Is a supplemental insurance needed when a person has Medicare and Medicaid?

Regular Medicare (A/B) only pays for 'nursing homes' for medical care purposes; and it only covers short-term stays. If you want Medicare to help pay for long-term care (nursing home or 'memory care'), then a person has to have a specific supplemental policy for that. It is not included in "regular" Medicare benefits. Medicare only pays for short-term 'rehab' care (after hospitalization, etc.); after a certain number of allotted days, Medicare stops paying and a person/family has to find out how to foot the bill if more than the allotted days are needed in a care facility.
If she ends up being Medicaid eligible (qualifications differs from state to state), Medicaid will pick up the nursing home cost. However, she'd then have restricted choices of where to go, based on which facilities accept/have openings for 'Medicaid waiver' patients.
If a person is close to qualifying for Medicaid, but not quite low enough with their income/assets, then most states offer the option of having the person pay for a private insurance policy as a "spend down" to make their income limit low enough to qualify for Medicaid. That needs to be a particular kind of policy - in our state (NE), it can't be just a 'regular' medical care policy, it needs to be vision/dental/cancer care, etc. Insurance agents that help with elder care policies should know the types that qualify, as would Elder Care attorneys. Our NE state's limit to qualify for Medicaid eligibility is $1,028/mo income and not more than $2,000 in 'assets'- that includes property, life insurance policies, retirement plans, annuities, savings/checking accounts- basically everything excepts a 'special needs trust' handled by a conservator/lawyer and an 'irrevocable burial fund' directly paid to a funeral home/cemetery.
I believe that for Medicare qualification, a person can purchase a supplemental policy to 'spend down' their income to become eligible if they are close to the eligibility capped limit. I don't think those have to be a specific type of policy.
As you have unfortunately found out, sorting through options for care, cost of care, and insurance coverage gets very complicated when you're trying to figure out private pay vs. entitlements. And it is even more difficult, now that most states (NE included) have done away with dedicated case managers to cut DHHS costs. Every state or county should have an AAA Agency for Aging Assistance whose contact info could be found in the government pages of a phone book or by calling the national "211" number for local resource assistance. Hopefully, your mother's Primary Care Physician has a medical social worker at that office (likely have one if they are a hospital-based clinic). Both of these sources can be very helpful in figuring out levels of care and costs/coverage for such.

AL

Is your amount in Assisted Living or Nursing Home?

My understanding is this. If you keep her supplemental, her PPA (patient paid amount goes down the amount of the monthly premium so that she can continue to pay the premium. In other words, it shouldn't cost her anything more. And, 97yroldmom is right, some doctors don't accept Medicaid patients....and that list is growing. I would keep the supplemental and have Medicaid Long-term care adjust the PPA. Same cost, better coverage with all three. With this set-up, Medicare is the primary coverage, her supplemental is her secondary insurance, and Medicaid is the tertiary. Generally, the cost of supplemental premiums is less than the bills your loved one will generate in any given year, especially if there is a hospitalization which is why Medicaid allows people to maintain their supplemental insurance. Why not reinstate it until you can figure out all of this to your satisfaction? I wouldn't base my decision solely on the nursing home business office:)

Lol. I’m confused too. But it looks like you could go either way.
After reading on the Medicare.gov website I see that all medical claims are first paid by Medicare and the supplement before being paid by Medicaid.
So the Mutual of Omaha payments would have been paid for any dr appointments that took Medicare. It wouldn’t mean they didn’t take Medicaid. You would have to ask the doctors office.
As far as cost goes it’s the same to your mom regardless as has been discussed in the previous posts.
The only advantage to keeping the supplement would be if there was a doctor or procedure needed that Medicaid didn’t pay for but that Medicare and the supplement would. So for the same money you potentially get additional coverage. ( if I understand it correctly).
You do have the chore of paying for the supplement with the money Medicaid allowed mom to keep for that purpose.

