My mom's physical therapist has asked me to switch her from a Medicare Advantage plan to original Medicare. Her reason is that because my mom has Parkinson's, she would benefit greatly from regular, ongoing physical therapy, and Original Medicare covers that.

The physical therapist says right now, my mom has to be seen by a doctor and get authorization for physical therapy, and the therapy only lasts for a set amount of time (like six weeks). She said it took a week to get it all authorized last time. She says this is different than how it works with Original Medicare. With Original Medicare, my mom can get covered, ongoing PT without needing to re-authorize.

I think she is annoyed at having to do the extra work, but also she wants my mom to benefit from ongoing PT, as do I. She says we can also pay out of pocket for her services ($50/session after partial insurance coverage), which we can't afford more than a few times each month.

I emailed a local agent who said this:

"Since she has had her current plan for several years she would not be able to switch back to a Medicare Supplement and Prescription drug plan unless she moved to another county where her plan is not portable. It does not sound like she will be moving. So the only way she can change plans now she gets Extra Help (the Low-Income Subsidy) through Social Security or she is dual eligible and has Medicare and Medicaid."

So I assumed it was a lost cause and told my mom's physical therapist, but the physical therapist is pushing me to contact Medicare directly to ask because she thinks it's possible. I think maybe she's had people just switch back to original Medicare, no MediGap, which sounds scary to me? I'm assuming that my mom would be denied MediGap.

Is it worth it all to call Medicare about this, or should I just let it go? Is it unreasonable to ask the physical therapist to just keep renewing my mom's PT?

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So, my mother had a Medicare Advantage plan with crappo benefits too. Here's what I did. I told the physical therapist that we could NOT AFFORD any co-pays; that I'd like mom to have as much PT and OT as her plan would allow, but that we would not be able to make the co pays. The PT company would get the amount of money mom's Medicare Advantage plan paid them for each session, and that was IT. If they wanted the business, that's the deal. I had to fill out an application stating her monthly income, which showed she was financially unable to pay for PT co pays, and they were WAIVED by the PT company. This went on for 2 years.

Ask your PT company if such a thing is doable with HER company. I'd rather ask that question than jump thru fiery hoops to try and change mom's Medicare plan to something else that may be better for PT benefits but worse for other coverage! If you haven't had issues with her current coverage other than PT, I wouldn't make any changes, personally. If your current PT company says no, call around and ask other PT companies for their input. If ONE company does such a thing (like mom's), I'll betcha other companies do too!

**I realize you may not get the number of sessions you'd like to get if you go this route, but mom did get quite a bit of PT and OT this way nevertheless. You may want to check into 'original Medicare' first to see if what this PT is saying is true in the first place. Just a thought, b/c I tend not to trust what anyone says blindly.**

Helpful Answer (1)
Reply to lealonnie1
tiredmouse Jun 23, 2022
Wow, thank you for this answer! It never occured to me that I might be able to negotiate with the PT company.

She has Aetna Medicare Advantage, and other than all the co-pays, it's been ok otherwise.

Changing insurance definitely seems like fiery hoops, very fiery hoops.
I think she might be a bit deceptive. You can’t change NOW, but you can change during open season which starts in October, which would go into effect next year. Some of these Medicare advantage plans are good and some are scammy and agents may get paid to sign you up for one.
Helpful Answer (1)
Reply to TopsailJanet
Isthisrealyreal Jun 22, 2022
Agents do get paid for signing clients up. That is how they earn their living, because Medicare is the only market open to them now.

Have the rules changed and you can go back and forth from standard Medicare to Advantage plans every open enrollment?

Under 65 has to use the government marketplace.
Well, I would listen to the agent. That's how they earn their living, so they keep up with all the requirements, regulations and nonsense.

I would tell the PT that you did call and she can't change.

If reauthorization is a problem, perhaps she can refer you to someone that doesn't mind doing this every 6 weeks.

My understanding is that you can only change the 1st year or by moving out of coverage area.
Helpful Answer (2)
Reply to Isthisrealyreal
tiredmouse Jun 23, 2022
Thanks, I will probably just tell her this. She's the in-house PT person at my mom's assisting living facility, so I might have to stick with her.
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