direction is a little bit more challenging.” —Matt
“You always want to wear loose clothing because you're going to be doing things physical.” —Kaitlin
“Statistics say the average cost in a nursing facility of some sort is $72,000 per year. I would say there's a good chunk of people out there, especially in the market we deal in, that if you're retired, that $72,000 is probably pretty tough to come up with.” —Zach
BenchMark Physical Therapy:
- Parkwest Physical Therapy
- Centers for Medicare & Medicaid Services
- Senior Benefit Inc.
Announcer: Welcome to our fireside chat with Seniors Living Healthy, the podcast that helps prepare and educate you as you enter and live out your golden years. With over 10 years of experience, Nick and Zach are experts in the senior market and are here to help you live a healthy, full life. And now fireside with your hosts Nick Keene and Zach Haire.
Zach: Hello, and welcome to episode one of our inaugural season of Seniors Living Healthy. I'm your host, Zach, and here with me is our co-host, Nick.
Nick: Hello, folks.
Zach: This month's episode, we will go over Part A of Medicare, which is hospitalization. So, as I'm sure you've guessed, this episode’s ABC of Medicare is going to be Part A, hospitalization. Most people are going to get that the month they turn 65 with a few exceptions, so we're going to jump right in. And Nick, why don't you tell us how an individual gets that once they turn 65.
Nick: So, if an individual has worked 40 quarters or 10 years and paid into Medicare, traditionally via payroll taxes, then they will automatically qualify for Part A. They will receive Medicare Part A on the first day of the month of their 65th birthday with one exception: if their birthday is the first day of the month, they get it the month prior.
Zach: Thanks, Nick. So, with that one exception, is there any other kinds of exceptions out there to Part A, how somebody can receive it, and when they can receive it?
Nick: Absolutely, Zach, great question. So, if an individual doesn't qualify themselves for Medicare at age 65, they can qualify off a spouse, whether alive or deceased. Also, if an individual is under 65, but has been on disability, and received benefits for 24 months straight, they can also receive benefits, and then the third situation would be if individuals have been diagnosed with End Stage Renal Disease or ESRD, or Lou Gehrig's disease, they can also qualify for Medicare.
Zach: Thanks, Nick. So, now we know how someone gets Part A; when they get it, how they can get it, what's it going to cover for them out there, once they receive it?
Nick: So, Medicare Part A is listed as covering semi-private room and board, general nursing and miscellaneous services and supplies. So, in a nutshell, what Part A of Medicare is, is hospitalization insurance for individuals on Medicare. So, the way Medicare Part A works is it is designed based on a benefit period of 60 days, and when one is admitted to the hospital, they have a Part A deductible that they are responsible for, which is $1408 each 60-day benefit period.
Zach: Now, is that deductible going to change depending on where they go to the hospital? You know, if they're out of town, they go to the hospital, is it going to be different? Are they going to have—how does that work for him?
Nick: Yeah, so great question. Keep in mind, Zach, that Medicare is a nationwide program. So, Medicare beneficiaries, whether from California, North Carolina, Michigan, to Florida all have the same program. So, as long as they qualify for Medicare and it's in place, there are no networks or referrals for any physicians or medical facilities.
Zach: Perfect that makes it nice being able to go wherever you need to go to get the [crosstalk] you need.
Nick: Absolutely. Absolutely.
Zach: So, in that 60-day period of care, when that 60 days up, does it start over again? How does that work? Break that down a little bit more for us.
Nick: Yeah. So, the way the benefit period works, Zach, is the 60-day benefit period starts when an individual is first admitted, and continues as long as someone is receiving services, whether in the hospital and/or medical facility: things like skilled facility care. So, when they're admitted originally, they pay a $1408 deductible that covers them whether they stay in the hospital for continuous 60 days, maybe they leave the hospital halfway through, go to a skilled facility care then come back into the hospital: they're still covered under that same benefit period.