They paid a portion after Medicare then Medicaid picked up the rest.
I chose not to reinstate because Medicaid told me since she's on full Medicaid it wasn't necessary
Now I'm REALLY confused

want to give up

Well maybe I read it incorrectly.
It seemed like earlier you were deciding to keep the supplement after all because you found it had paid some bills not covered by Medicaid.
Then today you found out that your mom was on full Medicaid so even though you are within the time frame to reinstate you had decided to not reinstate because she has full Medicaid.
Not all drs take Medicaid. Mom has some doctors that evidently don’t because the supplement paid.
Did I misunderstand your intentions?

I'm sorry, I don't know what you mean??

Bella
What happened to this post where you realized you were using the supplement?


“Went over moms EOB's from Mutual of Omaha and it has been paying pretty good on different doctor visits and procedures etc. Based on the advice given here, I want to try to get that insurance reinstated on Monday
Last Thursday is when she canceled it, I just hope it's not too late!!
Does anyone know???”

Hi all, I called mutual of Omaha headquarters here in Illinois today and they said we had 14 days to reinstate the insurance from the day we canceled. However, in the meantime, the financial office at my moms AL, called Medicaid for me and was told mom is on "full" Medicaid, therefore does not need a supplement that she has been paying on for two years.  I do a real realize that money she's been paying out goes to the  AL.  I'm wondering why no one caught this before when my mom signed up to live there ?  Very thankful for that because in the past it has always been so difficult to get help from that office. I'm just now stepping in and helping mom with her finances and learning how to navigate the system. Whew! What a mental challenge it is... not sure if I've gained or lost brain cells on this one but definitely have learned a lot of valuable information. 
My biggest beef is, is that the local insurance company here that sold her the Mutual of Omaha, told me her agent (that signed her up) a couple of years ago retired and there was no one that could answer our questions. When I finally called Mutual of Omaha headquarters yesterday, the girl that helped us was very kind and explained things so well, it was very easy actually.  My parents are divorced,  they live at the same AL ...my dad has Medicare and full Medicaid with no supplement.  Mom has Medicare, plus a pension from ex-husband and on Medicaid.  I think I see now why she was on a supplement, was it because she had that extra income and could afford it  and helps out with Medicaid part ? And I still don't understand the "full" Medicaid thing.

If I would have the POA papers already sent to Medicaid, I could have called them myself instead of driving myself nuts last week and took care of it from the beginning.  That was something I got lazy with and just didn't do because mom was doing so well for so long but now she's not.
 Save yourself some frustration and get your POA's out!!😉

 Thank you everyone for your help 💜

Mom accidentally let her supplemental insurance lapse. What I learned was that (in Massachusetts) it could be reinstated for up to 6 months after. Six months had already passed. At that time, she was not receiving Medicaid. I could, however, re-enroll her. In terms of someone already on Medicaid, not sure if anything changes, but I say, "No time like the present!" Hope that you were able to already:)

FYI. Many people do not know that you can suspend your Medicare Supp. Coverage for up to 24 months, and later reinstate it.

I read a bunch of different things online; it looks like 10 days is pretty typical.

Please call them first thing tomorrow, just in case it's 72 hours.

Is it hard to get an insurance supplement reinstated?

Went over moms EOB's from Mutual of Omaha and it has been paying pretty good on different doctor visits and procedures etc. Based on the advice given here, I want to try to get that insurance reinstated on Monday
Last Thursday is when she canceled it, I just hope it's not too late!!
Does anyone know???

My mother was in a NH and applied for Medicaid. After she was approved, she kept her Medicare Supplement and it was paid for from her Social Security check as it was previously. Illinois Medicaid wanted her to keep it.

Get in touch with your local SHIP/HIICAP counsellor. Usually at the local Office for Aging in her state/county. They are trained to sort out this stuff and can explain to you if she is better off keeping it or has no need for it. My Mom is in AL with Medicare, Medicaid and a Medicare supplement. If she needs to go to the hospital she would have copays if she didn't have the supplement. The Medicaid is only for out patient care. They allow the cost of the premium off her Medicaid buy in, so that would end up being paid to them to continue her Medicaid coverage so we just keep the supplement. Hope this is helpful. Everyone in every state is different, so check it out.

