Is it "ok" for my nearly 80 year old Mom to drop her private insurance when she has Medicare and Medicaid? -

Is it "ok" for my nearly 80 year old Mom to drop her private insurance when she has Medicare and Medicaid?


Probably will make an appointment with someone to talk this over but thought I'd start here. Some is probably off topic, possibly belongs in the other sections, but I'm trying to explain the situation, what she has, main question is the insurance. She was self employed on a dairy/cattle ranch all her life, but her income all went in on her mother and later husband's taxes, income was very good many years and a lot of taxes were paid. Dad died almost 20 years ago (Mom had all the assets before the marriage, Dad came in with nothing at all, literally), and she doesn't get much social security, so looking at some options rearranging things. She's been paying out of pocket for private insurance in addition to Medicare and Medicaid, I believe it's around $250 per month.

I bought most of the land over 10 years ago, that income went to existing debt. She kept a small 20 acre patch in her name with the main house, some old outbuildings. About 5 or more years ago her land was changed to a "life use" thing, my name was supposed to be on it, if the lawyer did it right. I am the only child. I planned on moving out some years ago, either fixing up a very, very old house on what I bought or something, I lived in a small trailer on hers for a while, but her health has been preventing me from ...going very far.... She has made it clear she doesn't want to go to assisted living or anything. She is relatively ok much of the time, but has had several mini-strokes, has had issues getting around, back surgery years ago, falls down sometimes and can't get up, and usual age related things, etc. She stopped driving, has no vehicle of her own. She's been having "mind" issues (like forgetting who I am a couple times for a while, etc.), but rarely. I sort out her large amount of medication into those tray things, and I have to set them out each time of the day, she doesn't take them right if I don't, takes the wrong ones at the wrong times. Talking to her she sounds ok 99% of the time, most probably couldn't tell anything. I do the running around (town is 30 miles away, she doctors there and 65 miles away, my vehicle, my time, and my gas), get the mail (1/4 mile away), cook a lot of the time, and just check on her several times a day, etc. I don't get any monetary compensation. With the land payments and everything I have going on with myself and with this, I can't really help out monetarily with her, what she gets doesn't really cover everything she has going on by herself. But where "her" land is, I use it as my own outside. My old equipment and tools are in the buildings, I store hay on it, and have various pens/stuff there. We've discussed the situation with Social Security and some of the offices around when she's had to go in, but haven't really sat down with an overall expert.

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Thank you everyone. I know this is a complicated topic. I have been in her finances for well over a decade, know most of it, just not smart with it and hard to keep track of everything, good to have everything pointed out that needs checked and asked. Yes, she has Medicare and Medicaid, she has no assets other than the land, house, what I mentioned. Forgot she also gets SSI, the drugs aren't covered with Medicare exactly, she has a separate plan, drug company that is being paid for by gov't (off the top of my head Silverscript?, she did that on her own, I'm bad with remembering names, and I could find a statement...), her copay is around $1+ or so each drug. Private insurance is personally purchased, self employed her entire life (as myself). Correct, she just never cancelled the policy. She is also on oxygen at night. That machine rental and many of her bills are going through the private insurance.

She does get around yet, bathing herself etc. The back is an issue, surgery before, three bulged discs now, sciatic nerve issues, said she could use surgery again but they don't want to and neither does she. Stairs, etc. bother. Falling down, but not too often yet, last time she did she couldn't walk for about a week (her hip's very bad too). Cooking she can do herself, kinda like me she doesn't get hungry sometimes. If she does cook, it takes a considerable amount of time, like most things do. Cleaning up afterwards as well (if I pick up sometimes it's not enough I guess...). Not saying that's a bad thing. She wants to do it sometimes, and has been safe so far. She sometimes gets quite cranky though while doing that sort of thing (I know she wants to be able to do it better), when I'm helping too, so I try best I can to get stuff done. But of course if I say she doesn't need to this time, sometimes there's a bad reaction. Hard to always know how to word everything. So I just try to do it most of the time if I can, and it's usually ok.

Stuff being situated. That life estate thing -should be right, I was there for all of that, that's what the paperwork said, filed at the court house. Lawyers office there tried to do some other eldercare stuff, wouldn't return phone calls, someone gone when they were supposed to be there, couldn't get SS office to call them back, basically a headache so I don't know if I trust everything they did. I do have power of attorney and have had that for years.

There was a social services type office 30 miles away, all that closed and now the office is 150 miles away, they handle everything by phone. Social Security office is 65 miles away.

If her income had only been reported in her name, she would be getting considerably more SS, and wouldn't be having the issue with finances as much at least. I don't know why the accountant did it the way he did. I don't know how an older person would sort everything on their own the way it is now.

I'll try to get stuff done. Thanks everyone.

I always have a time trying to think of names for forums....
Helpful Answer (0)

"jonq" - btw love the name! The points that HolyCow has brought up is important.
You need to find out if the $ 250 a month policy will cover the costs that Medicare & Medicaid will not. If it is like most policies, they will not pay if there is a secondary funded insurer in place (which Medicaid would be).