Zach: Perfect. So, once that 60 days is up, what are they're going to get them for after that?
Nick: So, Medicare has defined benefits, Zach, beyond day 60, that dictates how much someone on traditional Medicare is responsible for. So, if an individual is continually admitted, whether in the hospital or and skilled facility care, beyond day 60, day 61 through 90 will cost an individual $352 per day.
Zach: That's a lot. Per day especially.
Nick: Yeah, it can add up, but more importantly, if an individual is in there continuously beyond day 90, they have what's called 60 days of lifetime reserve coverage. Under the 60 days. They are responsible for $704 each day.
Zach: Talk about a punch in the gut there, with that those prices.
Nick: Sure, absolutely.
Zach: So, looking there at it, Nick, let's say that I am getting ready to turn 65. I'm still working, or over 65 and continue to work. You have to take Part A, or can I just keep rolling with my company's group insurance?
Nick: Yeah, great question. So, we field this question continuously as you know. With over 10,000 people turning 65 each and every day, people are constantly asking, “What do I do? I keep my group insurance, do I drop my group insurance, go on Medicare?” The simple answer is you have the ability to keep your group insurance without going on Medicare Part B. However, for today's topic, Medicare Part A is automatic.
Typically, you've paid in throughout your career in the form of a payroll deduction, so the month you turn 65, you're automatically enrolled in Part A. One thing to know though, Zach, is if someone has group insurance, and they're going to continue doing it, they need to ask their HR benefits department, whether they will have Medicare as their primary, or whether they will have their group insurance as their primary. And one of the main things that dictates that, is the number of employees covered on that group insurance plan.
Zach: Great, great. So, Nick, I know—kind of talked a lot about Part A, kind of getting it set in there. One of the things I wanted to point out there is, if you haven't worked your full 40 quarters yet, you are able to draw off your spouse. That's possible, but if not, someone that’s, let's say they don't have 36 quarters, and they're turning 65, so they're going to have pay for their Part A, are they still going to be able to continue to work and then, when they get those last four quarters off, quit paying for that Part A?
Nick: Yeah Zach. So, let me give you a good answer to this question. For individuals that don't qualify for Part A of Medicare, they have the ability to purchase Medicare directly through Medicare. So, that is all based on the amount of hours they have worked and paid in throughout their life. So, for your example, if they worked 36 quarters, or nine years and paid in, they're responsible for four more quarters or a year before they qualify. They would have the ability to continue working, paying into Medicare while also funding Medicare Part A where they so wish.
Zach: That's one of those situations where we refer somebody to go back to work.
Nick: Yeah, yeah. It's good for the soul they say. But long story short, Medicare Part A is hospitalization. Different individuals qualify; covers when you're admitted to the hospital, Zach.
Nick: All right, folks, we're here with Matt from BenchMark Physical Therapy. This is Nick, and I've got Zach with me here as well. We've brought Matt in; he is a local physical therapist, and we've got some questions we want to ask him that we think could be beneficial to you guys. So, we'll get started here, and see what Matt has for us.
Zach: All right, man. Hey, this is Zach here—
Matt: Hey Zach, thanks for having me. I'm happy to be here.
Zach: Hey, no problem. We're glad we could have you. This episode, we've kind of been talking about different types of recovery care and things like that in the senior market. So, what are some typical services that you guys provide their BenchMark for Medicare beneficiaries, more in the senior market, everything?
Matt: Sure. So, I would say that the Medicare population counts for a significant portion of our total patient population. Most of the time this patient population is going to be dealing with some type of musculoskeletal problem. It can be back pain, neck pain, shoulder pain, we see a lot of foot and ankle pain, plantar fasciitis, that kind of thing. As the population ages a little bit more, you start to see more concerning issues: things like generalized weakness and balance issues, things that the concern there is a fall. As we get older, our system just doesn't do what we tell it to do. Our brains try to tell our body what to do, and it doesn’t react the way it did when we were in our teens.
