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My mom is in a nursing home with Dementia and will soon be on Medicaid with no income. She has health coverage with United Healthcare and a monthly premium of $180. My sense is that I should cancel the coverage since she can't afford it and since she will be covered by Medicare and Medicaid. She is 88 and has dementia but no know diseases or injuries. Can anyone share your thoughts on this? Thanks!

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Yes, please KEEP THE insurance coverage no matter what.
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When mom gets put on medicade, they take every thing. If there is a house and its in her name it has to sold. All banks acccounts they will look at, stocks, My mom had Blue cross blue Shield. it helped my out alot. I also set up a pre buriel funeral plan years beffore she got sick. In some states they can take everything. If dad is a veteran they can help. Some nursing homes and do know assisting living have programs that can help. Elder care needs to be called. Go through all paper work there may be some paid up inurance polices that can be claimed in if you are durable power of attorney or stocks. May be even bank accounts that were set up in your name. I found so much my mom had hidden. money was all over the house hidden in gloves, socks. mattress. She had dementia/altzimers. I saw it no one else.
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My Mom is in long term care, under Medicaid, with dementia and also needs 24/7 care for basic care and several health problems. When all this started I was advised by several people from different points of view....ltc facilities, insurance companies, other people dealing with similar issues...to keep her supplemental insurance going and I did.

All of her income goes directly to the facility each month and the facility pays her insurance premium. I suspect this benefits the facility in that they can get reimbursed from the insurance company for certain procedures that Medicaid might not cover. In any case, there's nothing to be gained by cancelling the supplemantal insurance as the facility takes all income anyway.

This all started about a year ago and my Mom has had 2 hospitalizations and other extra procedures and there have been no extra charges. Mom is in NJ and a lot of these "rules" seem to vary among states so it's best to check the regs where you live.
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There are 2 different "styles" of MediCare supplemental coverage plans - one is called "Medicare Advantage" - that is an HMO plan - you'll know that's what you have if you/your loved one pays co-pays for EVERYTHING, but the monthly premium is cheaper. The other is a "Medicare Supplement" plan - the premiums are higher, but there aren't many co-pays. Kaiser, of course, is HMO, as is Scan Health Plan, Secure Horizons, etc. The plans through AARP (via United Healthcare), Aetna, etc. are generally the supplement plans - higher premiums, but better coverage. In my mother's case, she started out with an HMO plan - the only thing she saw was the "cheap" premiums...turned out she was spending over $5,000. out of pocket every year on copays and services that were not covered. When I started checking into the difference, it was ridiculous to me that she stay on the HMO plan & I convinced her to switch to Plan F through Aetna. It covers virtually everything that Medicare doesn't cover. Of course the prescription plans are regulated by Part D medicare, and in California Medi-Cal picks up the majority of what Medicare doesn't cover, so that alone is a good reason to keep Medi-Cal if you are on crazy-expensive prescriptions.
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Keep the Insurance. Mom is on NH Medicaid for two years now. All of her small income is sent to the NH each month, minus the $50. she can keep for personal items. A monthly amount goes to her supplemental health insurance, which had become costly. However, in time the Medicaid Office will see this, and the Insurance payment will be reduced. Keep the Insurance to cover what Medicaid does not. People think that Medicaid covers everything...it does not. Nursing Home Medicaid is different.
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Trish888: Was United Health Care considered an HMO? Do they pay for everything 100%? I have heard of them but I am not familiar with their payments and I am curious.

I think the reason most people wind up on Medicaid is because on Medicare they only cover 80% of the charges and they have recently made changes where there are many items that use to be covered that no longer are. The only reason I went to Medi Cal was because I needed a 2ndary insurance carrier but could not afford one and I needed help with the cost of medication....one prescription alone was $567 a MONTH!

In reality keeping Medicare would be great if you could afford a 2ndary to pick up the balance. I have never wanted to get off anything as bad as I would like to get off Medi Cal!!!

My sister just got Medicare and signed it over to Kaiser and her copays ON EVERYTHING are outrageous. As a senior she is paying more now in copays than she did prior to having Medicare and being on Kaiser through her employer.

