My mother lives in an AL and has Medicare, Mutual of Omaha, and Medicaid. There's no possibility of her ever leaving assisted-living. Can anyone tell me if she needs this supplement for any reason?
I have contacted the local office that signed her up with Mutual of Omaha in our town and her agent has since left. They said I have to contact headquarters, so, in the meantime I'm waiting till they receive POA papers from me.
I am trying to resolve this myself without involving my mom because she has had another stroke and anything like this brings on major anxiety for her.
Since she's in AL and on Medicaid I don't understand why she would need to have a supplement too. It is costing her $240 a month.
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.
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.
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
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?
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???”
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 💜
Please call them first thing tomorrow, just in case it's 72 hours.
Last Thursday is when she canceled it, I just hope it's not too late!!
Does anyone know???
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.
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.
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
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.
selection of providers (PCP, labs, Hospital/ER, specialists, etc) along with delayed access to using them.
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.