So, really focusing on strength and safety first. So, our clinicians will prioritize their treatments based on certain risk factors with the age population. So, we do fall risk screens to really give us some information on when this patient goes home, what am I really worried about them? Were they going to be able to get on and off the couch, get on and off the toilet, getting in and out of the shower without slipping and falling down. And then, once we have a good feel for the higher risk problems, then we can start picking off some of those lower-risk problems.
So, prioritize health and safety and balance, but then as we start to feel good about that, how does Nana get the dishes out of the cabinet, reaching up overhead? I think as we get older, we realize that aches and pains are going to be a part of our life, but can we maintain the lifestyle that we want to live in the way that we want to live it? And so, all of my therapists are very excellently trained in communicating with the Medicare patients, saying, “Hey, I see that this is what's hurting you. But let's also talk about what's limiting you, and what's important to you.” And specializing those treatments to the patient's needs and function, so that they can hold that grandbaby. Sure.
Nick: Sure. Yeah, we hear that quite a bit, Matt. Quick question for you, just a quick follow up there. Speaking about some of these seniors, and maybe we call them their ADLs, activities of daily living, does someone have to have a referral to come see you guys typically, or can these individuals walk in and get care?
Matt: So, that's a good question, and for decades, we were required to have an order from a physician for physical therapy until about, I believe it was in 2007, 2008, in the state of Tennessee, which is when we acquired direct access. And direct access means that anybody off the street can come into the clinic and get treated based on certain guidelines: you got to be making progress, and we have to follow up your physician a certain amount of days if we don't have an order. Unfortunately, the one insurance that does require an order, of course, is Medicare.
If Medicare is your primary, in order to get them to pay for it, they do require an order. The good thing is all of our office coordinators up front are very well trained and versed in that, and so what it usually comes down to is Medicare patient comes into the door and says, “Hey, I've got this problem. Can I get on so and so’s schedule?” And then, a lot of times, if it's a physician that we know, or we have direct contact, we just reach out to him and say, “Hey, Miss Johnson has been telling us she's complaining of shoulder, you mind writing us an order?”
Nick: Great. Great. Great. Yeah. And just I guess, really, the next question would be there, Matt, what are some typical services you guys do that may not be covered by Medicare?
Matt: So, it's a good question. There's generally not anything that we do on a regular basis that's not covered by Medicare. There are, based on the way that we code, what we do, we have to do it a certain way, but there is no lack in care for a Medicare patient versus a commercial payer patient. We certainly have to modify the way that we do things, in terms of having one on one care versus having care with another patient as well, and those are some details that we have to work out as clinicians. But from a treatment standpoint, there is no difference between a Medicare patient and a commercial payer patient. Every service is provided the way that we would do it, regardless of payer. Whatever the patient needs, that's what we provide.
Zach: Great. Thanks, Matt. So, looking there at it, in your experience we've, like you said, a lot of seniors, a pretty heavy market for you guys. For someone getting ready to come in for rehab, what is something that, to be prepared coming in, what should they be looking for? Is there something to help themselves get prepared, whether it be mentally or physically, coming in for that rehab?
Matt: Physical therapy is a commitment. It's a time commitment. It's a financial commitment. It’s a lifestyle commitment. You have to do things in a different way than you have been doing them in order to resolve the pain, the functional limitations that you're dealing with. And the more that you commit to it, the better off you're going to be. And by better off, I mean, you're going to require less visits to come in—and this isn't just me talking, we've done a lot of research on it—“We” being BenchMark, but then “We” also being just the field of physical therapy—have looked at compliance to visits, compliance with home exercise program, and overall outcomes. And our outcomes are far better when we have somebody who comes in, does, the exercise at home is reliable.
the commitment to the idea of it is, I think, the biggest hurdle for a lot of people because it's so new; you're doing things that you've never done before. Everybody's gotten their routine, and some of the older population, they've been in that routine for 50, 60, 70 years. And so, turning things in a different direction is a little bit more challenging. So, yeah, that's probably the biggest thing is compliance, and being able to know that we're going to commit to a different atmosphere of our life.