If anyone knows of any great insurance available in California please let me know!
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I was told to keep the medical insurance, because I had applied for Medicaid for long-term care coverage only. Out of Mom's monthly social security, I was allowed to keep the amount of the insurance premiums plus $60 for her personal expenses. I paid the rest over to the nursing home. So as I understood it (in Michigan) Medicaid would not cover her medical costs. A lady at my county Dept. of Human Services office was very helpful with this.
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I just assumed Medicaid was universal, but it appears States are different. My mothers health insurance CANCELLED HER when she went on medicaid. Currently what medicare doesn't cover, medicaid does. We purchased a burial trust so that when monies are gone at least that is covered (that is if Dad dies first). Also, my father receives my mothers social security for himself. I'm surprised that during your spend down application process that this wasn't addressed. The dept. of aging & disability is a great resource for Q & A.
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Question: why don't you just have Medicare for her health insurance? I was very unhappy with United HealthCare for my elderly mother. We found some rehab centers and other providers simply would not take us, if she had United Health Care, or Medicare Advantage. When we went back on traditional Medicare for my mom, she got much better services. Can you switch to traditional Medicare this coming November, during open enrollment? (I don't want to imply I'm an expert on this; it's only based on my experience.) Good luck! Hugs.
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My FIL is in a nursing home under the 90 day rehab. He will be staying and we are in the spend down phase. It took 10K to fix his house (could not list on the market until the repairs were made). We have been told that we need to sell his house and put the money in an account for this montly expenses and that when that is gone, he will be eligible for medicaid.
His pension is too much to qualify for medicaid, so it has to go into a trust that will collect and then go to medicaid upon his death.
His insurance is also $180 a month. If he is only allowed to keep a small amount for personal money every month, would his insurance premium be paid out of money that goes into his trust? If not, who pays the premium?
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I have performed medical insurance billing for over ten years and it use to be that if you had straight Medicare and Medicaid/Medi Cal, then you really did not need any additional insurance...Medicare paid their 80% and hopefully Medicaid picked up the remainder and the patient had a zero balance and could not be billed for any outstanding balances. HOWEVER YOU MUST MAKE SURE YOU ARE SEEING A DOCTOR OR IN A FACILITY THAT ACCEPTS MEDICARE AND MEDICAID/MEDI CAL.

Just to let you know, not all doctors or facilities accept Medicare and Medicaid, also known as Medi/Medi. If you go to see a doctor that does not accept Medicaid then they may accept your Medicare but you will be responsible for the remaining 20%. In reality they are suppose to refuse to see you if you are Medi/Medi and they do not accept it, because as a Medi/Medi patient you are not suppose to be billed for any balance.

Now what makes this even worse is many elderly people THINK THEY HAVE MEDICARE, BUT THEY DONT! Many of these people have "signed over their benefits" to insurance companies such as Blue Cross Blue Shield, Humana, Kaiser and they are now in HMO's and some are even PPO's but the elderly person believes they still have their Medicare, which they do NOT!

We now have to run a report every single day on every single patient to see if they truly do still have Medicare or have they signed it over to an HMO or a PPO that we are not affiliated with. These people come to us for surgery so the costs can be thousands of dollars that these people would owe us out of their pockets if we did not check. We have had to call numerous patients and cancel surgeries because from the time surgery was set up to the day of surgery, they changed their insurance coverage and signed up with an HMO and as we all know you can ONLY SEE DOCTORS OR ENTER FACILITIES THAT ARE IN YOUR HMO PLAN AND YOU HAVE TO HAVE PRIOR AUTHORIZATION!

In the State of California it gets even worse, our Legislators in Sacramento in all their wisdom have seen to it to mess up our Medi Cal even worse than it already was. They have now demanded that EVERY MEDI CAL RECEPIENT MUST SIGN UP WITH AN HMO PLAN! But what if you are Medicare/Medi Cal and your Medicare was not signed up with an HMO. I personally have to deal with this, we have straight Medicare and now have had our Medi Cal put into an HMO that none of our doctors are in! So if you go to see your normal doctor and he is not in the Medi Cal HMO plan they have assigned you to, well Medicare might pay, but Medi Cal will not pay and if you did not get a prior authorization for your secondary insurance carrier they will not pay. OUR GOVERNMENT HAS SCREWED THE SYSTEM UP SO HORRIBLY IT DOESN'T WORK ANY LONGER AND NO I AM NOT REFERRING TO OBAMA CARE. I am referring to The State of California!

