Does my mother need a private-pay medical policy in addition to being on Medicare and Medicaid?

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My mother is 95 years old and has Medicare, Medicaid and a medical policy with private pay that costs $300. Does she need the private policy?

Answers 1 to 9 of 9
Expert Answer
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We can't know the future, so it's hard to say. You could pay that extra amount for years and wish you hadn't, but a serious medical condition may make you wish you had kept it. I'd check with an expert on insurance and your parent's health. Since she has both Medicare and Medicaid, she has better coverage than many. An expert on Medicare/Medicaid should be able to help you.
Expert Answer
394 helpful answers
Assuming she is over age 65 probably not. As a "dual-eligible" participating in both Medicare and Medicaid your mom's primary insurer continues to be Medicare. Medicaid now acts as her "secondary" and pays her Medicare deductibles and co-payments as well as her Part B Medicare premium. As a Medicaid recipient she is required to have a Part D Medicare Rx plan the premium for which is also subsidized; her Rx co-pays go down to $1 and $5 and there is no Rx "doughnut hole".

Some of my clients have employer based retirement health plans which they keep; others are in HMO's or other managed care plans which they prefer to remain involved with.

Unless there is some extenuating circumstance, there really is no reason to keep it. If anything, I would save the money to "buy-up" to a better Part D prescription drug plan.

As you may or may not know, different plans have different prices AND different formularies. The lower priced plans, those subsidized by Medicaid, may not have the meds your mom needs at some point. When and if that time arrives she can, as a low-income dual eligible, switch plans at any time of year to one that would meet her needs (and which will probably be more expensive).
Hi RLK~As previous mentioned in this forum, I would check with an insurance expert, or a department of elderly affairs to see if an additional insurance-Private Pay policy -would be worth having in your situation, and then act accordingly. As Carol stated-'who knows what the future holds with healh related insurance questions, and I am sure you do NOT want to buy a policy, you find that was not necessary. This can possibly be a complicated matter-and thus seeking some advice from an "expert"--is the way to go at this point.
Hello RLK, Medicare is her primary so she's covered up to 80% of all her medical bills; now the other 20% should come from Medicaid ( a state-supported program ), however, the additional monies that you are paying privately, such as a Medi-gap policy may not be necessary. I would call both Medicare and Medicaid to verify if additional funds are necessary.
If your Mom has both medicare and medicade coverage it may coverage all the medical bills which may have bill to her. You can call up the number on her cards to see what the coverage is for. Mt own mom took out Bluecross Blueshield many years before she got ill. She was in good health and the premium was not that high. I am glad she did and I set up the pre authorized withdraw from her account. you see when she got sick and was in the hospital I had Medicare and also well care and blucroos blueshiel to help me out. No bills were due. Only when she went into assisting living the mthere was a small amount for her medicines. She was in the hospital almost every year sometimes several times due to the illness later in life. There is no harm in calling. patrica61
Thanks to each of you for your time and thoughtfulness in answering my question about my mother's health care support needs. I truly appreciate it. RLK
i have medicare and an hmo. which is my primary insurance
Always confusion amongst Medicare managed care plan members...Do I have Medicare or not?

The answer to the question "....which is primary, Medicare or HMO?" is neither. Medicare HMO coverage (Part C) is offered by private corporations and accepted by beneficiaries INSTEAD of Original Medicare (Part A & B).

As such, ALL of your coverage is the responsibility of the HMO unless you switch back to original Medicare. You can not have two Medicare plans of any kind simultaneously.

By law Medicare managed care plans (Part C) must offer benefits equal to or greater than that offered by Original Medicare. Generally, HMO's require that contracted network physicians, hospitals, and suppliers by used. No benefits are available outside of the network without prior approval.

This contrasts with Original Medicare in that a beneficiary may go to any doctor or hospital that accepts Medicare.
Mr. Robbins commentary seems to make sense, as he knows the law. I would stick with the Original Medicare plan.

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