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Honored Contributor
Posts: 17,144
Registered: ‎10-25-2010

Re: Medicare Advantage plans & inpatient rehab


@BalletBabe wrote:

@Carmie wrote:

@Kachina624 wrote:

@conlt wrote:

I have said it many times on these boards and people always argue with me but the Medicare Advantage Plans do not pay just like Medicare. I have worked in health care specifically with the elderly as a RN executive in home care. My business is a Medicare business. I think the advantage plans are fine for a healthy individual who wants to save money on prescriptions however, I have seen many times when they don't want to take care of someone who needs more intensive care. When Medicare rolls around for me I am taking straight Medicare, a supplement to cover the other 20% and then a part D drug plan. My 91 year old mother is on this and she never pays a dime for anything other than her insurance. Please be careful with the Medicare Advantage plans, you never know when a critical illness is going to happen and you need good coverage. 


@conlt  I don't know what you're talking about because my plan has no maximum lifetime limit.  Mine also has a part D drug plan.  It covers everything I would ever need. These plans are not all the same. 


I know what she is talking about.  I worked in Health a Insurance for over 25 years, and I agree with Halo117.

 

You might be surprised what your Advantage plan does not cover at 100%.  You won't know until you need that benefit.  

 

One of my family members is in the hospital right now.  She has an Advantage plan that covers just about everything.  She pays $90 a month for it.  

 

I just checked into her benefits today.  She has a $200 deductible for the first through the  7th day of an inpatient admission.  She has been there four days already and will probably owe $1400 at least for seven days when she is discharged.

 

She used to have Traditional Medicare and Plan F which paid 100% of all her inpatient admissions.  She dropped that insurance on Jan. 1.  I have no idea where she will get the money to pay this bill.  She is living on $1200 a month from SS.


You can set up a payment plan with the hospital.  They have to take what she can give.  Do not give them a charge card or a debit card.  They try to get it out of you while you are there.  DON'T GIVE IT TO THEM.    


I know what you are saying is true. The hospital won't bill her until after the claim is processed, so no CC on file.

 

I just don't have a clue where the extra money for this bill will come from.  Her monthly bills for her RX drugs are very high. Hundreds a month because she takes so many.   17 pills in the am and 12 in the pm.  She also has a mortgage and pays her utilitiy bills.  My brother pays her RE taxes and I help her with her grocery bills and other expenses. Her home is in need of repair.  My sons can fix things for her, but things need replaced and updated, not fixed.

 

There is no money left at the end of the month.  Her clothing is getting worn out. Her health is not good and mentally, she isn't always "with it". Sometimes she will spend money she can't afford to or give it to the small children in the family as a gift for a birthday or holiday and her bills suffer.  

 

She used to work in finance, so this is unlike her.

 

I have been trying to get the family together for a meeting, but they keep resisting.  

I would suggest she sell her house and move to a senior apartment that has an income based rent. Something small.  She lived with me for 9 months after a serious hip injury and back surgery, but begged to go home. So home she went home last April.

 

I am her POA, but don't want to make or force her do anything.  I want her to except change and move on. She keeps saying, "but I want to live here in my home." Well, she can't afford to.

 

Lately she has been sick, hence the hospitalization. Her kitchen was so dirty and gross when I went to check on her, that I almost fell over from the stink.  She was too sick to clean or do dishes.

 

She has always been clean crazy and used to re do everything I did because it was never clean enough for her. I just spent a whole day cleaning her home, scrubbing and deep cleaning because it was so bad.

 

She was sick, but didn't tell anyone how bad she was.  She called me for an unrelated issue and I knew something was wrong right away.  I took her to the ER still in her nightgown, slippers and robe and she was admitted. 

 

I don't think she should live alone anymore, but I don't know what to do for her.  I am going to call the office for the aging on Monday.  I hope they can help or offer suggestions.

 

Sorry for the long rant.  I just needed to vent..

Valued Contributor
Posts: 694
Registered: ‎09-09-2010

Re: Medicare Advantage plans & inpatient rehab

@gidgetgh, without being snarky, let's just say it is from a VERY reliable source...