Let me just say this, before you cancel any insurance on your loved one, speak to a minimum of 2 if not 3 people at Medicare, Medicaid, your private insurance or nursing home and hopefully you will find a knowledgeable person who can best direct you and let you know if there will be balances due that Medicaid will not cover. It may be beneficial to keep the coverage if you can. Someone said you are not responsible for your loved ones expenses, but laws are changing and they are trying to make the children responsible for the outstanding bills of the parent, so please do not go into this blindly. Protect yourself.
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DO NOT EVER CANCEL THE MEDICARE 65+ coverage for any reason. If the elder gets injured or sick or requires hospice care, the medicare advantage will cover most of the costs of care. Sort of like our health insurance for people age 64 and younger.
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When my dd sister went on Medicaid, I was advised to disenroll her from her Medigold - her premium was around $100 a month, plus copays for doc visits. the medical director at the group home was not under contract with Medigold, and even the Medigold folk told me she probably could get by with traditional Medicare and Medicaid as secondary. So far, we have had no problems.
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Absolutely not! Keep her fully covered until her last day. Trust me. Its the best decision I ever made. I understand that Medicaid and Medicare will cover most everything. But you never know what the future holds. And the way the Medicaid rules keep changing, you don't know if your mom is going to need the extra coverage. I kept my moms medicare supplemental coverage even when the nursing home wanted me to discontinue it. In the end, there were certain medications that were not covered under Medicaid but they were covered under Medicare and her supplemental.
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Another thing to look at - what will the insurance pay for. Will it pay for those little charges that Medicaid and medicare might not. Or would you be paying the premium and still paying for those extra charges. As others have said you really need to look at your states rules, also about having it.
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Do not remove her insurance! Medicaid and Medicare won't pay for a lot of things or will refuse many things. I have dealt with this with a lot of relatives and you will regret dropping it, believe me.
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I would keep it if at all possible. Never hurts to have a safety net! Hope all works out . Have a great day!
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I meant it will just go to the nursing home* (fingers too fast for brain)
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I would keep it - if she winds up needing to go to the hospital for whatever reason, it will cover that, and other things medicaid doesn't cover. If you cancel it the premium money will just go to medicaid anyways, so there's no benefit to cancelling it, but there is a benefit to keeping it.
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EEEK! do not cancel!!! Can of Worms! Pandora's Box!!!
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When my mother was in that exact situation, also with dementia, I wondered the same thing, and asked the attorney who helped me file her Medicaid application. She said that I should continue my mother's private medical insurance because Medicaid may not cover certain procedures. Also, as I write in my book "Inside the Dementia Epidemic: A Daughter's Memoir," Medicaid will deduct the cost of the insurance premiums from the amount they expect your mother to pay for her nursing home care; if you cancel the insurance, that money will have to be paid toward the nursing home bill. So either way she won't get to keep that money. I wish you the best of luck as you continue your caregiving journey.
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Also OrangeBlossom is spot on on the coverage. If your mom is like hers and still is able to go to see MD's outside of the NH, then keep the coverage. My mom is at the point that she physically cannot go to a provider outside of the NH. So much of all this is what their NH can & will do as a part of their care.
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My mom is in a NH and on Medicaid in Texas. She has had a high option federal Blue Cross & Blue Shield secondary insurance since the 1970's (my dad was a fed) and the premium was automatically deduced from her monthly federal retirement annuity. Really excellent policy and no co-pay ever. Once she got into a NH and on Medicaid (took about 6 months to get paperwork through & get approval letter), her BCBS policy can get either cancelled or suspended. We opt'ed for suspended so she could go back onto BCBS if she for whatever reason got out of Medicaid. There was specific forms that she had to do for this and I as DPOA cannot do them as the fed's like SS do not recognize DPOA's. What we were told that once Medicaid is approved then it (Medicaid) becomes the default secondary insurer for whatever Medicare does not pay for, and as such BCBS will decline coverage. Eventually the dual coverage will come up and payments denied retroactively by the non-Medicaid insurer and BCBS will do a clawback on payments to providers. You probably will get a refund of the monthly insurance premium less adminstrative fees.

If you do this (cancel a policy) there can be an issue if the service provider does NOT take Medicaid...as they can private pay rate bill your elder for services. I sent a letter to the NH that BCBS was going to be cancelled once Medicaid was approved and that any & all providers needed to be Medicare &/or Medicaid as of the approval letter date. imho you have to do this to cya as my experience with NH billing is that they make mistakes often and will not do the paperwork to change things. If your parents NH is more private pay residents, then you need to ask what insurance their outside providers accept as payment in full and make it clear that mom is not to have any providers who do not take Medicare and Medicaid as their payment in full.
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If you can afford to keep the insurance keep it. Medicare does not cover all medical costs, Medicaid is probably to pay for the nursing home. There will likely be costs which each of these will not cover. Having a policy for the uncovered costs would not be a bad thing. Otherwise they will bill your mother's estate however if she has nothing left in her estate due to the spend down, she will just not pay these bills at that point.
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I have to say that the people at the medicaid office have always been very helpful. We often think that government employees are cranky or not helpful. That has not been my experience. I think if we make it clear that we are not trying to hide money or get money from our family member . . . but are trying to insure that they get the best possible care to meet all their health and living needs . . . these folks are our best bet for accurate information.
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$50 in GA. Again, check with the council on aging or your local ombudsman's office.
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Most insurances with exception of long term insurance, will not pay for NH. Secondary insurance picks up medical bills that Medicaid or Medicare doesn't cover.
What the nursing home is paid is based on the money they receive, minus the cost of the secondary insurance.
Before you decide to cancel anything, be sure to check with your local council on aging. They provide a wealth of information.
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Daughterone's situation is same as mine. I have held onto Mom's secondary health ins ($287/mo) for reasons she stated, as well as freedom to take her to other doctors outside the NH if I want to - for example a second medical opinion. She is right also about the NH taking the extra money if you give up the secondary health ins plan. Any way you cut it, the NH will only allow her to keep $35/mo for personal expenses (in NJ).
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My mother is 87, in a NH....she too has dementia....I kept her insurance in tact because Medicaid does not cover some costs that may occur if she had to go to the hospital....play it safe...keep insurance...you will need it for the final billing after the fact....besides Medicaid will just take the extra money for the cost of your Moms stay at the NH....if you do cancel.
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sorry meant when she got sick
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