Nick: All right, very good. Thanks for that, Matt. Well, I'll tell you what. Just kind of wrap this up a little bit. You are local to us. In fact, across the street from us. Tell us a little bit about what you do, and what your facility provides for our senior market here in Knoxville.
Matt: Sure. So, the clinic that I am at is our North Peters location. It's in the Cedar Bluff area and is kind of our flagship for the Knoxville area. So, we have multiple services; our biggest patient population is orthopedics, as is most physical therapy clinics, so backs, necks, shoulders, hips, knees. We do post-operative treatments. We do see a lot of foot and ankle issues, so a lot of plantar fasciitis, a lot of toe problems, issues like that. But then beyond orthopedics, we have a pretty diverse platform of treatment. So, we see lymphedema management, which you're not going to be able to find—there’s just not a lot of locations around the Knoxville area; we see a big population of those patients. We have a lot of pediatrics as well, so maybe 100 kids or so a week come in for various issues, which really I absolutely love because I've seen it just light up our senior population in the clinic.
So, we'll have a gym that's mostly full with 50-, 60-, 70-, 80-year-olds, and a three-year-old comes skipping in for her treatment with the occupational therapist, and it's just amazing to see that reaction from the seniors of just having that brief interaction with the kid, and how they can all instantly just not be worried about their issues. So, we treat a lot of pediatric patients. We do pelvic health as well. So, patients who've had prostatectomies or postpartum issues. So, we see, let's see, lymph, pelvic, pediatric.
We do massage therapy as well. We have hand therapy as well. We have—this is a pretty diverse little group. We have a geriatric certified specialist. So, one of our clinicians is certified to treat this older population. We do dry needling. We do other soft tissue techniques. It's a very diverse clinic, and it's a lot of fun to be in the big open clinic. Everybody knows everybody, and we have the ability to kind of take patients in isolation and put them in private rooms if they are immunocompromised, but for the most part, most people are in the open and feed off of one another, and they have a tendency to really thrive on that social interaction as well.
Zach: Yeah, sounds good, Matt. So, sounds like you guys have a lot that you can offer out there. I want to thank you for joining us, jumping on here and answer some questions for us, and definitely want to let everybody know if they're out there looking for a physical therapist, reach out to you guys over BenchMark.
Matt: Yeah. We have, I think, 30 plus locations stretching across the greater Knoxville area, and excellent clinicians across the board. We have more certifications in BenchMark than any of the other physical therapy clinics in the area, and we've really tried to remain laser-focused on our safety during this pandemic situation. It is certainly a challenging time for everybody to be engaged in health care, but certainly the senior population, and we want to always make sure that they feel comfortable and safe in our environment. And we'll just keep it that way as long as it needs to stay that way.
Zach: Perfect, Matt. Well, again, thanks for hopping on here with us. And l say, guys if you need anything, reach out to Matt there at BenchMark.
Matt: Yeah, I really appreciate you guys giving me some time today. Y'all have a good one.
Zach: Hey, you as well. Thanks, Matt.
Nick: Take care, Matt.
Nick: All right, folks. This is Nick here in the Seniors Living Healthy podcast with my co-host Zach. And we have Kaitlin with us from Parkwest Physical Therapy today. We've asked her on to answer some questions for our market, and let her give her insight. Kaitlin, thanks for being with us today.
Kaitlin: Yeah, no problem.
Nick: All right, great. Well, we'll jump in here; get started. What are some typical services you provide for the Medicare market, the senior market?
Kaitlin: So, like you said, I'm a physical therapist at Parkwest, and we cover quite a variety of different services that we have available. A lot of things, I guess, that we see as far as seniors go, we see everything from joint replacement to stroke, even Parkinson’s, or just the regular neck, back pain, all the way to balance therapy as well. So, we cover just about everything. We're a relatively large clinic. So, between all probably 14, 15 therapists, we all kind of cover quite the variety of different things.
