Just posting this because I am at my wits end and feeling like I have nowhere to turn to. I am 38 years old, single and have had my parents move in with me at the beginning of this year because they could no longer afford to live on their own and my mother alone could not care for my father who has had worsening dementia over the years.
I had no idea how Medicare and Medicaid worked and found out the hard way when both my parents lost their Medicaid coverage due to the change in address. They moved from NYC to Westchester County. I notified SSA of the address change for both of them and with the help of a social worker who works at the adult daycare center they attend, my parents were able to get Medicaid coverage back in Westchester.
Fast forward to October of this year, my mother sustained a burn on her foot that required her to go a wound care center for weeks. Last week Wed. 11/30 we were told that she would need to get a debridement and possible toe amputation. She was started on oral antibiotics. On 12/1, I was told that my mother needed another antibiotic. When the script was sent to her pharmacy, the pharmacist called us to tell us that she was no longer covered by her plan. Alarmed, I called Empire and found out that she was disenrolled on Thurs. 12/1 from their dual advantage plan due to "no longer having Medicaid or a qualifying level of Medicaid per state contract" and that Original Medicare would be covering her starting that day. The "enrollment specialist" told me that a letter was sent out in August stating these facts. We never received this letter, possibly due to the move. I told this rep that my parents have been receiving benefits through Medicaid such as attending an adult day care center and home care so it is not possible that they wouldn't have Medicaid coverage. He verified that this was true by calling their verification department and verifying both my parents' Medicaid coverage by a 3 way call with me. He then said he thinks that there was an error and tried to contact a customer service rep but was not able to. He told me that his best advice would be for me to contact the local Medicaid office and have them send information about my parents' active coverage to both Empire and Medicare. I told him that I can't undersand why that would have to be done since he just verified it with the verifications department. At this point I was exasperated since I had spent hours on the phone being transferred from one person to another to another. I thought that since the letter Empire sent stated that she would be covered by Original Medicare I didn't really think too much of it and would contact Medicaid later as it was already almost 8pm.
Monday 12/5, my mother and I went to the hospital to be registered prior to surgery. They needed to verify my mother's insurance and we handed over her Medicare and Medicaid cards. Medicare still said my mother's insurance was the plan through Empire but they still did the surgery and my mother was recovering well. The plan was for her to be monitored overnight and get a wound vac and possibly a midline for IV antibiotics.
Tuesday 12/6, I am told that the hospital is still having trouble with my mother's insurance. Medicare is still saying she has Empire. I called Medicare who said that they haven't been notified that my mother was disenrolled from Empire, the coverage still shows as ending on 12/31. They tell me to call Empire and to have them send updated information stating that her coveraged ended on 11/30. I called Empire who told me that her coverage ended 11/30 and the information gets automatically sent to Medicare. There is nothing they can do, call Medicare. Medicare tells me to call Empire.
So now my mother is stuck without any plan, while still having active Medicare A&B coverage but Medicare not covering her current treatments because they have Empire still listed as her coverage until 12/31. I don't know what to do. Any advice?
See if Mom can use something like GoodRx. Ask the pharmacist if there is any kind of help until her new policy takes effect. My grandson has asked for help when he lost his coverage and the pharmacist saved him lots of money.
I know I'm no longer on original Medicare while on Kaiser Advantage, but I must still pay those Original Medicare's premiums just to stay on Medicare Advantage without government penalties. It's still expensive to pay Part B at $165.80 (2023) monthly premiums, regardless of free or premium costs for Part C and D on Medicare Advantage.
I think it's just our federal government forcing all of us to pay in their pool of warped, expensive funding system that includes prescriptions and very ill people using it. The Alzheimer new drug study and use of 2022 impacted all of us. We see only a $5.90 decrease in original Medicare premiums, big deal. Social Security should pay the average retiree at least $200 more monthly to clear more than the cost of Medicare Part B to get ahead. I also learned that Social Security has lost around 40 percent of its value since about 30 years ago. What I am getting from SSA beats nothing. No point in further debates or complaints. Thanks again for advice.
