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My mom is currently in the hospital, since May 5th. She just cm home 4/6/24, from rehab. She changed her insurance, her condition is worse. Mom had fallen the day before she went into the hospital. The next day, she had no strength in her limbs, core, and she no control of her bladder. The hospital is saying she had a bladder infection or UTI, too weak for inpatient rehab. The rehab center she was at in March, doesn’t accept her current insurance. Most of the rehab centers are not in Network now. Insurance active as of May 1st and mom is 78 yrs old. She also to have a catheter possibly indefinitely.

You or she need to call the number on back of insurance card. Network sounds like Medicare advantage plans and they are so different depending on county and state we can’t really advise you.
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Reply to Guestshopadmin
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liz1906 May 28, 2024
You made a very important point. They are different. In Massachusetts my BCBS Medicare Advantage plan allows me to choose any provider or hospital even if they are not in network. There are also less expensive Medicare Advantage plans that have a network only plan. No one that I know has had any problem with the rehabs accepting BCBS Medicare Advantage. Sometimes in MA an elder on a fixed income can qualify for "extra help". This reduces the cost of the monthly Medicare bill.
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Why did she switch to a Medicare Advantage plan? Was she competent to do so?

I'd see if she's within the time frame where she can switch back.
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Reply to BarbBrooklyn
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Always talk to a SHIP counselor before making any changes to Insurance. Maybe a SHIP counselor can help in this situation.
They are independent counselors that are not beholden to any company.
SHIP stands for Senior Health Insurance Program
the service is free
they assess what the needs are and find a plan that works
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Reply to Grandma1954
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Yes, sounds like she has a Medicare Advantage. She has to stay in their network. Office of Aging can also help you find a plan for Mom. It may be better to go back to Traditional Medicare with a supplimental. With Traditional Mom can go to any doctor or facility that excepts Medicare. Open enrollment is not until Oct or Nov. Not sure if she can switch yet.
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Reply to JoAnn29
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It would help to know the reason why your Mom changed it and what exactly she changed.

I agree it sounds like she possibly went from supplemental gap plan to an Advantage plan. We can't give you guidance without confirming what actually happened and why.
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Reply to Geaton777
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it sounds like mom is currently in the hospital, correct?
and that mom owns a Home, correct?

Do NOT - again DO NOT - let the discharge planner at the hospital
1. talk you into ever coming to the hospital to take your mom home
OR
2. that mom can be discharged to go back into her home.
Tell them it is a totally unsafe discharge for mom to do either. Stick to that as your answer. You do not have to elaborate as to why it’s unsafe. The hospital will eventually find a place that will take her. This is what the discharge planners do (most are Social Workers). Their first step is pretty much always is to pressure family to come & get their mom or dad as that totally get rid of the problem for them. Again for those in the back seats, DO NOT PICK YOUR MOM UP!

My guess is it will be she gets transferred to a NH as a custodial care resident and the SWs will file a LtC Medicaid application for her. It will be an incomplete filing but the NH is betting she will be eligible or if not they can place a lein on the home she owns to eventually be paid from.

I agree with the others that the issue is your mom switched from Original Medicare to a Medicare Advantage Plan. Why mom did it is probably because it meant mom did not have to pay the Part B premium each mom of $175. But she did not realize the problem with Advantage Plans is they are extremely narrow as to who & what is including in network. NHs even with a rehab sector will not be in network. If she cannot switch back (what Barb suggested) or coverage is zero (what Guest thinks is happening), then once she has a significant change to her life she can switch to Original Medicare and if she is in a NH as a long term care resident, she will go onto Original Medicare and Medicaid as health insurance along with LTC Medicaid for room&board costs once she’s impoverished enough for program’s requirements. The NH she is in by this time will shepherd all these to happen.

Please pls realize…. if mom stays in the hospital, she will be getting care. Again if in the hospital = she will be getting care.

But what you can do during this is go through mom’s paperwork at her house to see exactly what her financial situation is. Why you are doing this is because for her to be ok for LTC Medicaid it will involve a 5 yr lookback. So anything financial back to 2019, set aside in a binder. Find her house documents - like her Release of Deed of Trust which shows mortgage paid off. Find her SSA letter from Nov 2023 that states what $ is being paid to her for 2024. Xerox all of this as you will eventually need them for LTC Medicaid application and its renewals.

If you are a signatory on her bank account or CCs, use that ability to pay for utilities and property taxes and insurance on her home while you can. Do not pay for her property related stuff from your own wallet if you can help it unless you absolutely have your own financials such that you don’t necessarily ever need to be repaid. By this I mean…. say it costs $18,000 to deal with moms house annually, then you have 18large to pay to do this without it crimping your own living expenses. I’d that is not yiur situation pls realize it will be beyond quite difficult to get repaid easily if ever. So if you don’t have the $, don’t pay for stuff. If water gets shut off, it is what it is.

