Currently have supplement that is HMO but primary care does not want to approve anything nursing home doctor recommends. Nursing home doctor does not accept any Medicare insurance but takes whatever Medicare pays so he can't be the PCP. Resident has full MOLST but still hate to be without additional coverage and don't feel an expensive supplement is needed.
Thanks for everyone's response. I hope I can provide some useful info to someone in the future.
For all the NH we’ve dealt with for my mom & MIL, the MD who is medical director of the NH is the point person for all health care orders for the residents. All have taken Medicaid & Medicare. None of the medical directors have been full time; they still have a regular gerontology oriented practice (which could take other insurance in addition to Medicare &Medicaid) and usually medical director at a few LTC facilities. Each facility seems to get “rounds” twice a week. They do not attend the every 90 day or so care plan meeting unless it’s something special or specific set for the meeting. In my experience it’s the DON (director of nursing) that really sets care plan & gets MD to do orders based on the DONs suggestions.
HMOs & MediCARE Advantage plans really require enrollees to get care from MDs and services that are “in network” for the HMO or Advantage plan to make it work financially for both enrolled and providers. They are closed systems for care. If you cannot get to the in network clinic / hospital / doctors office, and do all follow up care in network, then HMO / Advantage is of no benefit.
Smallchange, I’m surprised that the NH MD does not take Medicare as basically everyone over 65 has MediCARE in the US. Are you sure this is right? Are other NH services, like PT & OT, also excluded? So this is purely all private pay facility? If so, does your family member in the NH have a significant amount of $$$ easily accessible? Like do they have at least mid6 figures? 300-400-600k?
Where I live (New orleans) there are a couple of LTC Uptown that do this approach. I’ve had couple of friends who had mom’s / Aunts there. The room & board runs about 6-8k a mo and the monthly health care oversight 5-8k & all private pay. (And costs in the South generally are lots lower than east or west coast!). BUT whenever there’s a significant issue in care, they are sent via private ambulance to the ER so that they can become a hospital admit and Medicare can pay for hospitalization stay. Once better they return to the private pay LTC. Eventually they - if they live long enough- get too ill or need a more intense level of care plus run out of $, so they move from the private pay LTC to a more traditional NH that takes Medicaid and Medicare. If your elder or family is all “Queenie” about her/herself, this can be a real shocker.....
I mention this cause unless they have significant resources, they will run out of $ if they live long enough. Getting them into an acceptable facility then that takes Medicaid could be difficult. Could you or family pay on your own for months of private pay care if need be? Please please try to take a hard look at costs. If it’s flat not sustainable, move them ASAP into a place that accepts both Medicare and Medicaid now as private pay so they can later transition to a Medicaid bed at the same place so it’s as simple as possible. Being private pay at the beginning & for a while gives them lots more options at to location.