Nick: In general, what portion of the people that walk through your door are in the senior market?
Kaitlin: Probably anywhere from at least 50 percent on. Probably 50 to 75 percent, maybe. We only see occasional, really young, like, under 18. And the majority of our patients are probably of the senior population.
Zach: So, kind of looking there with the senior market, somebody's getting ready to come in, what do they need to do to be prepared physically, mentally, what to look for when they come in.
Kaitlin: So, of course, your clothing is going to be a big part. So, you always want to wear loose clothing because you're going to be doing things physical. So, as far as comfortable clothing goes, you want to be comfortable in moving around and what you're coming in wearing. But as far as the mental aspect of it. I think a lot of people have the mindset that every time you come to therapy, it's a no pain, no gain kind of mentality, but that's not always true. I mean, sometimes of course, when you have joint replacements and things like that, there is going to be some pain that goes along with that. But not every single case that a person comes in for physical therapy is there a no pain, no gain mentality.
I know a lot of times, for a lot of my patients, if that's painful, let's back off kind of thing. So, a lot of times people come in with that mentality. The first day is going to be more of a, let's figure out where you're at, what we need to work on. It's a lot of talking and more of the evaluation part of it. And be sure to come in with questions. Go ahead and ask your therapist, “What should I expect? What is the plan? How are we going to meet X, Y, and Z?” As far as what to expect for your treatments to come, after that first evaluation. And don't be afraid to come in with your own goals. Say, “I want to be able to walk this distance,” or, “I want to be able to do this, that or the other.” Be sure that you're coming in with, “Where am I at? Where do I want to be?” And you're vocalizing that with your therapist.
Zach: Definitely, yeah. I've had a few rehabs with my knee. And mental is a big part of it. Getting there knowing what you want to do going into it.
Nick: Very good. Very good. Well, how about this, Kaitlin, what are some ways for seniors to stay healthy from a physical therapist standpoint?
Kaitlin: From a physical therapist standpoint, it's all the things that you probably hear all the time: stay active, stay moving. I know we always get those wrinkles on the inside, is what I call them, so good ol’ arthritis, or you'll hear all these diagnoses that have all these crazy names as far as degenerative disc and all these types of things, but if you stay moving, and keep those joints moving, and stay active, even if you have to get in the pool to stay active, just keep moving, keep hydrated, balanced diet, but really just stay moving. Motion is lotion, I guess is what we say.
Zach: Perfect. Thank you, Kaitlin. So, just kind of wrapping it up here, tell us a little bit more about you and your facility there with Parkwest, what you guys have to offer, and everything that's out there.
Kaitlin: Sure, sure. So, I went to East Tennessee State. So, I got my undergrad and my doctorate from East Tennessee, and I've been with Parkwest coming up on three years now. And I myself just recently got, it's a pain certification. So, I'm a therapeutic pain specialist which is an upcoming thing that a lot of people aren't familiar with, I guess I should say. So, that is kind of my little niche is chronic pain, and treating pain of all sorts. It’s my little niche that I've kind of started there at Parkwest.
But as far as services go and what we offer, we have everything from aquatic therapy, we have hand therapy, we treat vertigo, we also treat Parkinson's, with the LSVT BIG and LOUD programs, and that's both with physical therapy and speech therapy. So, we have therapists there that are certified in that. We have therapists certified in McKenzie. And then, we also do pelvic health, and TMJ dysfunction as well. So, we have quite a wide variety as far as specialties go. But I myself, work in with the aquatic, and I do a little bit of everything. I'm probably the girl Friday of the clinic. I do a little bit of everything, but I am over our aquatic program, and then kind of getting started on our pain management program as well.
