Asst Living, Nursing Home, Medicare "Advantage", Medicaid for mom - I just want space to breath

[maxrandb]

My Gawd! This is why I don't want to live to my 90s.

Mom is 92. Recently fell at home and fractured her hip.

Surgery to put screws in her hip. 7 days in the hospital, now in rehab facility.

Under traditional Medicare, she would likely get 3 weeks in incall rehab, or more for a 7 day hospital stay. With her Medicare "Advantage" plan, insurance evaluates her every two days, and can decide at any time that she's good to be discharged. This particular "advantage" plan doesn't even require a 48 hour notice before she is discharged. No availability for Long Term care where she is currently rehabbing.

So, let's get on a waiting list at a facility that has availability.

At 9 - 10K per month, her savings will be gone in 3 months, or less.

Hey! Prepay for the Funeral. That will help "spend down" for Medicaid.

Oh wait! She has a small house. Let's sell it. Maybe $160K in proceeds. That will get her 12-16 months, then maybe Medicaid.

But, Medicaid only covers Nursing Home care. Assisted Living might work for her now, but when she runs out of money...

I think my mom would like this better. How about I just give Jeff Bezos or Elon Musk $150K, and mom gets to visit space for once in her life.

After 76 years of paying taxes to this country, isn't that the least the "private sector" could do for her?

BTW - make sure you read the fine print before deciding to switch from "traditional" Medicare to an "advantage" plan.

Greatest Country in the World MY ASS

[Ms. Toad]

1. You are absolutely right about traditional Medicare v. Advantage plans.

And it's not just switching, you get one (and only one) opportunity to sign up for original Medicare with (1) guaranteed issue (meaning they have to give you a plan) and (2) community rates (as opposed to rates based on your health status).

Medicare Advantage plans seem attractive - BUT - you are stuck at the whim of the insurance doctors, if you are really sick you may find annual costs very expensive - and - as you noted, the insurance company doctors tend to be pretty stingy and unpredictable.

There really needs to be education, and clear apples - to - apples comparisons so people can make informed decisions.

Sorry you are dealing with this.

[spooky3]

2. Our medical system is a mess, and Medicare for all is not a panacea.

Among other problems, there is a huge hole when it comes to middle class people who need assistance over a long period of time but don’t need to be in the hospital.

[edhopper]

11. It's not a panacea

but it sure is a hell of a lot better than what we have now.

[Skittles]

3. the "Advantage" scams are sickening

I wish people would understand it's just private insurance, where scamming is SOP.

[Rebl2]

4. My rheumatologist

told me a couple of years ago never go on an advantage plan because they won’t pay for my Humira. I have no desire to live into my 90’s. Have watched my parents do so and it’s been awful.

[Diamond_Dog]

5. I feel your pain.

Went through that with my mom 20 years ago, well she didn’t break her hip but she was wheelchair bound, had heart problems, diabetes, and was on dialysis.

Single payer PLEASE

[elleng]

6. Very glad my 'supplemental' is bc/bs as retired federal employee

(and recipient of something as beneficiary of deceased husband's federal benefits.)

SORRY for everyone 'depending' on 'supplements.'

[not fooled]

21. Except

for the supplemental, under bc/bs don't you have to stay "in network"? How good is the network?

[elleng]

22. Network seems to be pretty wide; haven't run into any probs, but

haven't used services often.

[llmart]

7. I would never recommend a Medicare Advantage plan.

They sound so wonderful up front that a lot of people are taken in by the "you get dental and vision coverage too!" I always tell people who are just thinking about what to get when they are eligible to get the highest supplemental plan that's offered, which I believe is still the Plan G. Sure, you'll see that the monthly premiums are more than some Advantage plans and you don't get coverage for regular dental and vision care, but goddess help you if you have even one injury/ailment that requires expensive treatment. My deductible is about $185 for the year but everything is covered after that.