Esteemed Contributor
Posts: 5,355
Registered: ‎03-09-2010

Re: Medicare Advantage plans & inpatient rehab


@151949 wrote:

@gidgetgh  This is WHY you get LTC policies way before you will actually need one - if you buy one when you are 50 or so - you pay it over many years and the price is low. Your friend definitely NEEDS to work with a social worker to help her to understand what exactly is in her policy and what her options are. If the facility doesn't have one on staff they will refer her to one in the community.


Some people can't afford LTC for Insurance. Some folks do not qualify. 

Esteemed Contributor
Posts: 6,861
Registered: ‎03-05-2011

Re: Medicare Advantage plans & inpatient rehab


@Carmie wrote:

@BalletBabe wrote:

@Carmie wrote:

@Kachina624 wrote:

@conlt wrote:

I have said it many times on these boards and people always argue with me but the Medicare Advantage Plans do not pay just like Medicare. I have worked in health care specifically with the elderly as a RN executive in home care. My business is a Medicare business. I think the advantage plans are fine for a healthy individual who wants to save money on prescriptions however, I have seen many times when they don't want to take care of someone who needs more intensive care. When Medicare rolls around for me I am taking straight Medicare, a supplement to cover the other 20% and then a part D drug plan. My 91 year old mother is on this and she never pays a dime for anything other than her insurance. Please be careful with the Medicare Advantage plans, you never know when a critical illness is going to happen and you need good coverage. 


@conlt  I don't know what you're talking about because my plan has no maximum lifetime limit.  Mine also has a part D drug plan.  It covers everything I would ever need. These plans are not all the same. 


I know what she is talking about.  I worked in Health a Insurance for over 25 years, and I agree with Halo117.

 

You might be surprised what your Advantage plan does not cover at 100%.  You won't know until you need that benefit.  

 

One of my family members is in the hospital right now.  She has an Advantage plan that covers just about everything.  She pays $90 a month for it.  

 

I just checked into her benefits today.  She has a $200 deductible for the first through the  7th day of an inpatient admission.  She has been there four days already and will probably owe $1400 at least for seven days when she is discharged.

 

She used to have Traditional Medicare and Plan F which paid 100% of all her inpatient admissions.  She dropped that insurance on Jan. 1.  I have no idea where she will get the money to pay this bill.  She is living on $1200 a month from SS.


You can set up a payment plan with the hospital.  They have to take what she can give.  Do not give them a charge card or a debit card.  They try to get it out of you while you are there.  DON'T GIVE IT TO THEM.    


I know what you are saying is true. The hospital won't bill her until after the claim is processed, so no CC on file.

 

I just don't have a clue where the extra money for this bill will come from.  Her monthly bills for her RX drugs are very high. Hundreds a month because she takes so many.   17 pills in the am and 12 in the pm.  She also has a mortgage and pays her utilitiy bills.  My brother pays her RE taxes and I help her with her grocery bills and other expenses. Her home is in need of repair.  My sons can fix things for her, but things need replaced and updated, not fixed.

 

There is no money left at the end of the month.  Her clothing is getting worn out. Her health is not good and mentally, she isn't always "with it". Sometimes she will spend money she can't afford to or give it to the small children in the family as a gift for a birthday or holiday and her bills suffer.  

 

She used to work in finance, so this is unlike her.

 

I have been trying to get the family together for a meeting, but they keep resisting.  

I would suggest she sell her house and move to a senior apartment that has an income based rent. Something small.  She lived with me for 9 months after a serious hip injury and back surgery, but begged to go home. So home she went home last April.

 

I am her POA, but don't want to make or force her do anything.  I want her to except change and move on. She keeps saying, "but I want to live here in my home." Well, she can't afford to.

 

Lately she has been sick, hence the hospitalization. Her kitchen was so dirty and gross when I went to check on her, that I almost fell over from the stink.  She was too sick to clean or do dishes.

 

She has always been clean crazy and used to re do everything I did because it was never clean enough for her. I just spent a whole day cleaning her home, scrubbing and deep cleaning because it was so bad.

 

She was sick, but didn't tell anyone how bad she was.  She called me for an unrelated issue and I knew something was wrong right away.  I took her to the ER still in her nightgown, slippers and robe and she was admitted. 

