Medicare Advantage Plan vs traditional Medicare and a Supplement?

Follow
Share

Is there an organization not affiliated with an insurance company to talk to about insurance options? The nursing home where my m-i-l resides is pushing a new company named "Simpra", that looks to be a special needs plan for individuals needing long term services and support. My m-i-l is currently on Medicare/Supplement/Medicaid, while waiting for my f-i-l's estate to be settled (2 years and counting). When it's settled she will be coming off Medicaid until that money is used, going back on Medicaid when it runs out, coming back off when the next payment (sale of a company) is made, going back off when the money is gone....for, assuming she lives that long, at least 5 years.
I really don't want to spend lots of time changing insurance companies back and forth so we are keeping the supplemental insurance because she will need it intermittently. But I'm not sure that my thinking is correct, especially as the nursing home is really pushing this medicare advantage plan. I need to talk to someone who "doesn't have a horse in the race" and won't try to sway me to a particular insurance company/method.
Any suggestions about who to call for advice? (Or does anyone out there have experience with this back-and-forth situation and know what's worked for them?)

This question has been closed for answers. Ask a New Question.
Find Care & Housing
15

Answers

Show:
Frugal1SBM,
So sorry for your recent loss!
Helpful Answer (0)
Report

It would be rare to be able to see a chiropractor under an HMO Medicare Advantage Plan, for example. But some plans pay your Medicare premium to get your business. What you get will be the Standard of Care protocol that everyone gets. imo.

With stand alone Medicare, you choose your doctor, do not need to be referred to physical therapy or a specialist.

However, I do not know how this computes for a nursing home patient.

Call H I C A P, which stands for Health Insurance Counseling........keep dialing.
Helpful Answer (0)
Report

Yes, I used an insurance agent pro bono to me to set up Medicare and Medicare Supplemental.
Helpful Answer (1)
Report

Problems of this kind I believe talking to you Medicare provided SHIP/HIICAP in the Office for Aging. They know the ins and outs of insurance and are unbiased. They are trained by Medicare and also work closely with Medicaid.
Helpful Answer (1)
Report

For my father-in-law in nursing home on Medicaid, our elder law attorney said that if we drop his extra insurance, his patient liability amount (what he has to pay the nursing home each month) will just increase by the amount of his current premium. So, if that is the same in your state, it wouldn't save any money to change plans unless the new one would pay for something Medicaid isn't covering under your current plan.
It sounds like you are happy with the plan she has, so I'd be making the NH convince me exactly why Mom would be better off to change before I'd even consider it. Could be just for them to get more of her monthly payment sooner and no benefit to her at all--especially if it's a PPO and she uses providers outside their plan.
Helpful Answer (1)
Report

I was so confused when the "donut hole" was introduced that I finally just contacted Medicare directly. They have a website.

I got a very knowledgeable 'agent' who asked me what coverage my dad & hubby had and I told him the VA supplies their medicines and we have that really old BC&BS plan. He said to hang on tight with both hands as in Medicare, they called it the "Oldie but Goodie Plan." I later learned it is an advantage plan. He said his own father is on it and he advised him to hang on tight.

I turned 65 last year and after doing much research, I realized I had to find an agent. An agent has access to multiple companies and will look for the best plan to fit your needs.

The advantage plans cost more but there is no deductible. But you pay more per monthly premium to have no deductible. I got the figures and my calculator out and I opted for the plan with the deductible and saved a couple hundred $$ for the year. I am not on any medications. I then took the $17 month Humana Drug plan and I guess I break even on the costs. At 65, I hopefully will not be facing anything major.

My DH has kept the BC & BS Advantage plan even though it costs about $50 more per month but the VA supplies his medicines and BC & BS picks up the cost the VA would be charging us ($9 per med per month). We come out a little ahead this way and it all gets mailed to us. The VA comes out ahead because BC & BS actually pays more than they would be charging us, or they accept the BC & BS payment as "paid."

Ask friends and relatives, neighbors what agent they are using and if they're satisfied. That's what I did for myself. I was very pleased with the results. The agent doesn't care which company you prefer and will do the paperwork.

Yes, it is all very confusing but when the determination went out that you MUST have supplemental, I knew I needed help as did millions of seniors.

P.S.  I did learn last year that the coverage is the same!  By law I guess, but every plan has to offer you the same protections and cover the same procedures.  So whichever company and plan you choose, it's basically the same coverage but with a different envelope.

P.P.S.  I hadn't heard of the "Medicare Advantage Plan" so I will ask my agent when I call him next week.  He said that all I have to do is call him the first week in November and he will make sure I am on the best available plan.  Just another reason to find an agent.  BTW, even Medicare suggested finding an agent on their website. 
Helpful Answer (1)
Report

I agree with vegaslady. Contact your local Area Agency on Aging. See if they have a SHINE person that you can meet with. Ours has volunteers that can meet with people in their main office or at your local Council on Aging.
Helpful Answer (1)
Report

I bought a Medicare Advantage plan associated with my husband's Assisted Living and the Nursing care home he had to be transferred to this year. It was the best decision I could have made. We had an Insurance provided Nurse Practitioner which provided continuity of care and proactive investigation. They ensured my husband did not go to the hospital for treatment. He had two strokes this year and they provided palliative care instead of my switching to hospice. He passed away Oct 7th.
Helpful Answer (2)
Report

Medicare.gov is a good website. Problem is that you are going to have to put all drugs in there and then they will display plans. You may have to call and find out what hospitals and Doctors the plan is affiliated with. Also an Advantage plan will pick up the deductible where just a supplement won't. I am confused this year myself and I was in the insurance industry. I need a plan that will work better on the prescriptions because I have to take so many.
Helpful Answer (1)
Report

Since Mom is under Medicaid I would check with them before doing anything. Why would you want to change, everything is paid for by Medicaid.
Helpful Answer (1)
Report

This question has been closed for answers. Ask a New Question.