I cannot speak for situations like your mother's, which is a horror story, but there may be others on here who can. I don't have any major medical issues (yet), and my parents both died before they were 60, so I never had to deal with that either. I just hate that at the end of your life, a person has to play these "games" in order to just get basic good care. Like you, I have always said I do not want to live into my 90's either.

[XanaDUer2]

8. This country sucks

I now say I feel my country doesn't help me, but actively works against me. I'm in the long haul to get ssdi now.

I have to mute those advantage ads.

Good luck.

[renate]

10. "My country actively works against me"

Yes! You put your finger on how I feel about what has happened to this country. I trust most Democrats to do their jobs for the people they serve but the GOP is purely about cutting services except for funding the military.

[XanaDUer2]

19. I burst into tears this morning

Talking to my psychologist about the hell of getting ssdi.

[slightlv]

9. Medicare Advantage

are the biggest scams this country has right now. And beyond that, whoever thought up the idea that anyone at the age of 65 and beyond needs to be making choices about which "insurance" company they need to be going with is flat out nuts and evil. After doing this since the age of late teens, one ought to get a break when you hit the point your brain cells decline! I had to do it for myself and my Mom for years. I thought I knew enough to catch all the traps when it came my time when I turned 65. But guess what? *I* got caught in the Medicare Advantage trap!

So now, I'm trying to get out of it, back onto regular Medicare and onto a Medicare Supplemental to take up the slack, and no idea HOW to do it. And no idea how to get the help I need. Where do I go? Who do I turn to help for the Supplemental? That's what got me into the mess with the Advantage plan in the first place. I've got a neurologist that's willing to do an MRI immediately on my back if I've got Medicare/Supplemental, instead of the 1 year physical rehab that Advantage will demand (which I've already been thru multiple times). He's a great doc; I trust him implicitly. I feel like he can actually help my pain levels. I realize I may end up paying more for a year or so until I can shake out other insurance issues. But again, I need help and have no idea who to turn to help me.

Anyone got any suggestions?

[Ziggysmom]

14. My husband is dumping his advantage plan that has a $4500/year out of pocket!

We have a friend who is a licensed independent insurance agent helping. I had looked online and Medicare just has the 800 number listed for getting out of advantage plans ☹️

https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/join-switch-or-drop-a-medicare-advantage-plan

[dhol82]

15. I have my supplemental plan through AARP

You can check it out with them and see if they can you swap out.
Otherwise, you should be able to contact the Medicare office itself. They do have help lines.
I don’t know how easily you can go back. I was told that if I drop my current plan I am screwed.
Good luck.

[Tadpole Raisin]

18. Find a SHINE counselor in your state.

https://states.aarp.org/work-in-your-community-as-a-shine-counselor


Sorry if that was only MA. Try this (hopefully you live in a state with good consumer laws.

https://www.shiphelp.org/

Good luck!

[twodogsbarking]

12. It is all true. Fucked up, but true.

[Xolodno]

13. Went straight up traditional for my Mom.

She has a multitude of problems, but gets well taken care of. My father passed right before the real estate crash, after the crash, we scooped up a home on the cheap for her and since my sister was a realtor, hence, unemployed and didn't want to scam people on short sales, etc. She got paid by the state to be her main caretaker and lives with her. Not a whole lot of money, but putting her in a convalescent home would have killed her already.

But to add just how bad health insurance companies are, I go to Mexico to get my Eliquis prescription. My Cardiologist prescribed it to me, but the insurance company wouldn't approve it. So he went with Xarelto, yeap, refused again, it was obvious they were trying to put me on Coumadin and do the annoying blood test. I said screw that, took a trip over the border and bought what I could legally bring back. In Mexico its about $100 for a 30 day supply, in the US, out of pocket, $600.

When I saw my Cardiologist again, told him what I did....he approved. And said would give me a month of free samples every so often. Kind of like it, I spend a night or two in Tijuana (or Rosarito/Ensenada/etc.), have a good time and pick up my meds. Declare it at the border and off I go.

