I keep reading your posts and thinking American “healthcare” is the most aggravating non-care. I mean, could they make it more difficult to make actual medical decisions for a patient?
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This is in no way intended at @kelsmom
When my mom fell and spent a minimum of 3 days in the hospital, because she had a Medicare supplement and not an advantage plan, she automatically could be put into a rehab center.
She did not need approval.
Now she could have been “kicked” out of rehab if she couldn’t or wouldn’t do the work. But she could go into the rehab facility with no approval
Mom would have had to get approval with an advantage plan for any home health aids when she was released from her rehabilitation facility. With a supplement, she did not.
You may find that your advantage plan is great. This is a situation where you can run into roadblocks.
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That is precisely why we have a supplement plan. My in laws were eligible for a retiree plan from FIL’s employer, and their nephew, a big shot at an insurance company, tried to get them to consider a supplement rather than the plan they have. But they wanted to stay with the insurance they “knew.” There have been a few times it was a problem, like when FIL wasn’t able to use the in-house PT at his AL facility … and when he was discharged quickly and without fanfare from the hospital after an injury because the insurance company wouldn’t approve his rehab. I know that there are good Advantage plans, because some people here have ones that they like. But theirs is not one of those, unfortunately - and it’s difficult to know if yours will be good if you don’t know people already on the plan (such as a union plan).
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Thanks. I won’t have to make Medicare/Advantage decision for a few years. I’ve had vague feelings about possible issues with Advantage (even though friends like this Advantage PPO plan), but it is helpful to see an example.
My mil has an advantage plan.
She made an appointment with my husband’s rheumatologist, he accepts Medicare . He didn’t accept her advantage plan.
She had to go to another provider. The good news for her is that she didn’t really need a rheumatologist.
We asked why she had an advantage plan. Because it has dental and eye coverage.
Probably for another thread but to choose the traditional Medicare vs taking an advantage plan is a one shot deal. You don’t get to change your mind. Just know that upfront.
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Good point. Thanks.
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New York is one of the states where it is possible to change. We switched SMom from an Advantage Plan to traditional + supplement this year.
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My parents had an irrevocable life insurance trust with a “second to die policy.” It was originally put into place to allow us to have funds if needed post-second-death to cover or assist with estate taxes.
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I believe, but I’m not sure, that if you move, you actually can change from an Advantage to a “regular” Medicare plan.
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It’s very state dependent on the rules whether or not you can switch from a Medicare Advantage plan to a Medicare supplement plan.
It’s as clear as mud, state dependent and the rules vary widely. The key thing to look for is if your state requires underwriting to switch.
Medigap state variation
Some states have implemented legislation that makes it easier for seniors to switch from one Medigap plan to another, and for people under age 65 to enroll in Medigap plans.
In New York and Connecticut, Medigap plans are guaranteed-issue year-round.
Massachusetts has a two-month window each year (February through March) during which Medigap plans are guaranteed-issue.
Five states (California, Idaho, Illinois, Nevada, and Oregon) have “birthday rules” that allow Medigap enrollees a 30-day window following their birthday each year when they can switch, without medical underwriting, to another Medigap plan with the same or lesser benefits.
In Maine, Medigap enrollees can switch to a different Medigap plan with the same or lesser benefits at any time during the year, and all carriers must designate one month each year when Medigap Plan A is available on a guaranteed issue basis to all enrollees.
Missouri has an Anniversary Guaranteed Issue Period; anyone with a Medigap plan has a 60-day window around their plan anniversary each year during which they can switch to the same plan from any other carrier, guaranteed issue.
For people who are under 65 and eligible for Medicare due to a disability, Medigap availability depends entirely on state regulations, as there is no federal regulation requiring a guaranteed issue Medigap enrollment period for under-65 enrollees. The majority of the states have established regulations regarding access to Medigap coverage for this population, although they vary considerably in scope. (Click on a state on the map above to see how access to Medigap is handled in the state.)