Thank you all for the advice!
We are in Illinois. I do understand the assisted-living will get that amount she has been paying monthly. I'm still re-reading all the answers here and not sure what to do.
 I'm thinking I need to try to get it reinstated.

My Mother lived in Nebraska. She made slightly too much to qualify for Medicare. When she bought supplemental insurance, her income was reduced enough so she could qualify for Medicare.

Call the insurance co. They don't know if you're mom or daughter.

My mother has all 3, Medicare, Medicaid and her AARP supplemental. At one time we did cancel the supplemental and Medicaid paid it, but since Rick Scott Governor of Florida, when he came back into office he made a lot of changes and we went back to AARP supplemental. I think I am going to revisit this situation myself and maybe cancel AARP.

My mother has been paying really high premiums for health insurance since her husband died. She has been paying around $600 a month and it has recently gone up to right under $700 a month. When she went into the nursing home a year a couple of years ago, I was not told to drop the insurance and was told it's better to keep it. So she still has a very expensive supplemental plan, her Medicare, and now her Medicaid. She paid the nursing home privately until all her savings were depleted.

If you drop it, you will be required to pay that amount to the nursing home. Once on Medicaid you are only allowed to keep a small amount of your income per month. The rest goes to the nursing home and then Medicaid pays the remainder.
It can be very complicated and frustrating dealing with the nursing home staff. I have been in situations where the Office Mgr. was not very helpful, nor seemed very knowledgeable, so I feel your frustration.

I'd suggest to keep the health insurance.

Bella, if Mutual of Omaha will not talk to you, tell them that you will get the state Insurance Commissioner after them. I worked in insurance for many years, but I never had to deal with something like that.

CAkers
Some posters on this forum mention that there are states that do take Medicaid.
Here is a list

google.com/amp/s/www.payingforseniorcare.com/medicaid-waivers/assisted-living.html%3ftmpl=amp

If it is an Assisted Living facility, and not a 'nursing home' for medical care reasons, they are not reimbursed by Medicaid or Medicare. Also, Medicare does not pay for long-term care (even medical), unless a person has a supplemental long-term care policy. Assisted Living facilities typically have a set 'room & board' cost that exceeds a person's income (usually SSI/SSDI).
I work in NE and our patients who are in this situation, residing in ALF's that are more costly than their monthly income, make up the difference in cost by applying for an an extra 'grant' from DHHS (Dept. of Health and Human Services) Economic Assistance called AABD ( Aged to the Blind and Disabled). That covers the monthly 'excess' cost.
Ask a DHHS rep if your state offers this option, since she is likely low-resources enough to qualify if your state has this.

Keeping the supplement, which is her choice for medical care (PCP, labs, Hospital/ER, specialists, etc) provides CHOICE. As many said, medi-Cal (California) has a very limited
selection of providers (PCP, labs, Hospital/ER, specialists, etc) along with delayed access to using them.

I wonder if a local center on aging could help you. I would not rely on the company selling the policy to decide whether it should be purchased. What you might want is a copy of the policy so you see what it covers.

I went through this situation as well and I asked the Elder Lawyer who helped us with the Medicaid application.

His suggestion was to KEEP Medicare Supplement, 1. because if she did not, then that money would automatically go to the NH anyhow, and 2. there are doctors who your loved one might need who only take Medicare and its supplements, and not Medicaid.

That seemed to make sense to me, so I have stayed with the Medicare supplemental insurance for my Mother.

If you just cancelled, I think you can quickly reinstate it. Do it.

It's not so cut and dry. There are instances where you may have more choice for specialists for your loved one if they need to see one. Some doctors don't take medicaid patients anymore. If upon applying for long-term care your LO had supplemental, that premium is deducted from the patient paid amount each month and the supplemental can be continued. In that case, I would keep it to allow for more choice. If your LO can by you or wheelchair van get to their cardiologist, neurologist, pulmonologist, oncologist (you get the idea), or if they are likely to be hospitalized once or twice in a year, keep it. It is actually worth it to the state because BCBS supplemental for example is far cheaper than the payment that Medicaid would have to make.