[Liberal In Texas]

16. I hope your mom doesn't also have a reverse mortgage.

Because odds are, if you have to find assisted living or something and need to sell the house to pay for it, the reverse mortgage people will be at the courthouse filing foreclosure proceedings as soon as they find out she is not living in the house anymore.

I know this from personal experience. Luckily I had a lawyer hired to take care of the mom's estate and she was able to keep the reverse mortgage lawyer at bay until I could get the house sold. Since I had to sell it fast the estate and heirs didn't get as much as if I'd been able to get it on the market for a decent amount of time.

[SleeplessinSoCal]

17. But we are living longer often because of our system.

It's a Catch 22.

I was pondering our dental bill the other day. We pay $100 a month for Cigna's best plan and still pay $180 for 3 fillings. That's insane.

Then looked around the dentist office and clocked the number of employees there. 6 plus dentist. Their overhead must be crazy expensive when you look at the services and equipment.

Back in the day, there was only a dentist. I'm on the lookout for that guy/gal near us today.

[trof]

24. And millions of dollars in equipment.

[SleeplessinSoCal]

37. yup.

I mentioned the equipment, as I was trying to do a really good assessment. It's said that I'd you don't take care of your teeth, your overall health suffers. But there is a lot of expensive equipment and man hours paying for cosmetic and "beautification" purposes. Whitening and replacing good teeth with perfect teeth for example.

[Historic NY]

20. There is no advantage with Medicare Advantage.

[not fooled]

23. This country has turned into an opportunity

for financial predators to extract every penny possible, including in your declining years so as to leave most people with nothing to pass on or in debt.

Disgusting. And don't forget that even under Biden the scheme to privatize Medicare and force everyone onto private insurance continues apace.

This country is becoming unrecognizable.

[samnsara]

25. going thru this with my 92 yo uncle...all others in his family dead..hes my uncle by marriage...

..love him dearly. After my aunt..his wife passed..he tried to care for himself. Thank gawd hubby commuted to that town for work so did checks on him. He was always bruised and bloody. We finally talked him into assisted living and again.. thank gawd..his home was paid for. BUT that $ will only get him about 2 1/2 years at this assisted living place he LOVES now. Hubby and I are fretting as he will need to go on welfare and you know what kind of facilities those are


If she gets ANY VA benefits..use them all.

[Evolve Dammit]

26. It is truly a FUCKED UP system. All of it. My only suggestion, having gone through this with mom

is to get into assisted living that will transition to Medicare/Medicaid when your money runs out. Some just don't and you have to get the fuck out. Another suggestion is to gift some monies to family (there are limits) because they will suck you dry and that way at least some family members actually get a small inheritance.
It's truly tragic that we have to market our elderly parents to assisted living/ rehab or long-term care facilities. You want to show they are not too bad off physically or mentally and have enough cash (savings) to be considered as a prospective "client/ resident". It really sucks unless you are wealthy. For the rest of us, it is a convoluted, predatory system that rewards the pharmaceutical, health care and rehab/residential care facilities that make enormous profits.
Good luck and Best wishes. Truly.

[Caliman73]

27. Yep, you can judge the ethics of a country by how they treat the very old, and the very young.

School shootings and elders who have to win the lotto to guarantee care at the end of life. We're NUMBER ONE!!

By the way, your mom can own her home and qualify for Medicaid. She just can't have more than 2,000 dollars of easily liquefiable assets (stocks, jewelry, cash, etc...). Medicaid will try to claw back any money they spend on skilled nursing from her estate after she passes though.

[Hekate]

28. My gods. This is so scary. I am so sorry for your mom & your situation -- and scared for myself

We are in our mid 70s and I actively dread my husband’s retirement when we have to make choices among the bewildering array of Medicare options.

[trof]

29. We have Medicare Advantage.

We like it.
Zero monthly premiums.
That, alone, is saving us several thousand dollars annually.
Drug coverage where we pay zero for all but one prescription.
$1000/an. each dental.
zero co-pay for PCP.
$25 for specialist.
Not an HMO, it's a PPO.
Basically, no network.