 

I don't think she should live alone anymore, but I don't know what to do for her.  I am going to call the office for the aging on Monday.  I hope they can help or offer suggestions.

 

Sorry for the long rant.  I just needed to vent..


She definitly needs to get off the Advantage plan.  That plan is for people that are healthy and don't need meds that are expensive.   You might want to have her apply for Medicaid, especially if she cannot afford a supplemental.   There are also pland to help patients with low income to get help with meds.  Make some phone calls!   Good Luck!   It is a shame that they do this to the older generation. 

Respected Contributor
Posts: 2,583
Registered: ‎03-16-2010

Re: Medicare Advantage plans & inpatient rehab

I did forget to mention that some of the advantage plans are only valid in a region. I live in Florida and we get many winter visitors here from other states. What I have seen is people with some advantage plans get sick, fall, break a bone etc. and need home health care. Sometimes they have a policy that only covers care in their own state. Now they are in Florida with no preferred providers. That is another mess within itself. We run the insurance and find out there is no coverage. Then we have to try and negotiate with the insurance company to get authorization to provide care. As I said, be very, very careful when choosing a plan. 

Honored Contributor
Posts: 17,144
Registered: ‎10-25-2010

Re: Medicare Advantage plans & inpatient rehab


@conlt wrote:

I did forget to mention that some of the advantage plans are only valid in a region. I live in Florida and we get many winter visitors here from other states. What I have seen is people with some advantage plans get sick, fall, break a bone etc. and need home health care. Sometimes they have a policy that only covers care in their own state. Now they are in Florida with no preferred providers. That is another mess within itself. We run the insurance and find out there is no coverage. Then we have to try and negotiate with the insurance company to get authorization to provide care. As I said, be very, very careful when choosing a plan. 


You're right.  Advantage plans that are HMO's and not PPO's are a big problem when you're not home.  Only emergency services are covered out of the area.

 

Esteemed Contributor
Posts: 6,802
Registered: ‎11-15-2011

Re: Medicare Advantage plans & inpatient rehab

[ Edited ]

Insurance has been that way for years.  We payed for extra room charge coverage in Florida and when I had my baby in Arkansas, Arkansas insurance did not have that so we had to pay the difference even though we were paying for the extra coverage in Florida.  That was 50 years ago!

 

We were not on Medicare or  an Advantage plan.

Esteemed Contributor
Posts: 5,660
Registered: ‎03-09-2010

Re: Medicare Advantage plans & inpatient rehab

UNfortunately with the Advantage plans or the standard Medicare supplement plans YOu often do not know what is not covered or what services have a high deductible until you have to use them.  PEople take one policy over another sometimes to save a few dollars a month on their premiums and then find out that needed services are not covered or there is a large deductible.  AS I have stated before on threads like this my DH had the Plan F Medicare supplement.  HE developed brain cancer and spent close to 100 days in the hospital plus another 15 days in a skilled nursing facilities in between chemo treatments.  HE had a Brian biopsy, two rounds of in hospital chemo treatments.  THe sticker price for all this was close to 1 million dollars.  

I paid not one single penny for any of it including a emergency helicopter ride from our local hospital to UVA Medical.  THis is one area when you can be penny wise and pound foolish.

Honored Contributor
Posts: 16,809
Registered: ‎03-10-2010

Re: Medicare Advantage plans & inpatient rehab


@BalletBabe wrote:

@Carmie wrote:

@BalletBabe wrote:

@Carmie wrote:

@Kachina624 wrote:

@conlt wrote:

I have said it many times on these boards and people always argue with me but the Medicare Advantage Plans do not pay just like Medicare. I have worked in health care specifically with the elderly as a RN executive in home care. My business is a Medicare business. I think the advantage plans are fine for a healthy individual who wants to save money on prescriptions however, I have seen many times when they don't want to take care of someone who needs more intensive care. When Medicare rolls around for me I am taking straight Medicare, a supplement to cover the other 20% and then a part D drug plan. My 91 year old mother is on this and she never pays a dime for anything other than her insurance. Please be careful with the Medicare Advantage plans, you never know when a critical illness is going to happen and you need good coverage. 


@conlt  I don't know what you're talking about because my plan has no maximum lifetime limit.  Mine also has a part D drug plan.  It covers everything I would ever need. These plans are not all the same. 