Kaiser Advantage takes care of my C, D, vision and dental care. Routine dental checkups, cleaning and Xrays have no copays, but I had to pay one third of the costs for several new filling and one root canal, costing me over $3,000 out of pocket. If I paid no Kaiser premiums, it's likely to cost me more copays for doctor and dental visits besides for the hospital.
Bottom line: My family is sending me gift funds because of my low income and expense status since, I must live alone and cannot even house-share with a roommate for income help. Renting out is a bad option because of legal issues with my ASD and anxiety disability that requires privacy. Very thankful for their help with my basic needs, including health care.
My dad's policy picked up from the cancellation date, ask Medicare about this.
Only with an Advantage plan do you no longer have original Medicare.
If you have an Advantage plan, have you checked to see if you can get one at no additional charge. Meaning the 175.00 monthly is ALL you would pay.
I feel for you but, I pay 879.00 monthly for my insurance and I have a 7,500.00 annual deductible and copays for everything. Thank you Obama.
I have to add, at the rate the good ole' USA is going, I won't be collecting anything from my social security withholding taxes paid. I knew this as a young teenager and have been saving and living accordingly, if by chance I am wrong, doubtful but, then anything I get will be a blessing and not required to live.
P.S. Its really hard to provide info when you don't have the information right before your eyes.
I'm sorry this is happening to you and your parents.
P.S. Don't be alarmed if the person that you are referred to is a volunteer for one of the agencies. The Office on Aging in each state, relies on volunteers to get the work done. Even the counselors are volunteers. With many boomer-age people retiring, many of them are keeping active and up-to-date, by volunteering in the many agencies that make up the Office of Aging.
Will any non-Medicare Advantage plan in addition to Original Medicare work for the Medicaid level her mother has moved to? Is it called Medicare G or something else? G works out for traveling and moving but costs more for coverage. Does Medicaid work with Medicare Plan G coverage?
Two years ago I learned about different options when I turned 65, but I decided to use Kaiser Senior Advantage Plus in CA that works out fine for me. Covers most services under one roof for my convenience. I cannot afford Medicare G because of my low income on only SSA but make too much to get Medicaid help.
I have no local relatives and would like to be closer to them, but I cannot even move due to my limited financial situation even though I have relatives who live out of state until further notice.
Perhaps you can make an appointment and get it done on Zoom before the holidays.
10 yrs ago, my MIL passed. This was when O care came in. None of us was aware that taking MIL from one state to another thought there would be a problem with her suppliment.
So we all know now that Medicaid is County based and supplimentals are State based. The problem is how do you get them straightened out.
Expecting your Congressional Rep or Senator to do anything for Medicaid is not where you want to go imo. They r going to refer you to the Area (Council) on Aging or your health department or state Medicaid website. I’ve had federal level elected in my family and really when it came to getting something local done the County Judge was the power (this for TX). As Co judge has emergency powers and can get the Red Sea parted to get someone into aSNF or a psychiatric facility
I, also, found this a huge benefit in that my dad could then get onto a supplemental policy without going through the physical and pre-exsisting conditions approval. Because he was cancelled for moving out of the coverage area.
I never once considered that his insurance wouldn't follow him, I didn't even know what I didn't know when our journey began.
I know people who have switched to Straight Medicare when an Advantage is not working for them.
This is for everyone who deals with Medicaid, its county based. So, if u leave one county moving to another in same State, you need to inform them you are moving so you can be set up in the next county. I found this out when searching for LTC for Mom. My Town is not far from the next County. If I found a home in the next County I liked, I would be dealing with their Social Services.
I would get a copy of the letter from Empire saying ur parents were terminated on 11/30. Call Medicare for a contact and fax/email it over. Sending a copy of their new Medicare card and Medicaid card with it. I would stick to straight Medicare since Medicaid is their supplimental. Medicaid should be picking up what Medicare does not cover. Again, someone at Office of Aging should be able to help you.
In the meantime, I can completely sympathize with what you are going through. I have a couple similarly frustrating situations on my hands,...nothing to do with health ins/medical care, but where no one will get to the bottom of a situation to fix it despite ENDLESS CALLS where one co points to another & visa-versa and it's soooo frustrating!
I hope you can find someone to finally get this solved for your mom.