Due to her dementia, we recently moved my mom out of her home to an AL near me, in a different county from where she lived. She recently received a letter from her Medicare Advantage plan saying her new address is outside of their coverage area, so I am going to have to find her a new plan. I have NO IDEA where to start. I don't know anything about Medicare at all, let alone "Advantage." Any ideas on where I should start??
It seems most Advantage plans include Part D drug coverage. If you miss getting drug coverage from the beginning, there is a surcharge added to future premiums. When my mom moved in and I was her caregiver, I found our she had no drug coverage. Luckily she was on common generic meds and I was able to save money using GoodRx.
Like someone else suggested, I also recommend SHIP for unbiased information.
If so, she would be considered a “dual” so on Medicare + Medicaid. All costs covered btw the 2 and if she’s low income enough she may get Medicaid to cover her Part B Medicare premium cost each month. If shes a dual, all costs covered as long as her providers are all participating.
it’s something to consider, if - IF! - it’s looking like in her near future, she will run out her own $ to pay for her AL and she probably can show to be medically and financially “at need” for placement in a NH. If this scenario is on the near horizon for her, then her becoming a dual now will mean just 1 less thing, you as her POA, will be saddled to deal with.
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and another lil something regarding Advantage Plans…. If they are on an AP and they go onto hospice, the AP does NOT and CANNOT deal at all with payment for hospice care.
What happens is the costs of & services specifically related to their being on hospice are billed to Original Medicare. The AP steps back with Original Medicare stepping in.
HOWEVER they still are enrolled in that AP for any health care costs related to non-hospice care and services. Those bills still go under their Advantage Plan and coverage as per their AP terms.
As you can very well imagine, there can be billing snafu’s.
Rarely, I disagree with Igloo but in this case, I partially do. If your mom is currently on an Advantage plan, it may not be possible to change to regular Medicare because she won't easily qualify for a supplement. There is a requirement for underwriting and with dementia (and possibly other illnesses of age) they wont want to take her on. This happened to my own mother. Due to cost, my parents opted for an Advantage plan from the beginning and no one would take her on a supplement plan once she got to her 70's. Frankly, she could not afford a supplement. This means that I must carefully vet every plan each year to be sure she can afford it. Here are some things I learned:
They have a maximum out of pocket per year. You'll want this to be a low number because once you reach it, everything is paid for until Dec 31. This applies to "In network" and then there will be a higher maximum for "out of network" doctors and facilities.
If you pay a small premium, it can sometimes increase benefits significantly. For a while, my mom had a plan that cost $25.00 a month and this gave her $5K for dental work, free glasses up to $350, hearing aids up to $2K per ear and most prescriptions were free at specific pharmacies. She spent most of January in the hospital and rehab that year. Her cost was $300, not much more than some premiums for supplemental plans.
Living in a larger city makes a huge difference and gives more options.
Contact any doctors directly to ensure they are on the plan and keep asking because they go on and off of them through the year and insurance companies are slow to update their sites.
The Medicare website will allow you to load all your doctors, pharmacies, and hospitals into the sight and match you with plans. That reduces the number by a lot in some cases. If you use an agent, they do all of this for you.
Be open to making minor changes to fit your needs. Mom had moved 200 miles so she needed all new doctors anyway. I stuck with Doctors with big medical groups because they are more likely to be on multiple plans giving you options. They also make keeping up with records a LOT easier.
E-health, a website that sells insurance has a great site for comparing plans. You tell it the drugs your LO takes and it will give you your yearly cost.
The suggestion of asking her AL is a good one, particularly if there is a doctor that visits her site as this may become necessary later.
I hope this helps!
Please contact the SHIP for your state. They work for the State and not any insurance company, so their evaluation as to what 3rd party health insurance exists for Part B in moms new zip code and what “mates” best for her drug plan (plan D) is something they routinely do. After this is done, then you contact the specific health insurance company for pricing their supplemental Part B and Part D coverage.
also there is an annual “Medicare and You” book printed by CMS (Centers for Medicare and Medicaid, it’s Federal) for each State. Your mom got one. If you cannot find it, it’s online or in the local library. It will go into detail as to what’s available in your State. Personally it can be beyond overwhelming to try to wade thru it. Especially if you are in a bigger State with lots of large metro areas (CA, NY, TX, IL). Here’s where your States SHIP consultation can come in handy.
the Medicare Advantage Plans make doing the above seem in excess and unnecessary. But AP imo really only work best for those who are relatively healthy and able to always completely on their own ONLY go to see the specific providers that are in the plan's network. Going outside their network of doctors and labs and healthcare facilities will mean out of network costs for anything and everything she does medically. This could be seriously expensive. And the billing can be very difficult to decipher.
Also another way to do this is ask at the AL she is in what the their residents use for their own health insurance in addition to their Original Medicare.
Call your County Area on Aging and see if they have someone who can help you pick a plan for the area you live in. They were a big help to me.
If she can afford a BCBS supplemental plan, I have loved mine these past 2 years. I've had a few surgeries, lots of PT and other procedures and have barely had to pay for anything. Plus, BCBS is has been around a long time and is more "portable" (ie covers you in some other states and even out of the country - limited, but better than nothing). I live in MN and my plan includes the Mayo Clinic even though it is almost 2 hours away in another county.
Sure, they are inexpensive and seem like a "good deal". Advantage plans are only an "advantage" as long as you stay healthy. They send you bandaids and OTC meds like generic acetaminophen and ibuprofen, but that won't be enough when the rubber meets the road.