I know what she is talking about.  I worked in Health a Insurance for over 25 years, and I agree with Halo117.

 

You might be surprised what your Advantage plan does not cover at 100%.  You won't know until you need that benefit.  

 

One of my family members is in the hospital right now.  She has an Advantage plan that covers just about everything.  She pays $90 a month for it.  

 

I just checked into her benefits today.  She has a $200 deductible for the first through the  7th day of an inpatient admission.  She has been there four days already and will probably owe $1400 at least for seven days when she is discharged.

 

She used to have Traditional Medicare and Plan F which paid 100% of all her inpatient admissions.  She dropped that insurance on Jan. 1.  I have no idea where she will get the money to pay this bill.  She is living on $1200 a month from SS.


You can set up a payment plan with the hospital.  They have to take what she can give.  Do not give them a charge card or a debit card.  They try to get it out of you while you are there.  DON'T GIVE IT TO THEM.    


I know what you are saying is true. The hospital won't bill her until after the claim is processed, so no CC on file.

 

I just don't have a clue where the extra money for this bill will come from.  Her monthly bills for her RX drugs are very high. Hundreds a month because she takes so many.   17 pills in the am and 12 in the pm.  She also has a mortgage and pays her utilitiy bills.  My brother pays her RE taxes and I help her with her grocery bills and other expenses. Her home is in need of repair.  My sons can fix things for her, but things need replaced and updated, not fixed.

 

There is no money left at the end of the month.  Her clothing is getting worn out. Her health is not good and mentally, she isn't always "with it". Sometimes she will spend money she can't afford to or give it to the small children in the family as a gift for a birthday or holiday and her bills suffer.  

 

She used to work in finance, so this is unlike her.

 

I have been trying to get the family together for a meeting, but they keep resisting.  

I would suggest she sell her house and move to a senior apartment that has an income based rent. Something small.  She lived with me for 9 months after a serious hip injury and back surgery, but begged to go home. So home she went home last April.

 

I am her POA, but don't want to make or force her do anything.  I want her to except change and move on. She keeps saying, "but I want to live here in my home." Well, she can't afford to.

 

Lately she has been sick, hence the hospitalization. Her kitchen was so dirty and gross when I went to check on her, that I almost fell over from the stink.  She was too sick to clean or do dishes.

 

She has always been clean crazy and used to re do everything I did because it was never clean enough for her. I just spent a whole day cleaning her home, scrubbing and deep cleaning because it was so bad.

 

She was sick, but didn't tell anyone how bad she was.  She called me for an unrelated issue and I knew something was wrong right away.  I took her to the ER still in her nightgown, slippers and robe and she was admitted. 

 

I don't think she should live alone anymore, but I don't know what to do for her.  I am going to call the office for the aging on Monday.  I hope they can help or offer suggestions.

 

Sorry for the long rant.  I just needed to vent..


She definitly needs to get off the Advantage plan.  That plan is for people that are healthy and don't need meds that are expensive.   You might want to have her apply for Medicaid, especially if she cannot afford a supplemental.   There are also pland to help patients with low income to get help with meds.  Make some phone calls!   Good Luck!   It is a shame that they do this to the older generation. 


She may be able to get on a Medicaid plan now, but she couldn't go to Plan F.  You can't switch from an Advantage plan once you're already on it.  At least that's the way I read it.


The Bluebird Carries The Sky On His Back"
-Henry David Thoreau





Honored Contributor
Posts: 25,929
Registered: ‎03-09-2010

Re: Medicare Advantage plans & inpatient rehab

People start on medicare at age 65. At that age we really are not senile - we are perfectly capable of learning and understanding and making our own decisions. We don't need our clergy or neighbor or esp. our children to tell us what to do . Unless of course you were never capable - which would be an entire different story altogether. Why on earth would someone go to their minister to ask him what medicare insurance to buy? How would he know? Make some effort and get yourself educated and then make your decision based on your individual needs and budget.And absolutely don't let anyone on a message board like this influence you - there is a ton -- really a ton - of incorrect information given on this board every time this is discussed. Just because someone says here they are an expert - DON"T BELIEVE THEM. Learn for yourself - be your own expert.