Zach: Gotcha. Well, perfect, Kaitlin. We want to thank you for taking some time out of your day to speak with us, and share what people can look forward to in going into therapy, and what to expect, and what your facility can provide. And like I said, definitely, anybody here in the Knoxville area, reach out to Parkwest, and I'm sure Kaitlin and all of her cohorts would be more than happy to help you guys out.
Kaitlin: Yes. Thank you so much for having me.
Nick: Take care, Kaitlin. Thank you.
Zach: Thanks, Kaitlin.
Zach: All right, for this episode's product review, we’re going to go over recovery care. Here at Senior Benefits, we work with several different companies, a wide variety, and portfolio of products. So, we chose recovery care for this episode, just because it really fits well with Part A of Medicare and what it covers, and we think it's a great product for clients. This is actually Nick's favorite product that we offer.
Nick: That's right.
Zach: And so, since Nick has a great love for this plan, we're going to let him break it down some for us. So, first off, Nick, what exactly is it going to cover for them?
Nick: Yeah, that's a great question, Zach. So, recovery care is an insurance policy designed to cover in addition to Medicare, or in some situations cover where Medicare doesn’t. Recovery care kicks in when an individual is assigned to a nursing home, or assisted living facility, and can't do two or more activities of daily living, or is diagnosed with a cognitive disorder. One thing to mention, Zach, I know we talked about this earlier today, is unlike Medicare, there is no requirement of prior hospitalization for this policy to pay.
Zach: Great, great. That's a big help there, too, not having to go to the hospital for those three days and whatnot to get basically permission to go into the facility there. So, now that we've kind of broken down what exactly it is, where all is it going to going to cover? I know one of the big things you like about this is because it—as you can break down for us—it's going to cover basically all three steps of recovery.
Nick: Yep, absolutely. Absolutely. So, recovery care itself is designed to pay a daily benefit when an individual meets the policy’s requirements for a predetermined number of days. The policy’s requirements very simply are an individual has to not be able to complete two or more activities of daily living or be diagnosed with a cognitive disorder. And, as Zach alluded to, this policy is designed for all three levels of skilled care. So, that’s skilled, intermediate, and custodial. The important thing to point out is this policy will pay out for people in assisted living facilities, as well as custodial care nursing homes. Medicare pays nothing for either portion. I know you have past experience with the nursing home portion of this, Zack. What did they pay for your grandmother?
Zach: Big fat zero.
Nick: Zero. Absolutely. Same thing for assisted living. It's not determined to be medically necessary, so therefore Medicare pays nothing.
Zach: This is a great plan to—almost a non-traditional way for a long term care plan of old, long term care plans today is quite expensive.
Nick: Yeah. Especially in this market.
Zach: Oh, yeah, definitely. This is a much cheaper way to get coverage out there if you were to go into long term care. So, looking at there, Nick, we've kind of said it's not a traditional insurance, so how does someone either pay the facility or get paid to pay the facility?
Nick: Yeah, so this policy is a traditional indemnity style policy. There is no insurance card, the providers are not actually billing the insurance companies. The way this works is the policy has a defined benefits to it, Zach, and the policy, when a service is rendered, pays out directly to the policy owner or in some instances, the policy owner can assign the benefits under this policy to any type of medical facility, doctor's office, hospital, etcetera. A couple things to point out on this product, Zach.
The reason I like it so much is this policy will actually pay for skilled facility care, intermediate, and custodial. So, what we find is not only will this help people pay when they're moved into skilled facility care, but it is giving people the opportunity to move into assisted living while being covered, without having to go into full-fledged nursing homes. We see later on down the road that over 70 percent of people 65 and older are using some sort of skilled facility care, and an overwhelming portion of those people do not want to go into the nursing home. By having this policy, it will allow you up to a year worth of benefits to go into assisted living while maintaining some sort of personal life.
Zach: Definitely. Yeah, this is, like I said, a great plan to look into. Statistics say the average cost in a nursing facility of some sort is $72,000 per year. I would say there's a good chunk of people out there, especially in the market we deal in, that if you're retired, that $72,000 is probably pretty tough to come up with—
Zach:—versus, planning in the long run, these types of plans definitely can fill in those needs for you.
