Bella7 Asked April 2018
Is a supplemental insurance needed when a person has Medicare and Medicaid?
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My biggest beef is, is that the local insurance company here that sold her the Mutual of Omaha, told me her agent (that signed her up) a couple of years ago retired and there was no one that could answer our questions. When I finally called Mutual of Omaha headquarters yesterday, the girl that helped us was very kind and explained things so well, it was very easy actually. My parents are divorced, they live at the same AL ...my dad has Medicare and full Medicaid with no supplement. Mom has Medicare, plus a pension from ex-husband and on Medicaid. I think I see now why she was on a supplement, was it because she had that extra income and could afford it and helps out with Medicaid part ? And I still don't understand the "full" Medicaid thing.
If I would have the POA papers already sent to Medicaid, I could have called them myself instead of driving myself nuts last week and took care of it from the beginning. That was something I got lazy with and just didn't do because mom was doing so well for so long but now she's not.
Save yourself some frustration and get your POA's out!!😉
Thank you everyone for your help 💜
What happened to this post where you realized you were using the supplement?
“Went over moms EOB's from Mutual of Omaha and it has been paying pretty good on different doctor visits and procedures etc. Based on the advice given here, I want to try to get that insurance reinstated on Monday
Last Thursday is when she canceled it, I just hope it's not too late!!
Does anyone know???”
It seemed like earlier you were deciding to keep the supplement after all because you found it had paid some bills not covered by Medicaid.
Then today you found out that your mom was on full Medicaid so even though you are within the time frame to reinstate you had decided to not reinstate because she has full Medicaid.
Not all drs take Medicaid. Mom has some doctors that evidently don’t because the supplement paid.
Did I misunderstand your intentions?
I chose not to reinstate because Medicaid told me since she's on full Medicaid it wasn't necessary
Now I'm REALLY confused
want to give up
After reading on the Medicare.gov website I see that all medical claims are first paid by Medicare and the supplement before being paid by Medicaid.
So the Mutual of Omaha payments would have been paid for any dr appointments that took Medicare. It wouldn’t mean they didn’t take Medicaid. You would have to ask the doctors office.
As far as cost goes it’s the same to your mom regardless as has been discussed in the previous posts.
The only advantage to keeping the supplement would be if there was a doctor or procedure needed that Medicaid didn’t pay for but that Medicare and the supplement would. So for the same money you potentially get additional coverage. ( if I understand it correctly).
You do have the chore of paying for the supplement with the money Medicaid allowed mom to keep for that purpose.
If she ends up being Medicaid eligible (qualifications differs from state to state), Medicaid will pick up the nursing home cost. However, she'd then have restricted choices of where to go, based on which facilities accept/have openings for 'Medicaid waiver' patients.
If a person is close to qualifying for Medicaid, but not quite low enough with their income/assets, then most states offer the option of having the person pay for a private insurance policy as a "spend down" to make their income limit low enough to qualify for Medicaid. That needs to be a particular kind of policy - in our state (NE), it can't be just a 'regular' medical care policy, it needs to be vision/dental/cancer care, etc. Insurance agents that help with elder care policies should know the types that qualify, as would Elder Care attorneys. Our NE state's limit to qualify for Medicaid eligibility is $1,028/mo income and not more than $2,000 in 'assets'- that includes property, life insurance policies, retirement plans, annuities, savings/checking accounts- basically everything excepts a 'special needs trust' handled by a conservator/lawyer and an 'irrevocable burial fund' directly paid to a funeral home/cemetery.
I believe that for Medicare qualification, a person can purchase a supplemental policy to 'spend down' their income to become eligible if they are close to the eligibility capped limit. I don't think those have to be a specific type of policy.
As you have unfortunately found out, sorting through options for care, cost of care, and insurance coverage gets very complicated when you're trying to figure out private pay vs. entitlements. And it is even more difficult, now that most states (NE included) have done away with dedicated case managers to cut DHHS costs. Every state or county should have an AAA Agency for Aging Assistance whose contact info could be found in the government pages of a phone book or by calling the national "211" number for local resource assistance. Hopefully, your mother's Primary Care Physician has a medical social worker at that office (likely have one if they are a hospital-based clinic). Both of these sources can be very helpful in figuring out levels of care and costs/coverage for such.