topic Kind Help With Insurance Question, Please. in Wellness

Kind Help With Insurance Question, Please.

Caaareful Shopper — Tue, 03 Jan 2023 21:45:40 GMT

I realize nsurance is very convoluted. But may I ask if any of you can point me in the right direction with this situation? My head is exploding. I'm eternally grateful, in advance.

My mom is 96 years old. She is officially a resident of NY.

However, since the pandemic, she has been staying with my sister in VA for about half of each year. Very recently, travel to her NY has come to an end. She can no longer see her NY doctor as a result.

Her NY insurance is only for NY. Her Medicare Advantage insurance is tied to her NY-only insurance, so she has no insurance in VA. Any doctor's visit she's had in VA we have paid out of pocket.

Now we know she will stay in VA and not go back to NY at all.

It's so cumbersome to have her insurance changed to one in VA.

Do any of you know of supplemental insurance for out of state coverage?

Sorry this was so long.

Re: Kind Help With Insurance Question, Please.

Kachina624 — Tue, 03 Jan 2023 22:08:52 GMT

@Caaareful Shopper That is indeed a very strange policy. My advantage group plan allows me to see any licensed doctor in the world. What would she do if she was injured while travelling?

I'd get her a new policy in VA and fast. Aren't there brokers who can evaluate the aspects of various policies for you? Also I believe each state is supposed to gave a number for advice on supplemental policies, probably a state agency. Perhaps the state insurance oversight agency could advise you where to call.

Re: Kind Help With Insurance Question, Please.

Caaareful Shopper — Tue, 03 Jan 2023 22:17:35 GMT

@Kachina624 wrote:
@Caaareful Shopper That is indeed a very strange policy. My advantage group plan allows me to see any licensed doctor in the world. What would she do if she was injured while travelling?

I'd get her a new policy in VA and fast. Aren't there brokers who can evaluate the aspects of various policies for you? Also I believe each state is supposed to gave a number for advice on supplemental policies, probably a state agency. Perhaps the state insurance oversight agency could advise you where to call.

@Kachina624 After they accepted my HIPPA form and got my mom's consent, I was able to finally speak with someone at length at her insurance just now. They basically said just what you said about a broker for her out of state insurance needs. I set up an appointment because the agent I had on the line knew nothing more than that.

At least that gets me pointed in the right direction.

Thank you as well

Re: Kind Help With Insurance Question, Please.

CelticCrafter — Tue, 03 Jan 2023 22:58:37 GMT

If I recall, I may be wrong but Medicare Advantage plans don't travel from state to state, she's going to have to find insurance in VA in order to have coverage.

Supplement plans are different and if you have an Advantage plan you can't buy a supplement to go along with it.

Maybe if she see this, @Carmie can help answer you better.

Re: Kind Help With Insurance Question, Please.

Caaareful Shopper — Tue, 03 Jan 2023 23:01:28 GMT

@CelticCrafter @Kachina624 True. I was informed that Medicare Advantage doesn't travel state to state. Straight Medicare does, but that's not what my mom has.

The Broker will be able to tell me about PPO plans for her out of state insurance that we can get.

Thank you so much!

Re: Kind Help With Insurance Question, Please.

NickNack — Tue, 03 Jan 2023 23:08:07 GMT

@Caaareful Shopper This is from ehealth. I would contact someone from SHIP (State Health Insurance Assistance Program) for VA and talk with someone. They can tell you exactly what to do for your mom. I'll bet she can get enrolled with a new Advantage plan in VA easier than it sounds.

I have a Medicare Advantage plan or Medicare prescription drug plan and I’m moving

If you’re enrolled in a Medicare Advantage plan or stand-alone Medicare prescription drug plan and are moving outside your Medicare plan’s service area (either to a new address in your state or a new state altogether), you will need to enroll into a plan that is within your new service area.

In some cases, the insurance company may offer the same plan in your new service area, and you may have the option to enroll in the same plan if the Medicare plan is accepting new members.

You may have a Special Election Period to make changes to your coverage if:

You’re moving out of your Medicare plan’s service area.
You’re moving to a new location that’s still in your Medicare plan’s service area, but you also have new plan options available in your new area.

In both cases, you can use your Special Election Period to switch to a different Medicare Prescription Drug Plan or Medicare Advantage plan. You can contact your Medicare plan to disenroll. If you notify your Medicare plan before you move, your Special Election Period starts the month before you move and continues for two more months after you move. If you let your Medicare plan know after you’ve moved, your Special Election Period starts the month you tell your plan and continues for another two months.

Please note that if you have Medicare Part C and there aren’t any Medicare Advantage plans available in the new service area that you’re moving to (or you don’t want to enroll in one), you can also choose to return to Original Medicare. You can then sign up for a stand-alone Medicare Part D prescription drug plan, and you might be able to buy a Medicare Supplement insurance plan.

Re: Kind Help With Insurance Question, Please.

gertrudecloset — Tue, 03 Jan 2023 23:18:40 GMT

@Caaareful Shopper wrote:
I realize nsurance is very convoluted. But may I ask if any of you can point me in the right direction with this situation? My head is exploding. I'm eternally grateful, in advance.

My mom is 96 years old. She is officially a resident of NY.

However, since the pandemic, she has been staying with my sister in VA for about half of each year. Very recently, travel to her NY has come to an end. She can no longer see her NY doctor as a result.