Nick: Absolutely. And lastly, Zach, let's not forget to point out this policy comes with the ability to purchase a home care rider. So, traditionally, Medicare covers home care in some limited instances, but with this policy, the only qualifying events are that medical professionals have to come out at least three times per week for a one hour visit, and the home care rider will actually pay up to $1200 per week for the insured, and a statistic is $44,000 is what traditional home care costs on an eight-hour basis. So, it adds up quickly.
Zach: Oh, yeah definitely. This is why it's a great plan like I said. You can use it from a knee or hip replacement, gets you in the hospital with your surgery all the way to working your way back home with rehab, or if you were to have even something more catastrophic, whether a stroke or something like that and need longer-term care, this is definitely a great product for you.
Nick: You got it.
Zach: All right, for our last part here is going to be our Medicare confession. This is where Nick or I are going to share some stories with you. Clients we deal with on a daily basis, they deal with a lot of this stuff, so we see where these products, where the parts of Medicare, things like that, we are seeing where these work in daily lives. And we think this would be a great part to bring to you guys so you can actually see how this stuff works on a daily basis, not just us telling you about it: it actually working. So, for this Medicare confession on this first episode, Nick has a client that is going to use the recovery care. And he's going to tell us a little bit about it just based off of safety protection for them. Not going to use their name or anything, but he is kind of wants to share with you how he's had a client that had a recovery care plan, and it paid off big dividends for him in the end.
Nick: Yeah, Zach, that's a great point. As we sat down, thinking about this podcast, this client’s story came to me very clearly. So, for the sake of security, we're not going to mention the client’s name, I'm simply going to refer to them as CP from here on out. So, just kind of moving into the story, guys. The way it worked is CP, unfortunately, fell down some steps and broke both her arms back in September of 2019. She was hospitalized for four days, and released directly, post-surgery into skilled facility care. So, luckily, CP had purchased a Medicare supplemental policy from us a couple years back, so all of her hospitalization and surgery was covered, but the recovery care portion came in once she was released. So, without the use of either hands, CP was unable to perform multiple activities of daily living for some time until she regained the use of both of her arms. So, because she had purchased a recovery care policy from us, and couldn't perform several ADLs, she was able to collect $200 per day. She was in the skilled facility, which added up to almost $6,000 by the time she was released. Now, not only did she have Medicare and a supplement that paid the majority of her bills, but by having the recovery care policy, she was able to pay the rest of the portion as well as take several thousand dollars home in the meantime. So, this policy for her certainly paid good dividends.
Zach: Definitely, definitely. That's one of those times when you like to hear—we never want to hear anybody getting sick or hurt, but it is always nice we know we've helped somebody, and we can hear those stories what we've helped them do has paid off and is working for him.
Nick: Absolutely, absolutely. And just to point out, I spoke with CP several months back, and she has ultimately still been going through physical therapy, but through the purchase of a home care rider on this policy, she has been able to continue that therapy at home: hasn't had to go to medical facilities, and the policy has been paying for her to do that, as well.
Zach: We hope you enjoyed our first full episode and we hope you got some helpful information from it. Remember, as long as you or your spouse have worked 10 or more years, once you turn 65, you're automatically eligible for Medicare Part A, or you can draw from a deceased spouse or an ex. Part A of Medicare is going to cover your hospitalization and the deductible for 2020 which is $1,408. Don't forget that no matter what coverage you have, you will get this at age 65. We'd like to thank you for listening, with thanks to our guest, Matt Smith from BenchMark Physical Therapy, and Kaitlin Wallace from Parkwest Physical Therapy at Fort Sanders. Hope you guys have a great day and don't forget to subscribe. And be on the lookout for our next episode; we're going to cover all things Part B of Medicare. Thank you and stay safe.
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