Switching from a Medicare Advantage plan to regular Medicare plan - has anyone had any experience with this for their parent? Pros and cons?
My 94yo mother, who is still of sound mind (short of forgetfulness) insists on aging in place and is house bound. I'm her long-distance caregiver (two hours away and FT job). I travel every other weekend to care for her and her large home. She developed edema and last year was hospitalized twice for cellulitis in her legs. She has had a home health nurse to wrap her legs since, as with her back issues she has trouble keeping her legs elevated; thus, it is difficult to keep the swelling from occurring. The leg wraps are the only solution for her as she can't get compression stockings on, nor can others get them on her because she has little strength in her legs. Recently, continuation of her insurance coverage for this was denied as the nurse's assessment indicated her legs were healed. However, her legs began weeping within 12 hours of the removal of the wraps. After many phone calls to the nursing agency, a re-assessment was completed and the insurance company authorized 8 more weeks of visits through the first week in December. The nursing agency suggested we switch from my mother's current Medicare Advantage plan to regular Medicare, as a regular Medicare plan usually does not require prior authorizations. Has anyone had this experience and how did it work out? Did switching to regular Medicare prove to be a better choice? Thanks for any insight.
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- Insurance.
I tried one time to check on how to get my friends changed. A broker told me the problem was when you go on Medicare it is extremely important that you make the choice for the right one the first time you sign up.
Part A no problem. Part B should be no problem. The problem is the MediGap plan doesn’t have to take you after the initial opportunity to sign up when you first registered. You must put down all the preexisting conditions and they will charge more than if you had just signed up when the preexisting didn’t count against you. Also each year as you get older, it will go up. There are about a dozen plans to choose from in my area for the medigap. You put in your zip code on the Medicare site and all will appear. You can see the prices there for the first time applicants.
I have a good friend whose sister has an advantage plan. She has just been diagnosed with bladder cancer. First of all she had two cultures (supposedly) for an UTI and had been on antibiotics. My friend just happened to call and found that her sister sounded so bad that she called 911 from several states away. She needed 6 pints of blood. Then the hospital experience was a nightmare then she went to a rehab, 1 of 3 that the advantage plan would cover. On the Medicare site there was a red hand meaning no don’t go there, abuse, on two of the three.
There she was thought to be not doing so well in therapy when what the problem was (discovered by my friend when she arrived) she had low oxygen. Back to the hospital to have blood clots treated in her lungs. The orig surgeon had taken her off blood thinners because she was bleeding. Next she learned she couldn’t go for the best cancer treatment because they wouldn’t take her plan. So my friend wants to change her sisters plan but I don’t know what she has found out. She wants to get her to better care than she can find in her sisters small rural town with the advantage plan.
Here is a link to an article recently posted on JIMMO. I posted one there as well regarding appealing advantage plans when they deny coverage. This might help inform you on helping your mom get services.
Let us know what you find out. We learn from one another.
https://www.agingcare.com/discussions/jimmo-settlement-490035.htm?orderby=recent
See also this question today, and it's answers. This medicare coverage mentioned available apparently only to patients without advantage plans:
Does medicare cover in-home care for patient with cancer? - AgingCare.com.
This could pertain to mom's care for sure, I would think.
I couldn't copy paste the link, but that is the title of the question and it is in todays threads. You will find it by going up to timeline in blue, finding magnifying glass, typing question into the search bar. Good luck.
By the way my father had leg swelling and he had an electronic compression device that helped a lot. His vein doctor prescribed it. We used the device a half hour each day and it really kept the swelling at bay.
I really can’t answer your insurance question.
It cost twice what my Kaiser Advantage did. At the time of his death 5 years ago it was 250.00 a month, so I can only imagine cost today. So one comparison is that the non-advantage program is almost always more costly.
I don't know that home care would have provided him more than had he been on an advantage, with it's limitations. BUT, I do know that most insurance will not continue to cover in home services for this forever.
I really cannot "guess" what would be covered by a "not-advantage care" policy in terms of a need for ongoing in home visits daily; most insurance will not cover this.
With no one there to assist your mom when she can no longer care for herself or even manage, because of other factors, to keep her legs elevated, this will go on and will be a constant which requires, in all truth, daily management.
You may be looking at a situation that requires daily care. Will your mother be able to manage that? Or does she need someone with her to keep her legs elevated, wrapped, monitored daily?
I can't find an answer now, for mom's daily needs, in an "insurance supplement". I do not believe that any will pay for daily management by medical. And without her legs staying elevated I am afraid this is chronic and ongoing for her. The time when she can manage alone at home is almost over, I am afraid is my best guess.
I wish you good luck. You might consider checking on any policy how long they would care in home for such a condition, because this is chronic and ongoing.
I am by the way assuming that this is "dependent edema" by diagnosis and not Congestive Heart Failure which in the case of right sided failure would cause edema, require diuretics and their emergency trips to the bathroom and monitoring for potassium depletion and etc. I know you are hoping your mom can remain at home and die as home (the hope of all us oldsters). But you are skating close to the edge of what's safe, I am fearing.
Get on Medicare, find a good supplemental plan, and stop having your treatments being denied.
SHIP is Senior Health Insurance Program.
They are people that have been trained to help you navigate the various Health Plans and they can help find the one that is best suited for the least cost.
They are not paid by any Insurance Plan so they are not beholden to any of them and they will give you unbiased information.