Do we need to continue the Medicare supplement and Plan D Rx insurance? - AgingCare.com

Do we need to continue the Medicare supplement and Plan D Rx insurance?

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My Mom is now on Medicaid in a nursing home and Hospice Care.

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When in a nursing home and receiving Medicaid long-term care benefits the recipient required to have a Medicare Part D Rx plan. The recipient will automatically be enrolled in the "Low Income Subsidy" program (LIS) and can switch between Part D plans at will. If the recipient does not choose a plan one will be chosen for him/her at random. The premium is paid by the state and the maximum premium amount allowed varies by state (you can search for "low income subsidy premiums by state" to find your state's maximum allowable premium - do not choose a plan with a premium higher than this amount). Rx deductibles and co-pays are also paid for by Medicaid. I always recommend asking the nursing home which plan to choose since they will be responsible for navigating pharmacy needs.

With respect to Medicare supplements, a Medicaid recipient may keep a Medicare supplement and the premium can be paid from the recipients income before Patient Responsibility is paid to the nursing home. You must receive approval for the premium payment from the Medicaid agency. The only negative consequence to retaining the supplement is that the premium may reduce income that can be diverted to the community spouse if there is one. Otherwise, since there is no other negative consequence to retaining a Medicare supplement and, depending on the state, perhaps some advantage, I generally recommend keeping the supplement.
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Ask Medicaid in your state what their requirements are regarding prescriptions and if you should still be paying the premiums for Medicare or to Medicaid.
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I'm not sure if I understand the question but when my Mom was in this situation we continued these payments. The ltc facility paid the premiums out of Mom's monthly social security and pension income, all if which went directly to them. I never gave it much thought...just figured there may be a benefit for the facility if the insurance continued to be paid. My only concern was that Mom was given the care she needed and that she was comfortable and content.
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I do not know
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Where do u go for the answer?
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Thanks, Ralph! We're going to be in that situation hopefully sooner or later with a Medicaid application pending and a supplemental insurance policy paid from Mom's survivor annunity from Dad's federal retirement. The supplemental has paid prescription costs with the exception of a co-pay. Mom is currently in a LTC facility.

We're working to have Mom Medicaid eligible by Nov 1st.

At what point would Medicare part D take effect? Would any of that be retroactive and cover prescriptions costs from the point at which she became Medicaid eligible or is this a totally separate situation that takes effect later with no retroactive period?

Reason we're asking is that we need to know if we should pay the pharmacy costs with the remainder of her funds going to the LTC facility while waiting for Medicaid to approve.
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Thanks, Ralph. Sorry to get back to you so late. Really appreciate your answer.

In summary, we'll likely keep the secondary insurance coverage through the retirement annuity survivor benefit and would then add Part D, if required, on top of that. According to what our state has posted online, it looks having Medicare Part D, Medicaid, and other insurance is a legal possiblity for which they account.

The big question is now that we're in official limbo status...Medicaid pending and now eligible since the beginning of November, do we have to pay the pharmacy bill? The question doesn't apply this month because they didn't send us a bill. Next month they probably will and we'll owe them. Should we pay the pharmacy or should we wait for Medicaid once it approves?

Sounds like a quick call to 800-MEDICARE might be in order, and we really appreciate that advice.
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