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!
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
Is your Mom on Medicaid or may need it in the future? If Medicaid is in the picture than Mom only needs Medicare, Medicaid picks up the 20% Medicare doesn't. Medicaid supplies dental and vision/glasses and scripts.
I would ask for some written material where you can compare your present policy with the one they are suggesting. I would also ask why the need for a NP when their affilated doctor/s should be able to do this.
So ArtMom58, I guess it depends on how much medical care your Mom needs, if it’s worth changing plans. And get clarification on what the monthly “nurse” visit means.
That poster was being hounded also which would put my antenna up.
While Rocket seems to like it I would personally rather have a little more control should changes need to be made. Also I would check with some of the others who have had it for awhile at your facility. But it’s all relative. The person you check with may have had a bad policy before or may have had an advantage plan. So what is good for one person won’t necessarily be for another.
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.
have 3 things.
My mom has United, human for medical and long term (alf/nurse home).
She is 97 and I am getting ready to put her in one Of the alf small homes.
We're is your mom now?
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.
Emily's weekly podcast are great. Mondays or Tuesdays. Youtube channel as well . Reach out to them.