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My mother has several major illnesses, and she needs hospice. The hospice providers said she would have to drop her Partners Advantage, leaving her with only Medicare. What can we do?

Asked by pcall | Mar 3, 2010

Hospice was recommended by her physican for COPD.

Answers 1 to 1 of 1

Ralph Robbins, Mar 3, 2010

Ralph S. Robbins, CFP© is a fully licensed Certified Financial Planning Practitioner specializing in Eldercare Financial Planning. He works everyday helping families in crisis find creative ways to fund long-term care expenses and deal with family financial issues.

Hi Pcall...

Correct me if I am wrong but I am going to assume that "her Partners Advantage" is a Medicare Advantage plan under Medicare Part C. If this is indeed the case your mother does not have Original Medicare which permits her to go to any doctor or hospital (or hospice) that accepts Medicare.

Instead, her Medicare benefits are being provided by a corporate entity that is paid a monthly capitation to provide almost all of her Medicare benefits including Medicare hospice services.

Most Part C Medicare Advantage plans contract with a limited number of ancillary service providers such as hospice. It is likely the hospice provider you have selected is not contracted with Partners Advantage which provides your mother's Medicare benefits.

You have the following options:

The first thing to do is contact Partners Advantage and ask them if there are participating hospice providers that she can choose from.

If you a partial to the hospice provider that told you she has to drop her Medicare plan she can do that. Beware, however, that she will be back on Original Medicare with no supplemental insurance. She will be responsible for deductibles and co-pays which can become exorbitant.

Fortunately, she can avoid this two ways: First, since it is not yet March 31st, she can switch to another Part C Medicare Advantage plan that may be contracted with that hospice. You can do this by contacting the hospice provider and asking them who they participate with and then switch to that plan by calling the plan or Medicare. After March 31st she will not be able to do this again until January 1st of next year.

Or, if she elects to go back to Original Medicare she can avoid deductibles and co-pays by purchasing a Medicare supplement. This may be difficult to do in your state due to the fact that she has pre-existing conditions, but there are usually one or two carriers, including AARP, that are guaranteed issue.

Lastly, there is Medicaid hospice. If mom is virtually impoverished anyway, you might consider applying for Medicaid. Medicare would be her primary so she could use any hospice facility that accepts Medicare and Medicaid will pick up the co-pays and deductibles.

Good luck...