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Esteemed Contributor
Posts: 6,952
Registered: ‎10-21-2010

Re: Medicare Advantage plans & inpatient rehab

I don't think this has much to do with a advantage plan. Most insurance is like this. I was in the hospital for three months. My parents house was no way ready for me to come home. I am disabled and after three months I needed to get strength back. They refused to pay for me to go to a rehab center. Instead they made me leave the hospital and come home. I had physical therapy come to the house a couple times a week. It took a good month to two months to get the house ready. I had no shower until we remodeled. But looking back it was a huge blessing. I got back to a normal routine and gained a ton of strength back. Being disabled there was not much they could do in a rehab center. I would of been stuck in bed because I didn't have a lift recliner I could get out of. So once I got home I regained a lot really quickly just by getting back to a normal routine.

Esteemed Contributor
Posts: 6,952
Registered: ‎10-21-2010

Re: Medicare Advantage plans & inpatient rehab

Is this person over 65. If they are not then they can't get a supplemental plan. I am disabled and I will not qualify for a supplemental plan until I am 65. A advantage plan is my only choice. But we have had no problems. They have approved my tmj surgery. I am not on any medications except Stelara. This is the one big issue I have. They will not let you use your copay card and get it for zero dollars with a advantage plan. And I was turned down by the foundation because I have insurance. So my rheumatologist had been giving me free samples. I don't know where they think I am going to get $2000 every three months for this shot. When I had my private ACA plan I used the pharmacy card and paid zero. That so far is my only complaint with my advantage plan.

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

Re: Medicare Advantage plans & inpatient rehab


@ccassaday wrote:

Is this person over 65. If they are not then they can't get a supplemental plan. I am disabled and I will not qualify for a supplemental plan until I am 65. A advantage plan is my only choice. But we have had no problems. They have approved my tmj surgery. I am not on any medications except Stelara. This is the one big issue I have. They will not let you use your copay card and get it for zero dollars with a advantage plan. And I was turned down by the foundation because I have insurance. So my rheumatologist had been giving me free samples. I don't know where they think I am going to get $2000 every three months for this shot. When I had my private ACA plan I used the pharmacy card and paid zero. That so far is my only complaint with my advantage plan.


Whenever you say this about supplements/advantange plans I don't understand. I retired at 58 on disability and went on medicare at 60. I had choices of advantage plans or supplements. I've never heard of what you say here. I really think you are misunderstanding this.

Honored Contributor
Posts: 16,837
Registered: ‎03-10-2010

Re: Medicare Advantage plans & inpatient rehab


@ccassaday wrote:

Is this person over 65. If they are not then they can't get a supplemental plan. I am disabled and I will not qualify for a supplemental plan until I am 65. A advantage plan is my only choice. But we have had no problems. They have approved my tmj surgery. I am not on any medications except Stelara. This is the one big issue I have. They will not let you use your copay card and get it for zero dollars with a advantage plan. And I was turned down by the foundation because I have insurance. So my rheumatologist had been giving me free samples. I don't know where they think I am going to get $2000 every three months for this shot. When I had my private ACA plan I used the pharmacy card and paid zero. That so far is my only complaint with my advantage plan.


@ccassaday  I retired last year on disability and had my choice of an Advantage plan or a supplemental plan.  The problem for me was that Plan F for someone under 65 on disability was going to be $450+ a month.  Plan D was also going to be quite expensive.  The Advantage plan was $0 a month.  The person that I spoke with about this told me that I could switch to Plan F when I turned 65 and it would be the regular price that everyone else pays.  Then when I read about it on Medicare's site is when I thought that you couldn't switch to a supplemental plan after having an Advantage plan.  I was glad to read from 151949 that this is not the case.

 

So far I'm happy with my Advantage plan, but will have to look into both plans more carefully when I'm approaching 65.


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





Esteemed Contributor
Posts: 6,952
Registered: ‎10-21-2010

Re: Medicare Advantage plans & inpatient rehab

[ Edited ]

@151949 wrote:

@ccassaday wrote:

Is this person over 65. If they are not then they can't get a supplemental plan. I am disabled and I will not qualify for a supplemental plan until I am 65. A advantage plan is my only choice. But we have had no problems. They have approved my tmj surgery. I am not on any medications except Stelara. This is the one big issue I have. They will not let you use your copay card and get it for zero dollars with a advantage plan. And I was turned down by the foundation because I have insurance. So my rheumatologist had been giving me free samples. I don't know where they think I am going to get $2000 every three months for this shot. When I had my private ACA plan I used the pharmacy card and paid zero. That so far is my only complaint with my advantage plan.


Whenever you say this about supplements/advantange plans I don't understand. I retired at 58 on disability and went on medicare at 60. I had choices of advantage plans or supplements. I've never heard of what you say here. I really think you are misunderstanding this.


I think it might be the state you are in. All I know is we have a great insurance guy. And when he went over plans he said I will not qualify for a supplemental until 65. So I have a advantage plan with AARP. I am only 44.  The Medicare supplemental plans in Indiana are not offered to anyone under 65. Even if your on disability. There may be exceptions for renal disease or someone who is dying.