Her NY insurance is only for NY. Her Medicare Advantage insurance is tied to her NY-only insurance, so she has no insurance in VA. Any doctor's visit she's had in VA we have paid out of pocket.

Now we know she will stay in VA and not go back to NY at all.

It's so cumbersome to have her insurance changed to one in VA.

Do any of you know of supplemental insurance for out of state coverage?

Sorry this was so long.

@Caaareful Shopper Ideally, your mom should have changed Medicare Advantage Plans during the Open Enrollment period which was from October 15 - December 7th. It sounds as though this did not happen and she remained with her insurance that was underwritten for the New York market. Because Medicare Advantage Plans don't travel with you (private insurance companies have a right to do business where they want) it is best to just cancel the New York Policy by picking a policy in Viriginia.

Since Open Enrollment time has closed, there is another time period she can change to an Advantage Plan for Virginia.

Open Enrollment Period. From October 15 – December 7 each year, you can join, switch, or drop a plan. Your coverage will begin on January 1 (as long as the plan gets your request by December 7).
Medicare Advantage Open Enrollment Period. From January 1 – March 31 each year, if you’re enrolled in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Note: You can only switch plans once during this period.

https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan

Re: Kind Help With Insurance Question, Please.

Caffeina — Tue, 03 Jan 2023 23:29:12 GMT

https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan/special-circumstances-special-enrollment-periods

Re: Kind Help With Insurance Question, Please.

Desert Lily — Tue, 03 Jan 2023 23:45:05 GMT

The following is from Medicare dot gov. Idk if you considered her "moved" to a different state or not, or where you consider her to have residency. You might want to call someone & discuss it.

Special circumstances (Special Enrollment Periods)

You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs). Rules about when you can make changes and the type of changes you can make are different for each SEP.

If you’re in a Medicare Advantage (MA) Plan and you move outside your plan’s service area, you can also choose to return to Original Medicare. If you don’t enroll in a new MA Plan during the time explained below, you’ll be enrolled in Original Medicare when you’re disenrolled from your old Medicare Advantage Plan.

When?

If you tell your plan before you move, your chance to switch plans begins the month before the month you move and continues for 2 full months after you move.

If you tell your plan after you move, your chance to switch plans begins the month you tell your plan, plus 2 more full months.

Re: Kind Help With Insurance Question, Please.

proudlyfromNJ — Tue, 03 Jan 2023 23:49:30 GMT

I have a Medicare Advantage plan. I can see a Doctor in any state, in fact I live in NY and my Doctor is in NJ. Mine is UnitedHealthCare. Never had a problem and have changed from a NY Doctor to my now NJ Doctor. Sorry for small print. Old IPad.

Re: Kind Help With Insurance Question, Please.

gertrudecloset — Tue, 03 Jan 2023 23:59:09 GMT

No Special Circumstances are needed. @Caaareful Shopper Right now is the time to make the switch to a Medicare Advantage Plan for Virginia. It is the Second of (2) enrollments that recipients get.

You have until March 31, 2023 to drop the NYC Plan to Find and Switch to a Virginia Plan.

Special Circumstances would apply if you outside the time period for either enrollment period. THAT DOES NOT APPLY TO YOU. YOU'VE GOT TIME TO GET IT DONE. So go ahead and do it.

Best wishes.

In addition, you could call the current plan (Private Insurance Company) to see what, if anything they offer in Virginia. If nothing, then find a new Insurance Company that offers Medicare Advantage in Virginia.

Re: Kind Help With Insurance Question, Please.

chrystaltree — Wed, 04 Jan 2023 00:19:18 GMT

She is a permanent resident of VA. She needs to be enrolled in a VA. I don't know why you are asking about out of state coverage. You have to go through whatever the process is for insurance in VA. The state She resides in. I would call her NY plan and explain that she has moved to VA and ask for assistance in obtaining coverage.

Re: Kind Help With Insurance Question, Please.

Caaareful Shopper — Wed, 04 Jan 2023 00:38:20 GMT

Thank you all so very much!

I'm on it!!

Re: Kind Help With Insurance Question, Please.

Carmie — Wed, 04 Jan 2023 02:06:59 GMT

I am guessing your mother has an HMO ADVANTAGE PLAN. Often these plans do not offer benefits for out if area providers.

Some PPO ADVANTAGE PLANS can also not pay for out of area providers, or pay them at a reduced level.

Most advantage plans will pay for emergency care in or out of network or state.

I would advise you call your SHIP office( # for your state will be found on the internet) or any health insurance company in your area ....AETNA, BLUE CROSS, UNITED HELTHCARE, etc. and explain your mother needs coverage that works locally.

When you move you can change insurance companies even when it's not during the open enrollment period.

Re: Kind Help With Insurance Question, Please.

Kachina624 — Wed, 04 Jan 2023 02:28:02 GMT

My Medicare advantage Plan with the State of Texas surely has travelled with me.

Re: Kind Help With Insurance Question, Please.

Mom2Dogs — Wed, 04 Jan 2023 16:57:26 GMT

For the best information I would contact an insurance broker in your area. He will have the best information for you. I used a broker to help me pick a carrier - every year he contacts me about my medicare and drug plan.

Every state is different.

Re: Kind Help With Insurance Question, Please.

poregirl — Thu, 05 Jan 2023 07:23:48 GMT

If you need a new insurance you can look for state co-op plan.These are almost always more affordable. It may be what your mom has now. If you know she's not leaving VA it won't be an issue.