What happens to your private insurance if you are eligible for Medicaid insurance after you go into a nursing home?

Your mother's Patient Paid Amount (PPA) is calculated by your state's Medicaid agency.

The Medicaid agency will add up your mother's gross monthly income from Social Security Retirement
+ Pensions
+ Annuities
+ any other source.

Subtracted from the gross income are:
- the small Personal Needs Allowance that the facility business office mentioned to you,
- Medicare premiums, and
- any other allowable expenses.

Health Insurance premiums may be an expense allowed by Medicaid, but you must provide the premium information to the Medicaid caseworker who is calculating the PPA.

After the allowed expenses are subtracted from the gross income, the PPA is paid to the facility, and then Medicaid pays the balance of the facility's monthly bill (based on a discounted Medicaid rate the facility is allowed to charge).

Some questions for you: how are the Health Insurance premiums being paid now? Are the premiums deducted from an employer pension payment (reducing your mother's monthly income)? Are the premiums paid by a check that your mother sends in to the Health Insurance company?

Decide how you will be handling your mother's monthly income going forward.

You could have all of your mother's income directly deposited to the care facility. The Medicare premiums are already being deducted from Social Security Retirement. But if the Health Insurance premium isn't being deducted from an income source (like an employer pension), the care facility probably won't be willing to manage the Health Insurance premium payments.

If not (and you decide to keep the Health Insurance) you would continue to receive the monthly income, continue to pay the monthly Health Insurance premium, and then write a check for the PPA to the facility.

Any health care costs not paid by the Health Insurance or Medicare are paid by Medicaid.

If you go in to long term care and Medicaid is footing all or part of the bill, you can no longer pay any of your bills. Your mom can drop her private insurance because she has Medicaid and Medicare. She won’t need Anthem anymore.

My Mom dropped her supplemental when she went on Medicaid. But it has been mentioned on the forum, that in some states they allow the resident to continue with their suppliment and the premium can be paid out of their SS. When billed for medical, Medicare is first, then supplimental then Medicaid. You may want to ask the Medicaid caseworker.