I am POA for 86 YO mother in a nursing home. It's no surprise that her remaining years are unknown, but she is doing ok. She has United Health Medicare and has for some time. I have recently been contacted (more like hounded) by a rep who wants to change her Medicare to a nursing home plan. Yes, it's cheaper, yes this will (supposedly) have a Medicare nurse check on her monthly, but the research I've done doesn't really tell me much more than that. Has anyone made this kind of change in their Medicare plan? Any advice or red flags I should be aware of? Thanks so much!
You must absolutely take these concerns and questions to her Nursing Home's Social Worker and Administrator. ONLY they will be able to guide you in the best possible insurance setup for your Mother at this point, and even assist in the transition if you/she would be better covered with such. Each individual nursing home is in-network with a different array of Replacement/Advantage, Supplemental/Gap, and Commercial insurance plans. You need to be IN-NETWORK with the appropriate plan(s) that are actually going to cover your Mother's costs when the need arises and she needs the Skilled (short-term) services that her NH provides. (Example: she breaks her ankle and needs extensive therapy to recover, along with a higher level of nursing services).
If it turns out that you are being harassed by a scam plan, then ask the Social Worker to assist you in reporting the company and contact information to the appropriate authorities and/or hotlines.
But I believe the difference is
1) a PPO plan (supplemental Medicare plan) allows you to choose your health care providers, but may cost more. Must go outside the NH for care.
2) An HMO plan (Medicare advantage plan) costs less, or can even be free because one assigns their Medicare benefits to the plan. This takes your choices away, you pay for a low premium, makes one have to wait to be approved to see a specialist, one "receives" only what is called "the standard of care" provided the same to all patients.
Imo, this "standard of care" is what gets a patient statins, b/,p meds, pain meds in lieu of treatment and cure, and g.e.r.d meds---all whether a patient actually needs them , or not. And, also, the standard dip stick urinalysis or a denial to test for a UTI, all to save on medical expenses for the plan.
IMO, disclaimer, disclaimer, disclaimer.
I could be wrong, but I don't care. I have "Stand alone, original Medicare".
But a Nursing Home plan is specifically targeted to NH residents and will be different from either than these.
Example: My Daddy needed cataract surgery and the medical group wanted him to go to one of these 3rd world surgery outlets and I told them no this was not going to happen it took 6 1/2 months because of going back and forth. After filing two grievances I finally got, the correct person from United Healthcare on the phone and told them that if this didn't happen within the next 30days I was going to sue for pain and suffering. United Healthcare went to the medical group and gee whiz it was approved within 2 hours. Daddy had both eyes done within 45 days.
Remember the insurance doesn't want the law suit - the medical group wants to save money.
Blessings
hgnhgn