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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.

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Thanks for all of your answers. I think I can switch her to Medicare supplement at any time, but I can certainly check on that part. The real issue was the cost. The drug portion alone will be higher than the full HMO payment so I was trying to avoid that, especially when considering that, with full MOLST and do not transport orders in place, the only items that I can think of that would not be addressed at the NH would be broken bones or geriatric-psych stays. However, with the HMO/PPO explanation provided by igloo572, I see why those don't work. The medicare supplement will cost at least 100 times more per year than the medicare advantage so I was trying desperately to avoid it.
Thanks for everyone's response. I hope I can provide some useful info to someone in the future.
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Like said, it sounds funny that a doctor on staff with a NH doesn't take Medicare and Medicaid. At Moms NH there was more than one doctor to choose from.
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My Mom had AARP and Medicare when she entered the NH plus State prescription plan. No problem in them working with what she had. Once on Medicaid, I dropped the AARP. When it comes to supplimental, each state has only a few it will deal with. So that narrows down what insurance company you can use.
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I’ve seen some posts on this site that led me to believe that some LTC are really pushing a particular Medicare Advantage plan. It made me think that they were somehow financially benefitting. Not at all sure if that is correct but aside from administration of charges could think of no other reason they would be so invested in pursuading residents to be on a specific plan. ??
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I’d like to echo what jjariz posted as important as there is a timeframe in which to use the “change in status” to switch to Original MediCARE.

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. 
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You shouldn't have to wait for open enrollment if he has moved and his living circumstances have changed. Call 1-800-633-4227 to talk directly to Medicare. If you don't get a satisfactory answer, call your local Area Agency on Aging and ask to speak to a Medicare expert. As I'm writing this, I'm thinking you may want to call AAA before you care Medicare.
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Don't you need to switch back to traditional Medicare? I think that's what most NH docs take.
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Thanks for your answer. This is entirely private pay. The NH doctor does not accept any medicare plans. Because this is a doctor who only visits nursing homes, HMO does not have him in their network. But...if doctor does not accept any medicare insurance, I don't quite know how to enroll in an advantage plan that require a PCP to be listed. I will check with doctor's office and with insurance, realizing that I probably cannot change anything until open enrollment, but trying to figure out what to do when that time comes. Local expert with Senior insurance did not have any suggestion.
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This is confusing to me. LO is not on Medicaid, private pay? NH doctors excepts Medicare so takes just what they OK. The same NH doctor does not except LOs HMO or HMO doesn't have him in their network? I dropped Moms primary when she went into a NH since home had a doctor on staff. Ask the NH doctor what insurance he recommends. Then start doing your research. You may not be able to do anything until open enrollment at the end of the year.
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