My mom is in skilled nursing rehab. She had a BCBS plan F. We didn't realize she didn't have premiums deducted from her bank, so they canceled her policy. I asked for a reinstatement if we paid in full. They denied the request.
My is question is, are supplements worthwhile? From what I was told, United Healthcare would become primary and they only pay $300/day the 1st 7 days in hospital. And doctor visits have a copay.
I'm at a loss on what to do. She will be in a nursing home private pay once her money runs out, then Medicaid.
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What you were quoting about UHC paying $300 a day for first 7 days in hospital is not how Original Medicare pays. Please see Medicare.gov. It has all the information.
ABOUT who can get plan F?
It is based on what year your mom turned 65. If she actually had Plan F before, then she would qualify now but as others have said plan G is actually cheaper per monthly payment. Again, there is a chart showing what each lettered plan covers on Medicare.gov.
ABOUT is it worth it to have a supplement. I have been in the hospital twice in the past 5 years for several days each time. I’ve had no out of pocket expense.
My DH aunt had to go into skilled nursing. She was private pay and then switched to Medicaid. Medicaid allowed her to keep her Part A,B,D and supplement F. She was able to see her geriatric doc (Telemed) using those policies when needed. I wanted her to be “over insured” not under insured. It must work for the state or they wouldn’t allow it.
Because Medicare supplements are state specific, go on Medicare.gov, put in your or moms zip code and you can find all the plans available in that area.
Plan F changed after 12/2019. My husband’s Plan F (pre 2019) payed EVERYTHING leftover from Medicare. His amputation required 15 days in the hospital and 3 months rehab. It even picked up the copay for his (now 2) prosthetics. It’s gotten increasingly expensive $360 a month but with his needs, worth it. I have Aetna Platinum and am happy with it so far.
Best of luck and I hope this all works out for you.
The alternatives are either (A) Medicare without a supplement (which is okay and will still provide a lot of coverage, but does not have a cap on out-of-pocket expenses) - or - (B) a Medicare Advantage Plan (Medicare Part C), which cannot turn down an applicant. If you go with (B), get a PPO plan instead of a HMO plan, so you have more options for doctors and hospitals. I'd go with (A) if you don't foresee large expenses (e.g. hospitalization). Advantage Plans can be a lot of work to get care and coverage for things like rehab.
Best to you and you mom.
A couple of other things to keep in mind for people checking out Medigap plans: 1) it seems that policies may if not always go by state for eligibility, provisos, probably pricing, etc; 2) these things change, sometimes from year to year, so it's wise to keep checking; 3) there are only a few states -- Massachusetts being one but I don't recall the others -- where there is a state law that a Medigap Provider cannot deny a prospective policy-holder being able to purchase a plan because of "pre-existing" conditions.
Her main problem is a permanent penalty for the rest of her life because of the payment gap and that length of time. She is also switching plans. Plus since she is beyond age 65, her co pay will be adjusted, called underwriting, due to whatever co morbidities she has. She made a permanent and costly mistake.
Please go to Ed Weir's channel! He's one of the most knowledgeable, helpful men in the field.
It’s that F unavailable for any new underwriting is the issue as cannot be reinstated, in my understanding.
On your quandary, I’m going to approach it differently, so she’s going to remain in the NH post-rehab, correct? No going back home, right?
- she’s on Original Medicare, so right now where is she on her rehab stay for Medicare coverage and daily copay costs? And what are the therapists thinking she’s good for continuing with rehab….. 2 weeks? Deduct all those copays as it’s pretty much a fixed $ amt.
- So with these deductions, and maybe buying some stuff she personally needs & a compliant for LTC Medicaid funeral/burial policy, how long of a private pay period does she have to get herself impoverished to be able to file for LTC Medicaid??
imho that’s the big factor. If a few weeks at best, easiest is to have her file for Medicaid as her secondary health insurance to her original Medicare. Here’s why…. She eventually is going to become a “dual” of Medicare + Medicaid as her health insurance if she goes onto LTC Medicaid to pay her room & board costs. So this just has that eventuality happen sooner for her health insurance.
But if it’s several months of spend down, ask at the NH what supplemental or secondary health insurance the other nonLTC Medicaid residents use. Then see which one she can do easiest for new enrollment for significant change of life enrollment situation. Realize Open enrollment has past, there may be just a narrow range of choices.
Medicare Advantage Plans really don’t work for those in facilities as they are out of network. But MCO / Managed Care Organization might & it could be that your States LTC Medicaid program has required enrollment on a MCO whenever feasible. For example, TX LTC Medicaid NH program does this and the big MCOs are Superior & Molina (it’s by county and some have choices but others flat don't). Fwiw Molina is the big player nationwide for MCO health insurance.
Also please, pls plz be sure that this NH is 100% ok on her staying there as a “Medicaid Pending” custodial care resident. It’s not automatic.
G just has a small deductible that F doesn’t have. I have F. My DH has G. It actually is cheaper as the deductible is not that much. Can’t remember right now. otherwise it is the same or last I compared it was.
When I did the research for my dad, I found that his annual out of pocket expenses for an Advantage plan were double what his annual premium was for a supplemental that picked up the 20% Medicare doesn't pay.
I don't know with all the changes what Advantage plans look like now but, me and mine will stick with Traditional Medicare and the supplemental plan G until they muck that up.