Health Insurance Considerations

fmb

My mother has Stage 6 ALZ and is in MC in hospice care. My brother holds her DPOA, and we three siblings all hold the healthcare POA, able to act individually. We consult often about her care and make major decisions jointly with no disagreements.

My mother's current Medicare Advantage Plan is being discontinued, and my brother has asked for my help since my DH has ALZ. However, DH and I get our insurance through a federal employee retirement plan and do not have to navigate the various types of coverage available to the general public.

Per my brother:

I realize traditional Medicare is paying all of her medical and pharmacy expenses while she is on hospice. However, there is a non-trivial chance that she will get booted from hospice sometime in the future if she is not declining quickly enough. There is also a chance that she will stay on hospice but have some serious injury from a fall or other misadventure that cannot be managed in her memory care facility and would need treatment in a hospital to alleviate her pain. I would have to temporarily dis-enroll her from hospice to obtain Medicare coverage for that treatment. So, she needs to have a backup plan to avoid getting stuck with a huge bill..

After reading various resources and talking to the hospice social worker, here's the approach I am thinking of:
a) Use traditional Medicare (not another Advantage plan) for her Part A and B services. She doesn't need the extra goodies that come with Advantage plans, like Silver Sneakers, dental coverage, etc.
b) Enroll her in a Medicare Part D plan so she would have drug coverage
c) Enroll her in a Medicare Supplement Plan F that would cover her cost share for Medicare services. 

One thing we have to consider is that she suffers from extreme paranoia, hallucinations and anxiety. She started Seroquel Sept. 23 in addition to Cymbalta and Remeron which she was already taking. The Seroquel seems to be having no effect. Should she have to be hospitalized for medication adjustment or if she becomes violent, we need to be sure that would be covered.

Does the above sound like a reasonable plan for her insurance? Are there other considerations that we have not thought of?

Quilting brings calm

Your brother is correct. You do need to have Medicare part A, B, and D in place or a different Medicare advantage plan in place for the reasons he stated.

The problem with returning to traditional Medicare is that the supplemental plans have a right to underwrite her now that she’s not in the initial enrollment period. Meaning she could get turned down for an F, G, etc plan. That would leave her responsible for 20% of her care and with a huge hospital deductible if she went off hospice. Not sure what happens in terms of that 20% while she is on hospice. Some states have requirements that there be a plan that offers guaranteed acceptance.
I would suggest that you go through an agent to determine the best plan for her. We used an agent when my spouse and then I turned 65. They know the rules and they can help you pick the best plan. It didn’t cost us anything to get their help. A state agency on aging might also have a SHIP consultant that could advise you.

M1

one question I don’t know the answer to: is Medicaid paying her long term care expenses? If so, does she have to be enrolled in an advantage plan to maintain that eligibility? I think I agree with QBC that I would ask an agent.

fmb

Thank you both for your input. I will pass your answers along to my brother.

@M1 No, Medicaid is not paying. She is private pay with more than enough assets to cover her LTC for the rest of her expected life.

@Quilting brings calm

Per my brother:

I am leaning toward Blue Cross - Blue Shield for the Part D and supplement plans based on what I have read so far in medicare.gov and on the state (Kansas) Medicare website. Because her current Advantage plan is being terminated, she has a "special right" to enroll in a supplement plan without regard to pre-existing conditions.

Quilting brings calm

I am leaning toward Blue Cross - Blue Shield for the Part D and supplement plans based on what I have read so far in medicare.gov and on the state (Kansas) Medicare website. Because her current Advantage plan is being terminated, she has a "special right" to enroll in a supplement plan without regard to pre-existing conditions.==

That’s great. Check into the premium difference between an F and G plan. The only difference in coverage is that you pay the part B deductible on a G plan, which was $240 this year. She might save more than that on the premium difference.





jfkoc

I think F is not longer available to new people.