Are there exceptions to the open enrollment time frame for extenuating factors? Mom has this crazy replacement medicare policy and it is way too restrictive with the doctors available in our area. I have read on several sites that if you are entering or leaving a nursing home, those are exceptions to the medicare open enrollment and we can change her policy. I called Medicare and they had me call Social Security. Social Security insists she has Medicare, because I have her Medicare card.
She had Medicare alone at first, then switched to a supplement and then a replacement, none of us knew what she was doing. She needs to see a neurologist, but the main clinic here doesn't take any Medicare replacement plans. I am assuming they take Medicare and maybe supplements.
She is in a nursing home, paying $6000 for her out of network max out of pocket, which allows her to stay for 100 days. The way I read her policy, if she was in network, she would pay $0 for the first 20 and then a $137.00 co pay for days 21 -100, that would amount to more than the $6000. I don't want to rock the boat about that, because it looks like she can't come home, she needs 24 hour care.
So, do I let the 100 days ride out, with her paying $6000 up front and staying the 100 days? If I can get this switched, then I assume she starts over with the days 1-20 at $0 and then would have to pay an additional 79 days at whatever the co pay is?
I have been told various things, open enrollment starts October 1 or 15? It goes into effect in November or January? It's crazy how many answers you get for this stuff.
I would love some input or direction in where to find the answers.