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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?

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I'm sorry you are going through this. What a nightmare. I wish I could tell you I know what to do to resolve this quickly, but I can't. Keep plugging away and keep contacting the insurance agency. I keep hearing horror stories about Medicare advantage plans, and I'm afraid were going to continue to hear more as more and more people enroll in these plans. Maybe the hospital can help as well.
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Lsny420 Dec 7, 2022
Care management at the hospital has been trying to help as well. I have been making calls to the insurance company and Medicare at the hospital while with my mother for hours on end. It's so unfortunate that this is happening when she needs the coverage the most. Thank you for your reply.
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Call your local Office if Aging and see if someoone there can help you straighten this out.

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.
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Lsny420 Dec 7, 2022
Thank you very much. I will try to do that.
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You should try going online to Empire's client portal and see if it has a copy of the letter cancelling coverage. Then do the same with medicare.gov showing coverage is still active. Send copies of both letters to Medicare and Empire. Tell them to talk to each other as they are the ones contracted together -- not you or your parents. For good measure, give copies to the hospital and let the hospital know it is being worked on between the two.
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Lsny420 Dec 7, 2022
The problem with the portal is that it still says her coverage is active.
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Speak to a Medicare insurance agent rather than going on your own. You do not pay for this service. The agent will help find a plan that has the lowest co pays in her area. Open enrolment just closed on Dec 7, but she has moved so that she is eligable to change plans beyond the enrolment period. The expiration date is the same for all Medicare plans. Now she needs a MA plan in her covered area. Her best plan may just be from one of the top 5 big insurance companies that have more doctors that are listed in the plan. I am not familiar with Empire which may not be as comprehensive. And since she started with a MA plan, it cannot be changed to the regular Medicare. Our choices are based on our thoughts on life expectancy when we first enrol at age 65. Expect to pay more for chronic conditions.
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"Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year."

I know people who have switched to Straight Medicare when an Advantage is not working for them.
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Definitely call your county’s Area Agency on Aging. You might need them down the road too! They can refer you to a SHIP counselor (all states have them) whose specific purpose is to assist Medicare beneficiaries and their caregivers. Best thing I ever did when trying to figure out insurance when my mom moved to another state and lost her Medicaid. You can also go to www.shiphelp.org.
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igloo572 Dec 13, 2022
This!! Yes, the AoA are a great resource as they are a regional clearinghouse for services. A lot of states have the ombudsman program within the AoA. So loads of knowledge as to which facilities have had issues.
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How ridiculous with this Empire and Medicare. Your mom either has Empire coverage or does not in Decenber 2022. You should have notified the former New York County's Medicaid, Empire Advantage and Medicare prior to your parent's moving to another residence in another County and verified Empire for coverage in the new region prior to the move. Perhaps much stress may have been saved during this difficult life event, such as moving yiur parents to a new area at a crucial time. Sorry you are going through this with your mom's Empire Medicare Dual Advantage. Your mom did pay Empire Medicare Advantage for December coverage?? Medicare says your mom still has Empire coverage but Empire said they transferred your mom back to Original Medicare in Decenber. Does the Empire termination letter state a confirmation number? Check for a digital copy in the coverage portal. Try to document as much as possible to work it out with Medicaid, Empire and Original Medicare in writing. And, it's bad enough sitting by a phone with limited staff everyplace!
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Isthisrealyreal Dec 13, 2022
Pat, I found out the hard way that advantage plans do not cross county lines, unless the county of coverage doesn't have the services.

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.
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Call your congressman or visit her/his office right away. Both Medicare and Medicaid are federal. These are situations where they can be of assistance.
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igloo572 Dec 13, 2022
Medicaid is administered by each State uniquely but under overall federal guidelines. And for more fun!, Medicaid is county specific. The power rests with the State for Medicaid.

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
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Just need to say something in Lsny's defense. The only way I know anything about Medicaid is from experience and this forum. Before hunting for an AL for Mom, I did not know that each County ran their own Medicaid. And Medicare? If you are not collecting you probably have no idea how it works. I worked for Visiting Nurses that was subsidized by the Township. Some of the Committee men wanted to shut us down. My boss tried to explain why the VNs were needed. Even said that Medicare does not cover what we do for people. After giving her speech one of the Committee men said "There's always Medicare". He turns 65 in a couple of more years so he will see how it works.

