Nursing Home Plan versus "regular" Medicare?

It may be in your best interest to hire an elder law attorney. These are sales people who may be directing you down the wrong path because, after all, a Nursing Home is still a business.

http://www.themedicarecoach.com

Emily's weekly podcast are great. Mondays or Tuesdays. Youtube channel as well . Reach out to them.

Usually when someone goes into a Nursing home on a permanent basis they switch to what is called a Special Needs Plan or SNP through Medicare. It is much cheaper and covers meds without any copay. Don't make any switches for her without discussing with the social worker at the Nursing Home. They will know which SNP will be the best fit for your Mom. as others here mentioned if this is a saleman calling he may not be looking for your Mom's best intest and is only looking at his commission.

Your Mother already has a Medicare Advantage plan... that is what United Healthcare Medicare Replacement is. Medicare "nursing home" plans do not exist, as Medicare does not pay for Long Term Care. If she is currently receiving Skilled Rehab services at the Nursing Home, then her insurance (Medicare Replacement United Healthcare) would/should be covering the short term services. Other than the short term Skilled Rehab services, again, Medicare NEVER pays for long term care. If, for instance, UHC is out of network with her Nursing Home for Skilled Rehab then transitioning her back to traditional Medicare Part A with another Part B (and others) or a supplemental/gap policy IS the best plan action. Medicare Part A is IN-NETWORK with every Medicare- Certified Nursing Home, whereas United is not.... and that can be VERY costly.

You must absolutely take these concerns and questions to her Nursing Home's Social Worker and Administrator. ONLY they will be able to guide you in the best possible insurance setup for your Mother at this point, and even assist in the transition if you/she would be better covered with such. Each individual nursing home is in-network with a different array of Replacement/Advantage, Supplemental/Gap, and Commercial insurance plans. You need to be IN-NETWORK with the appropriate plan(s) that are actually going to cover your Mother's costs when the need arises and she needs the Skilled (short-term) services that her NH provides. (Example: she breaks her ankle and needs extensive therapy to recover, along with a higher level of nursing services).

If it turns out that you are being harassed by a scam plan, then ask the Social Worker to assist you in reporting the company and contact information to the appropriate authorities and/or hotlines.

You might also ask at your Nursing Home, as usually they have an ombudsman (sorry -- spelling) who has a lot of knowledge in these issues. If there is no one there with any knowledge do consider an hour of time with an elder law attorney. If your town has any center that helps with senior issues they may guide you to a resource.

It sounds like a Medicare Advantage Plan. You may have only recalled or heard "nursing home plan". It very well could be a SNP-I. A Special Needs Plan - Institutional. These Medicare Advantage Plans are a great fit for many. Increased benefits and services at, generally, lower or no cost. Ask for printed material. If it is a Medicare Advantage Plan all materials are approved and will clearly document if government approved, will have numbers to call with questions, etc.

They are trying to SELL you something; keep this in mind. Don't answer the phone to this bloodsucker again. If you are satsfied with your mom's insurance plan, keep it. If your mother is elibigle for hospice care you have the right to choose which hospice service you use, and a not-for-profit is nearly always much much better than the for-profit ones. You pay nothing for any hospice service but the for-profits seem to pad their bills to medicare by requesting all kinds of unnecessary add-ons (new matress, etc.).

It sounds like a gentle way to switch to a Hospice plan. I would be real sure to inquire how this change would impact mom medically (continuing current necessary medications) and financially. I’m an old fan of “If it’s not broken don’t fix it” Good luck with everything.

This sounds strange to me. I would ask them if the nursing home plan is selected, then what happens if mom has to move to another facility? Do you have to try to get her existing plan back again?

You do not have to chance your unitec health care plan. My mom has it and Human. What you need is long term care. Of course it is based on her finances and assets. So you will
have 3 things.
My mom has United, human for medical and long term (alf/nurse home).
She is 97 and I am getting ready to put her in one Of the alf small homes.
We're is your mom now?

Having much trouble selecting a plan.

But I believe the difference is
1) a PPO plan (supplemental Medicare plan) allows you to choose your health care providers, but may cost more. Must go outside the NH for care.

2) An HMO plan (Medicare advantage plan) costs less, or can even be free because one assigns their Medicare benefits to the plan. This takes your choices away, you pay for a low premium, makes one have to wait to be approved to see a specialist, one "receives" only what is called "the standard of care" provided the same to all patients.

Imo, this "standard of care" is what gets a patient statins, b/,p meds, pain meds in lieu of treatment and cure, and g.e.r.d meds---all whether a patient actually needs them , or not. And, also, the standard dip stick urinalysis or a denial to test for a UTI, all to save on medical expenses for the plan.
IMO, disclaimer, disclaimer, disclaimer.

I could be wrong, but I don't care. I have "Stand alone, original Medicare".

There have been questions on this type program before.
That poster was being hounded also which would put my antenna up.
While Rocket seems to like it I would personally rather have a little more control should changes need to be made. Also I would check with some of the others who have had it for awhile at your facility. But it’s all relative. The person you check with may have had a bad policy before or may have had an advantage plan. So what is good for one person won’t necessarily be for another.

Yes, I don't understand the need for a NP either. There are nurses all the time and doctors affiliated so I don't see the need.

Is your Mom on Medicaid or may need it in the future? If Medicaid is in the picture than Mom only needs Medicare, Medicaid picks up the 20% Medicare doesn't. Medicaid supplies dental and vision/glasses and scripts.

I would ask for some written material where you can compare your present policy with the one they are suggesting. I would also ask why the need for a NP when their affilated doctor/s should be able to do this.

Its usually not the healthcare plan that is the problem it usually the medical group that is the problem. If you keep on top of the plan you will get what they tell you however the medical group says yes or no of who is the provider.
Example: My Daddy needed cataract surgery and the medical group wanted him to go to one of these 3rd world surgery outlets and I told them no this was not going to happen it took 6 1/2 months because of going back and forth. After filing two grievances I finally got, the correct person from United Healthcare on the phone and told them that if this didn't happen within the next 30days I was going to sue for pain and suffering. United Healthcare went to the medical group and gee whiz it was approved within 2 hours. Daddy had both eyes done within 45 days.
Remember the insurance doesn't want the law suit - the medical group wants to save money.
Blessings
hgnhgn

Prior to the NH Mom had Aetna Medicare. The NH suggested we switch to the United Healthcare NH plan and I researched and found it was better. In her NH it provides an on-site fulltime Nurse Practitioner for approx 60 residents who can write scripts. This has been invaluable and saved doctor visits. Will your Medicare nurse actually be a NP that can write scripts? Your NH already should have a full time regular RN on staff so I don’t see the big benefit of a monthly RN visit.