Respected Contributor
Posts: 3,458
Registered: ‎06-10-2015

Re: Medicare Advantage plans & inpatient rehab


@ccassaday wrote:

Is this person over 65. If they are not then they can't get a supplemental plan. I am disabled and I will not qualify for a supplemental plan until I am 65. A advantage plan is my only choice. But we have had no problems. They have approved my tmj surgery. I am not on any medications except Stelara. This is the one big issue I have. They will not let you use your copay card and get it for zero dollars with a advantage plan. And I was turned down by the foundation because I have insurance. So my rheumatologist had been giving me free samples. I don't know where they think I am going to get $2000 every three months for this shot. When I had my private ACA plan I used the pharmacy card and paid zero. That so far is my only complaint with my advantage plan.


AFAIK, the programs run by drug companies that provide otherwise expensive drugs at a low fee or free to people are not for anyone with government insurance. That includes state and local as well as Medicaid and Medicare. It's not an Advantage thing, it's much more extensive, and many needy people are excluded.

 

I believe biosimilars (like generics but not, for biologics) for ustekinumab are in the pipeline, and hopefully when they're available the prices will be lower. 

Respected Contributor
Posts: 2,664
Registered: ‎05-13-2010

Re: Medicare Advantage plans & inpatient rehab

@ccassaday  Sometimes the drug insurance people relent if you need an expensive drug to stay alive.

Honored Contributor
Posts: 19,854
Registered: ‎10-25-2010

Re: Medicare Advantage plans & inpatient rehab


@151949 wrote:

@ccassaday wrote:

Is this person over 65. If they are not then they can't get a supplemental plan. I am disabled and I will not qualify for a supplemental plan until I am 65. A advantage plan is my only choice. But we have had no problems. They have approved my tmj surgery. I am not on any medications except Stelara. This is the one big issue I have. They will not let you use your copay card and get it for zero dollars with a advantage plan. And I was turned down by the foundation because I have insurance. So my rheumatologist had been giving me free samples. I don't know where they think I am going to get $2000 every three months for this shot. When I had my private ACA plan I used the pharmacy card and paid zero. That so far is my only complaint with my advantage plan.


Whenever you say this about supplements/advantange plans I don't understand. I retired at 58 on disability and went on medicare at 60. I had choices of advantage plans or supplements. I've never heard of what you say here. I really think you are misunderstanding this.


There is no  Federal law stating that Supplemental Plans must be sold to people under the age of 65 even if they qualify for Medicare.  Because of this, some insurance companies will not offer this type of insurance.  People who live in areas and states where this is common, have no other choice except to enroll in an Advantage plan.

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

Re: Medicare Advantage plans & inpatient rehab

[ Edited ]

@Carmie wrote:

@151949 wrote:

@ccassaday wrote:

Is this person over 65. If they are not then they can't get a supplemental plan. I am disabled and I will not qualify for a supplemental plan until I am 65. A advantage plan is my only choice. But we have had no problems. They have approved my tmj surgery. I am not on any medications except Stelara. This is the one big issue I have. They will not let you use your copay card and get it for zero dollars with a advantage plan. And I was turned down by the foundation because I have insurance. So my rheumatologist had been giving me free samples. I don't know where they think I am going to get $2000 every three months for this shot. When I had my private ACA plan I used the pharmacy card and paid zero. That so far is my only complaint with my advantage plan.


Whenever you say this about supplements/advantange plans I don't understand. I retired at 58 on disability and went on medicare at 60. I had choices of advantage plans or supplements. I've never heard of what you say here. I really think you are misunderstanding this.


There is no  Federal law stating that Supplemental Plans must be sold to people under the age of 65 even if they qualify for Medicare.  Because of this, some insurance companies will not offer this type of insurance.  People who live in areas and states where this is common, have no other choice except to enroll in an Advantage plan.

 

I understand what your saying - that where she lives no company is offering it - but she is saying that medicare doesn't allow it and that is totally incorrect. There may be a company move into Indiana tomorrow that will offer it and if that happened it would be perfectly ok. It's got nothing to do with medicare that they aren't offering it there. Probably to do with politics but that is a taboo subject here.

Honored Contributor
Posts: 19,854
Registered: ‎10-25-2010

Re: Medicare Advantage plans & inpatient rehab


@Nicknack wrote:

@151949 wrote:

@Nicknack wrote:

@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.

 

That would be incorrect information. You can't switch from an advantage plan to regular medicare while you are being treated for something -- for instance if you are on an advantage plan and you get diagnosed with cancer - you can't just switch to a plan F now so they pay all your bills. You would have to stay on the advantage plan until you are through the treatments for your cancer, but then you could switch if you want to.If you aren't being treated for any major illness you could switch during the sign up period in the fall if you want to.


 


Thank you @151949.  I read this completely wrong then.  I'm glad to know this.


She can switch back to Traditional Medicare and go back to the same Supplemental  plan ( Plan F) she had before January as long as she does it soon.  You can change your mind, I think within a six month period. She can do this because she has had Traditional Medicare since she was first eligible.  It's  a one time option.

 

The problem is with her RX program.  If she switches back to Traditional Medicare, she will have no RX coverage at all and not be eligible to pick it up until open enrollment and it will be higher( pentality) because she had a lapse.

 

All of this came about because her original RX coverage was through her deceased spouses retirement plan for $20 a month. They cancelled that plan and now offer only three Advantage plans with RX coverage.  She chose the best they offered.

 

She could not afford the Supplemental plan that went up in price and a Medicare RX plan that was way for than $20 a month. Her best option at the time was Advantage at $90 a month.

 

She takes a lot of drugs due to many issues, so she can't go without RX coverage.  I have a lot to sort out.