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.
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(copy and paste into your search window)

https://aging.ny.gov/ltcop/contact-ombudsman-program

https://aging.ny.gov/long-term-care-ombudsman-program

Perhaps you can make an appointment and get it done on Zoom before the holidays.
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Lsny420: Speak to a Medicare insurance agent. Personally, I've stayed away from Medicare Advantage plans.
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Patathome01 Dec 14, 2022
Good choice to avoid Medicare Advantage plans, but premiums may cost more with other choice plans.

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.
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Call your state Office on Aging and tell them that you need help with Medicare, Medicaid and Empire. They should have access to an counselor in one of the agencies, who can help you through this. If no one is responsive, contact your Congressman (either senator or representative) and see if they have someone who can get to the bottom of your issue.

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.
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JoAnn29 Dec 14, 2022
Office of Aging is a County thing where I live.
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Just a thought. Is the Medicare Advantage Mom had provided thru Medicaid? If so, it is State written so you may be able to carry it across to the next county. Have you talk to the County Medicaid she is now in? Your problem is that you were not aware that you needed to make Medicaid/the insurance company aware that Mom was moving. It just may be a matter of calling the two County Medicaids and get it straightened out. Premiums will be caught up and retro paying her bills. Medicare is informed she now is back on the MA and your all set. Have you even talked to Moms Medicaid caseworker in her former County?

P.S. Its really hard to provide info when you don't have the information right before your eyes.
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Moves do create problems with Medicaid and Medicare insurance plans that are managed plans since local insurance companies manage those plans. Try calling/contacting AARP for help by a local representative who is knowledgeable about elder medical insurance in your area. Another option is to interview a few local companies that have managed plans in your area and pick one as the new company. A last option (that I can think of) is reach out to the case manager or social worker at the hospital and ask for assistance.
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JoAnn29 Dec 15, 2022
When someone is receiving Medicaid for Health, you cannot fool around with it. All changes must go through the Medicaid caseworker.
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The OP has not been back since the day she posted the question, a week ago.
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Lsny420 Dec 16, 2022
Sorry, I've been pretty busy to come back and update. On 12/10 my mother finally got coverage under Original Medicare. Unfortunately, she does not have a Part D plan for this month and I've had to pay out of pocket for her oral meds since discharge from the hospital. What boggles my mind is that Medicare kept telling me that they were not informed of the drop in coverage by her Advantage plan. What they should have said is that their systems don't get updated for up to 10 days. So from 12/5 (when she had her surgery) to 12/9, I was going crazy making calls to Medicare and Empire (her previous advantage plan) to try to straighten out the situation. It's all worked out now. She just has to wait until 1/1 for her new plan to kick in. So the 2 lessons I've learned through this experience is that if you move out of an advantage plan's coverage area, call the plan as soon as possible to not have a lapse in coverage for any period of time. Also, Medicare can take up to 10 days to update the info in their systems to reflect any change.
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This may not be related to our forum talk, but I will vent it, anyway. Your choose to have Medicare Advantage or some Medicare supplemental plan and pay premiums for that. With that choice, you then are not on Original Medicare. However, you are still forced always to pay that $164.80 (2023) monthly for Original Medicare premiums and that's what really sucks. I could buy food and other necessities instead of paying Original Medicare premiums government takes away. CA Kaiser premiums cost me just $100 monthly, but my combined monthly premiums cost me $264.80 per month. No Medicaid will help pay back my Original Medicare premiums because I receive too much income to get government's help. Still live independently but alone in my household. Yet, I receive less than $27k on only SSA income from the good 'ol USA.
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Isthisrealyreal Dec 16, 2022
Pat, if you have a supplemental policy, you DO have original Medicare.

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.
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Thank you for the update. Happy to hear it is all taken care of.

My dad's policy picked up from the cancellation date, ask Medicare about this.
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Thank you, IsThisReallyReal. I also feel for you with your expensive premiums, but can you afford them??

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.
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Thanks for the update. If Mom is low income, she maybe able to get a State prescription plan. NJs plan is called PAAD. Its not Medicaid.

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.



Also,
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