For example, my dad was a federal employee and had a extremely good high option federal Blue Cross policy. My mom never gave it up and the monthly cost was taken out from my dad's federal retirement every month that my mom gets paid. She never paid a cent in actual health care costs as between Medicare and my late dad's BCBC everything was paid. BcBS pays at a much higher rate too, so many of her providers loved being able to bill BCBS. Most of them would never take a Medicaid patient either so it was good she had BCBS. Fast forward to a couple of years ago & mom moves from IL to a NH. She applies for Medicaid to pay for NH and is accepted. BCBS starts to get bills from the NH for stuff - like physical therapy and other ancillary stuff - BCBS contacts mom (really me) regarding her status on other insurance. Long story short her federal BCBS is "suspended" (not cancelled) as long as she is covered by Medicaid. BCBS will not pay for a service that can be billed to another carrier, which Medicaid is. So if mom had continued to have the $ deducted from her monthly federal annuity, it would have been totally lost $ as BCBS would not have ever paid for anything.

On another note, I would look to see if mom can be evaluated for needing hospice. If not for now, then at least you have someone to speak too in a couple of years when she likely will qualify. Hospice is totally a Medicare benefit and they could if mom qualifies, come out to do for her 2, 3 or 5 times a week. Imagine if she had someone come twice a week to help bathe her and do monitoring of her health needs. There probably are several hospice groups that specialize in rural hospice needs. I bet it is lucrative too for rural areas as they get to bill mileage. My mom is in a NH and she now is on hospice since June when she broke her hip. Medicare pays her hospice right under 5K a month for their services which are 3 X a week. She has never been cleaner and has lots of individual attention from the hospice aide and the hospice staff. What a godsend. The two bigger hospice groups are VITAS & Compassus - they have national 1-800 numbers and if they don't work your area probably can give you names of smaller more regional hospice. Good luck and happy Holidays!
Helpful Answer (2)

Okay, you have to make SURE Mom has MEDICARE and MEDICAID first. That is what is know as a Medi/Medi patient...Medicare/Medicaid. On her Medicare does she had parts A, B & D? That is for regular doctor bills, hospitalization and drugs. If she has all three she is completely covered, except the 20% and any non covered expenses. Medicaid, is for those people who have little money and less than $2,000 in cash assets. Medicaid pays the left over expenses that Medicare did not cover, so your Mom should have a zero balance left between those two insurances. The only time this is not true would be if your Mom sees doctors that do not accept Medicaid (many don't) which would mean that your Mom might have to pay the remaining 20% after Medicare pays their share. I can't see that amounting to more than the $250 she is paying to keep the other insurance going.

I have a feeling that your Mom had this private insurance before she went on to Medicaid and she just never cancelled it, fearing she might need it in the future. Some of these insurance plans that came from former employers cannot be regained in the future if you decide to cancel it now. I would call all of Mom's doctors and ask if they accept her Medicare/Medicaid....if they do then I would consider cancelling the private insurance. I know Medicaid asks if you have any other private insurance but I never knew why, they could rely on them paying as the 2ndary which would then mean Medicaid would be 3rd, but why pay $250 a month if you do not have to? The other thing would be that you need to talk to your Mom's social worker and see if she has what is called a "Share of Cost" if she has, as an example a $300 Share of Cost, that means she has to pay the first $300 each month before Medicaid will pay a dime toward her expenses!!!! In this case her private insurance may cost her $250 a month but she has to pay $300 each month before Medicaid will step in.

This can all be very confusing so make sure you call her case worker and get answers BEFORE you do anything about cancelling Mom's insurance.

I have Medi Cal and at one point they told me I had a Share of Cost of $500 a month, which made me wonder why I would want them anyway as I could buy a 2ndary insurance cheaper than that. It was a mistake....thank God!!!

You have a lot of work to do to check this out and try to understand what is going on, please do it. Your Mom has a lot of medical issues and needs as much help as she can get. I believe Medicaid will pay for you to get in home help/care for her, check into now in case you need it later or get it started now. She needs someone cooking all meals for her and helping her around the house all day long. I would not want to leave her alone.
Helpful Answer (1)

Jeez, that's high for a medicare supplement insurance! We pay $170 a month in expensive Massachusetts! Find out for sure what kind of insurance it is. She may not need it at all, and you could sure find something good to do with that money!!!
Helpful Answer (1)

In this state, if you have Medicaid you select among a limited number of insurance companies who do the administrative work. You cannot really not have it, but it does not cost extra -- Medicaid pays them. Talk to Mom's Medicaid case worker for the details in your state.
Helpful Answer (2)

Sitting down with the "overall expert" whether estate planner or eldercare attorney consultation, and making sure papers are in order - including health care directives - would be a really good idea.
Helpful Answer (3)

I cannot see the need for private health insurance if she has both Medicare and Medicaid. If she had only Medicare, then a private health insurance helps offset out of pocket expenses not covered by Medicare.
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