Medicare & Medicaid....does mom still need to pay insurance premium monthly?

What’s imo going to matter is IF..
- the MediCARE policy she has is a “gap” or an “advantage” plan.

if it’s Advantage, then she has removed herself from federal original Medicare Part A and has chosen to instead be in an Advantage plan (which btw federal Medicare underwrites paying for as they are viewed as doing cost containment). For advantage policies it is a closed system so all care & vendors have to be “in-network” for your policy for coverage to happen. Like for us, there’s 2 big health systems (Ocshner & Touro) and they both have advantage plans but you have to see docs in their system & get care at their facilities for the advantage to work (participating point of service for care). Or it’s $$$ out of network billing. The issue for advantage plans is that they are NOT designed to work for those in a NH as the residents in a NH can’t just go over to one of the advantage plan participating clinics for care. She be paying a premium but could never get any in network care.

if it’s a gap, Gaps are different in that they are designed to fill in whatever original Medicare doesn’t cover & gaps usually with a insurance provider like Cigna or United. You pay a premium for a specific gap plan & still have original Medicare for Part A. If it’s a gap, then it’s not about seeing & getting care only at places “in network” but seeing & getting care from a provider who’s participating with the gap insurer. (No more Plan F written for 2020 btw, which I’m not happy about)

yeah it’s beyond confusing.... BUT the good part is right now is open enrollment so she can switch to whatever will work best to coordinate with Medicaid & all the companies are advertising. The key is finding one that is compatible with LTC NH Medicaid. That what Rockets post is about.

RocketJKats post is mucho importante as that’s imo what states Medicaid program is going to need to start doing in a big way to get insurance co. to do policies to deal with the staggering costs of LTC Medicaid program.
I’m gonna guess that most states will not do a “managed Medicaid” system.... most states are set up on the usual “dual” system since forever, like last millennium, where original Medicare is billed for whatever can be & everything else is billed to the state Medicaid.

It is always something!!! I think I've slept through one solid night since all of this! lol. I will go to the sources to find my answers. What a nightmare this all is! Thank you so much for your response!

I’m glad you asked this. My mom is in the nursing home and will be applying for Medicaid next month. The financial person at the nursing home says she will be “walking us through this process step by step”. My mom’s AARP supplemental policy is Currently $260 a month but is going up in January, and her prescriptions are costing her roughly an additional $180. We were told not to cancel this policy, that it would work out. We were just passing in the hall so I didn’t have the chance to ask how.

When Mom was approved for LTC Medicaid in the NH, I was confused as well regarding keeping her Aetna Supplemental Medicare plan. I called her Medicaid caseworker, who wasn’t sure whether to drop it or not. But I did get paperwork through the mail that in NY you have to sign up for a “Managed Medicaid” plan. I chose Nacentia and I met with that rep (she came to the nursing home) and that meeting showed that she no longer needed the Aetna Supplemental. All her meds, doctors, labs etc were covered and she never had to pay anything at all.

Talk to your social worker before you do anything.

I would also call united health care and ask them how they have seen this work. I have found them to be amazing to deal with, helpful, courteous and kind, not to mention knowledgeable.

I can't imagine that she is expected to keep an insurance that she can no longer afford to pay for. Maybe things are adjusted or cancelled, I would go to the sources for the solution to this problem.

Hugs! It seems like it is always something.