If there is a house, can be a difficult reality for families to deal with. Often they don’t realize that the folks were living on just 2K Social Security income and there is all sorts of debts / maintenance. Hopefully that is not your mom’s house. But Whatever the case, get all the paperwork you can find, get all clothing / shoes / glasses that she might need, then close the house up as secure as feasible; otherwise house and property problems will overwhelm you.
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Reply to igloo572
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read your profile. There is no house and you share 2 bedroom apt. When mom goes to nursing home, she will have no $$ money to pay for apartment you are still in. If you have comingled funds or need her $$ to keep apartment it will be tempting to bring her home. IN LA there is NO NADA NEVER 24 hour care paid by Medicaid or Medicare at home. You will be expected even if you are disabled to provide majority of care!! The social workers may mention hospice. HOSPICE DOES NOT PROVIDE 24 HOUR CARE AT HOME. Get social worker involved to figure out situation for both of you.
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igloo572 May 19, 2024
Owww no house! I missed that, Guest! & the OP seems to be on SSDI.

MomCG27, again do NOT allow your mom to return to the apt you share. Mom stays at the hospital and they will figure something out. That you are disabled should be enough in and of itself to be a reason why you cannot have her move back to the apt.

please reread Guests post…. If any of moms $ & your $ is commingling, that has to stop. Hopefully btw your SSDI and pension, you have your rent covered. So you don’t have to worry abt moving atop everything else. But you do want to give some thought once things settle down as to what happens to your finances once you personally reach full retirement age as your SSDI will stop and then you go onto regular SSA monthly retirement income. Like you might want to be proactive and start to put your name on better low income housing waiting lists that are disabled friendly.
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I think, if I recall correctly the last SHIP info program I attended they said that you can change Insurance IF you move. It is a Special enrollment Period but I do not know how far the move has to be if it is by distance or by ZIP Code.
It would be worth talking to someone at Social Security about.
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iameli May 19, 2024
You can change insurance but insurance company doesn't have to accept you for a supplemental plan. Since she's currently in bad shape I'd be worried about acceptance into a new plan.

I'm actually sort of confused about how she was able to change insurance May 1, outside of the annual enrollment period. But then, I'm still pretty new to Medicare.
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Thank you all so much for the answers and suggestions. First of all, mom doesn’t own a home anymore. She came to live with me last February, because she fell into the wall in her apartment. At that time she hit her head, broke her neck and her forehead needed stitches. She was released from the ER and I brought her home with me.
In April, she got a phone call about her insurance, she talked to the guy over an hour. She told me she'd changed her insurance, she thought it was a good thing. Unfortunately not.
Yes, mom is currently in the hospital, we’re in Michigan.
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Reply to MomCaregiver27
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Geaton777 May 19, 2024
Again going to ask specifically what did she have before and what did she change to? If she lives with you, you should know this info. We can give you better guidance if you give us the info requested. thx
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If your mother has changed her insurance to an Advantage Plan, her coverage is dependent upon what that Plan allows. Advantage Plans restrict coverage to Network doctors and facilities and come with many more limitations than traditional Medicare. Trying to save money on premiums costs the insured person a lot more in other ways.
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Reply to RedVanAnnie
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MomCaregiver27: Your mother could get Medicare Supplemental insurance via an insurance agent to assist with her current Medicare.
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Reply to Llamalover47
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From what I understand and I could be wrong you can’t go back to original Medicare once you’ve changed to an advantage plan if you have a pre-existing condition,
they have a list
dementia is one of them
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swmckeown76 May 29, 2024
You can most certainly do so, but it might be difficult to get a Medicare supplement to pay the 20% that Medicare doesn't pay. Only four states are guaranteed issued for life for Medicare supplements. If you don't live in one those states, it's important to weigh whether the person, her/his spouse and/or children are willing to pay that 20%, or face the limitations of a Medicare Advantage plan. My late husband was on early Medicare due to SSDI and we didn't live in one of the few states where Medicare supplements were available to people under 65 on SSDI. I had heard so many horror stories about Medicare Advantage plans, I readily paid the 20% that Medicare didn't pay out of his (and sometimes) my money. I also got him a Part D drug plan and added him to my vision insurance plan. I got him private dental insurance as well. Once he reached the window where he could get a supplement without understanding, I bought him a Plan G Medicare supplement. Very glad I did this.
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To MomCaregiver27:

Someone posted that if you have a preexisting condition, you can’t go back to Original Medicare once you’ve signed up for a Medicare Advantage plan. This is not true. Your mother CAN return to Original Medicare, even with a preexisting condition.

However, it’s important to note that while she can switch back, enrolling in a Medicare Supplement (Medigap) plan might be challenging since she has a preexisting condition. Medigap plans help cover the 20 percent of costs that Original Medicare doesn’t pay, so without one, she might have to pay that 20 percent out of pocket.

On the positive side, with Original Medicare, she’s not restricted to a network; she can see any provider in the United States that accepts Medicare. Additionally, she will need to purchase a standalone prescription drug plan (Medicare Part D) to cover her medications.

For more detailed information and guidance, it’s best to contact Medicare directly at (800) 633-4227.

.
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Reply to HaveYourBack
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It’s all very confusing. What’s worse is a single decision could haunt you the rest of your life. How can we make the administrators suffer the consequences if their policies.
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Reply to Sample
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I feel you need to speak to a local insurance agent on Medicare for your location. Just not one associated with 1 insurance agency.
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Reply to MACinCT
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Call the insurance company directly and ask for assistance in securing a place. If she is in the hospital, ask social worker or case manager to help find a place that will take her insurance.
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