Nationally, about 39% of Original Medicare beneficiaries are enrolled in a Medigap supplement (13.9 million, out of 36 million Original Medicare beneficiaries), but it ranges from a low of 3% in Hawaii to 51% in North Dakota.
Medigap plans are standardized, which means that a Plan F in Vermont provides the same benefits as a Plan F in Florida. But a Business Insider analysis of average 2016 Medigap Plan F premiums for 65-year-old enrollees found a variation from $109/month in Hawaii to $162/month in Massachusetts. (Note that Plan F and Plan C are no longer available for purchase by people who became newly eligible for Medicare on or after January 1, 2020.)
Medigap coverage can be priced in one of three ways: community rating, issue-age rating, or attained-age rating. As of 2018, eight states (Arkansas, Connecticut, Massachusetts, Maine, Minnesota, New York, Vermont, and Washington) required carriers to use community rating. The remaining states were simply listed as not requiring community rating, thus leaving it up to the insurer to allow for any rating type, including issue-age or attained-age.
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I am so sorry that she’s going through such traumatic pain. I was not aware that hospice has been involved. Hopefully they will help to develop/advocate a plan for subacute rehab so she received more direct care. It must have been so hard for you and H to see her in pain…
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100%. When my dad needed rehab after 3 days of hospitalization He had an advantage plan then and the hospital social work staff had a hard time finding a bed for him, especially since he also had vascular dementia where he needed memory care. While there, rehab staff had to receive approval from the advantage plan every 3 to 4 days for longer stay and additional PT. The staff advised mom and me to switch his plan to traditional medicare that allowed more flexibility and no approval. I was so new to all of this then and had no idea that I could have changed the plan fairly easily. No one told me explicitly how to do it or I didn’t know what questions to ask for clarification and guidance when we were in crisis mode. The following year, I did switch his plan to traditional and added Plan G supplemental plan. Mom is now also on the same plan. She fought me about it because she didn’t want to pay more, but in reality it was only about $20 more per month.
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She’s been on hospice three years. It’s so that she doesn’t get sent to the hospital by the AL staff - she wants comfort care only (help her recover when hurt, for example, but not provide aggressive treatment such as surgery). We had to take her off hospice when she went into the hospital, and she will stay off until she gets back into the AL facility - hospice will be involved again at that point. It’s really hard when our loved ones are at the end of their life but not actually ready to die. My H is an emotional mess. I have to say, he is great … feeding his mom, helping move things around to help with PT, patiently answering those same questions she asks over and over (her short term memory isn’t as good as it once was, and the pain meds add a layer of confusion). Our goal with rehab is to try to get her to a point where she can at least stand. We told her that she is going to be hanging around for a while, so it’s important to regain as much mobility as possible.
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State specific. And sometimes if a group, group specific. In my state and with my large group, I can switch from one to the other during open enrollment annually without underwriting.
But we had a whole thread and discussion about health insurance, and really, I wish we could stick to the topic here instead if opening the door again to dissing MA plans vs supplement. Since this is so plan specific.
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I think we are allowed to discuss a topical discussion when it’s pertinent to the situation at hand
If anyone doesn’t like the discussion, they are free to skip over
DO NOT PM ME, I do not wish to discuss
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Thank you for all this information!
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What is stated as able to do and what in actuality is able to do can be two different things. And I agree with you “it’s as clear as mud”.
Having vision and dental is a modest payoff for the medical benefits that may be put into jeopardy for ‘best care’.
Very dependent on state and area. Also the Advantage plans can change significantly (for the worse) and then, in some states, where do you go? You often would have to medically qualify for better supplement plan, and your rate may be much higher than if you went to supplement right at Medicare being primary coverage.
Learning from parents on this may influence your own decisions with Medicare choices.
We did have another whole thread about this for many good reasons but I just brought it up in case anyone missed it. It’s a major crossroads decision that shouldn’t be missed and not easily corrected. It really does impact you over many years and shouldn’t be tossed aside lightly.
But yes!, back to caring for parents (after figuring out what is covered…)
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