Medicare Question

NadiaSookar

Hi everyone,

My mom was just diagnosed with Alzheimer's (mild) state. She currently has Medicare under an Advantage Plan - United Healthcare. Because of her new diagnosis, we are considering moving her back to Original Medicare in order to have more options for care. Does anyone have advice about this (i.e. having Original Medicare vs. an advantage plan) with a dementia diagnosis. Is there a preferred option?

Any insight would be greatly appreciated!

cdgbdr

In general, if you have prescription drug coverage figured out, I would opt for traditional Medicare for the flexibility. I am still working so DH has commercial insurance and Medicare A&B secondary. He has a complex medical history and dementia and I have felt this was best so I could obtain care where I wanted him to receive it. Once I retire, I would like to continue that for him if it is feasible.

Quilting brings calm

It might be difficult to switch back. I’m sure you can get Medicare parts A ( hospital), B ( doctors, and non hospital expenses), and D( prescription). You might not be able to get a supplement to cover the hospital and other deductibles and co-pays. Yes. Medicare has deductibles and co-pays(20%). Supplements are written by private insurers and they will ask questions about her and either charge her more or deny her altogether. Our state has one supplement written by Blue Cross Blue Shield called guaranteed acceptance that takes all applicants regardless of health conditions. Some states don’t have any. I suggest you ask friends if they went through an insurance agent that answered all their questions. If you can get a supplement, Part G ones are the best to get

SDianeL

Sorry about your Mom’s diagnosis. Unfortunately, neither original Medicare or an advantage plan will cover long term care. Medicaid does. So I would just compare the 2 options using financial and doctor availability. Medicare has copays. Does the advantage plan? How much? In many states you can have both Medicare and Medicaid if you qualify financially. I would meet with an Elder Care Attorney who can explain the Medicaid rules in your state. Also get DPOAs & other documents done asap.

harshedbuzz

@NadiaSookar

Hi and welcome. I am sorry for your reason to be here but pleased you found this place.

This is a great question. SDianeL is correct in that neither type of plan covers residential/custodial care.

It's really hard to make general comparisons to Traditional Medicare and MAPs because there are so many different plans within each category. Many folks feel TM is preferable, but my mom's MAP provided as part of her retirement package has been excellent but doesn't include "extras" like transportation to appointments from which I might benefit.

That said, there is a new program being rolled out by Medicare for PWD and their families called GUIDE. It's not widely available at this point and it does seem to vary by state but does include some in-home help in some places. At this time, GUIDE is limited to those folks who have Traditional Medicare.

https://www.cms.gov/priorities/innovation/innovation-models/guide

The other piece you will want to be looking at is whether your mom has enough assets to fund a MCF should one be needed down the road. If she doesn't, she may need institutional Medicaid to be her safety net. There is a 5-Year-Lookback associated with qualifying for that program and you'll want to make sure nothing is done to prevent her becoming eligible. An elder law attorney can assist with this important piece.

HB

Quilting brings calm

FYI-I saw an headline that United Advantage plans were being discontinued in 109 counties. If so, this might make it easier for her to transfer back and get a supplement. Check into it.

Robert1320

https://alzconnected.org/discussion/74268/medicare-question

I've found our local Counsel on Aging very helpful in providing advice and/or referrals to local experts who are familiar with local services and your particular State's laws.