BarbBrooklyn Asked July 2023
Medicare or Medicare Advantage?
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A friend just called to ask a question about her elderly uncle who is currently in rehab in Florida after surgery for prostate cancer that has metastasized.
Uncle's sibling is POA; the 20th day of rehab is coming up. POA has been told that the co-pay after day 20 is about $150 day.
Uncle has a Humana Medicare Advantage plan. Is it true that Medicare Advantage will not pick up the co-pay for rehab after day 20? Or does it depend upon the plan, i.e., some are better than others?
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FWIW, Humana advantage was great for doctor care but became a nightmare for MIL's care as soon as she hit rehab and we heard thru the grapevine, "that's Humana".
I recommend to pick up this year's version of Medicare for Dummies. Next would be to line up a Medicare insurance broker in his area since plans are determined by zip code and current medications that he is on. The disadvantage right now is that the next open enrollment begins in October and new plans begin in January.
Your friend's uncle will have to make some decisions on paying by spending down what he has.
The other monkey wrench is the metastatic cancer that you provide no details, if uncle will seek cancer treatment, or will he get worse with treatment. If it is stage 4, it might help to look at hospice for which Medicare will provide even more coverage. There is much more going on here than just completing the part of rehab that covers 100%. He may be still pretty ill.
The thing is, when you have Original Medicare and a supplement, the supplement will pick up the co-pay.
I am personally currently in a situation where I have Original Medicare and a supplement from my former employer.
Former employer is trying to force all retired employees into a MA plan, saying that it is "just as good". This proposed MA plan does include 100 days of rehab, paid in full on provided there is progress. I guess I didn't realize that not ALL MA plans included this.
https://www.vox.com/policy/2023/3/17/23639685/insurance-health-care-medicare-advantage-enrollment-growth
"This week, STAT reported on the increasing use of AI algorithms by these plans to determine when to cut off benefits for a customer. The lead example of their reporting was an 85-year-old woman with a broken left shoulder, whose insurer followed an algorithm that said she should be ready to leave a nursing facility and return home within 17 days."
"On the 17th day of her stay, the insurer said it would no longer cover the bills for her stay, even though her doctors and nurses observed that the woman was still in extreme pain and incapable of doing basic activities, such as dressing herself or going to the bathroom."
I will not have a Medicare Advantage and my DHs Union is pushing them. But from what I understand, they are contracted out by Medicare. They must follow the rules for A&B. Meaning that if Medicare allows 100 days of Rehab, so should the MA.
I think people get Supplementals picking up the 20% that Medicare doesn't pay and the Rehab 50% after 20 days confused. Two complete different things. Mine and my Moms supplimental never paid the whole 20%. After retirement both of us were then under a share copay thing. We always had a balance due.
If your friend is having a problem understanding this MA, have her/him talk to someone at Office of Aging. They should be able to help.
MAs are written in State, which means if you need medical help out of State you may not be covered.
My DH is with a Union so our benefits are provided. After 40 yrs of marriage we have been offered more than one plan, but have kept to Traditional BC/BS even though we pay out of pocket. Back in the beginning it was HMOs using their doctors only. I would not go to their doctors. Then PPOs where you if you stayed in network, you didn't pay as much. Did not like their network Drs. So we stayed with traditional BC and went into straight Medicare with a supplemental. For us, its good. A Medicare Advantage may be good for someone else if they get a good one. My DD ran a Woundcare unit and called me to see if we had a MA I said no, she said good, She was having problems with MAs paying for her clients supplies. They fall under parts A&B and the MA was telling my daughter they weren't covered. Me, at 73 I do not want to fight with an insurance company about what the should be covering. I will stay, for now, with what I have.
My husband has had some G-d-awful medical emergencies, so far, none of them while we've been away from home. My Medicare supplement does not appear to cover outside the US (it's free through my former employer, so it's not a high end plan); the inexpensive outside the US coverage gives us a hefty "repatriation" allowance--air medical transport back to the US-- and THAT'S what I'm paying for.
A family member retired a few years ago, had just lost his wife and decided to spend some time in Spain, the country his ancestors were from, to do some genealogical research. He became ill, end up hospitalized and then in a Spanish nursing facility where he developed horrific bedsores. My poor SIL had to fly over, get him released and hire a MedEvac flight on her own dime to get him back to NYC where he sadly died of sepsis after several weeks at Mt. Sinai.
She fought with his Medicare supplement plan for YEARS to get that flight reimbursed and did not prevail.
The peace of mind I buy for a measly $84 each time we travel is worth it.