[erronis]

30. Just don't get really sick. You'll hate it.

The corporates will have a say on whether or not you can get treatment and for how long.

And how is your PPO not a network?

Somehow this seems like a simplistic rah-rah for your Advantage purveyor. Who is it?

[trof]

31. So far, so good.

UHC through AARP.

[Yo_Mama_Been_Loggin]

32. My mom died eleven years ago

The cost of her care was 5000 a month. Sad to see it's gone up so much.

I just applied for Medicare since I turn 65 in August.

[cilla4progress]

33. Omg max -

Yes. Major problem in this country. Like someone here once said before - it boils down to a money making racket for the assisted living home industry!

[maxrandb]

35. Thanks. I am not so much angry with the care providers

Some have been fantastic with rehab and care. I imagine that they operate within the constraints of the system.

The sad thing is, we are in a better financial and insurance position than most families in America. It's hard, but I can't imagine what folks that don't have our resources have to go through.

Part of it is poor planning by my mom, and part of it is that we, as a country, with our votes, have said; "this is our values".

We have the resources to do more. Unfortunately, our attitude is that "lifting someone else up, diminishes me".

It shouldn't be this hard to let people have some dignity in their twilight

[waterwatcher123]

34. Sorry to Hear About Your Difficulties with Your Mom's Care - There May Be Some Options.

I had to manage my mother's care too when she ended up in assisted living and then went to an expensive nursing home. We did rent out my mother's house to help defer the nursing home expenses and to keep it from being vandalized. The county where your mom will reside typically administers the Medicaid program. So, they will not care if her house is rented as a way to defer expenses (especially if you pay the nursing home). They will attach a lien to the house and try to settle up once she passes away. She still has to meet the $3000 limit for the Medicaid program (but, they do not count the house). If you mom was married to a service member or served herself during a period of active combat, she is likely eligible for a little known program at the Veterans Administration (VA) called Aid and Attendance. The application process for this program is a pain (requires a lot of documentation). But, the pension is on par with what my mother received in Social Security. This will also help defer the costs for her care as well. If you get into this program, do not sell the house (it will cause her to lose the VA pension and will end up kicking her out of the Medicaid Program too).

I am not sure about Medicare Advantage programs. But, these insurance companies would have an incentive to bill the federal government for as many days as possible (it is just an overlay to some degree on Medicare). So, it would be interesting to know if they are cheating the federal government by trying to kick patients out early and then billing for the entire eligible period. It might get their attention if you wrote to the Medicare program or your local health department so you could compare what they are telling you and billing the feds (might copy the Advantage plan too - will get their attention quickly). One other important thing to do for sure is to make sure the nursing home bills Medicare every time your mom is hospitalized (forget the hospitalization requirement - more than a day I think). This will also help defer some costs from this incredibly expensive nursing home care.

I know all too well how difficult this process is for the person who has to manage it. I did most of the paperwork for my mom's stay of four years in assisted living and then a nursing home. However, we ended up with a 50K lien out of about 350-400K in billed Medicaid expenses. The county and feds also got paid every dime they billed.

Best of luck with your mom.

[maxrandb]

36. Thanks for the suggestions

You have given me some things to look at. Appreciate it.

[waterwatcher123]

38. Sure - good luck again with your mom.

[keithbvadu2]

39. Some previous discussion on Medicare Advantage

https://www.democraticunderground.com/100216622964

Katie Porter leads letter urging Biden not to dump more money into Medicare Advantage

After reading up on it, MA is more of a HMO and it was less risky for me to pay the Part B for better coverage.
-----------------------------------

https://www.democraticunderground.com/10142909182

Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds
---------
https://www.democraticunderground.com/1017732643
Get Medicare! No to Medicare Advantage. It's perfume-covered doo-doo that'll bankrupt or kill you.

https://egbertowillies.com/2022/04/30/get-medicare-no-to-medicare-advantage-its-perfume-covered-doo-doo-thatll-bankrupt-or-kill-you/
--------------------
https://www.democraticunderground.com/1261935

[Demovictory9]

40. K&R