93 Year Old MAPD Question

[SusieQ2]

I have a client that had to put their 93 year old mother in a nursing home. She put her in the same nursing home as her mother-in-law and father-in-law because it was more convenient for her.

She is on a Medicare Advantage plan and the doctor's at the facility do not take the HMO of the MAPD.

My understanding is that she can disenroll from the MAPD and enroll in a Med supp when she goes into a nursing home as a special enrollment? Am I missing anything?

 

[vic120]

She can enroll in a new MAPD. They have that specifically for in Nursing home, I know in many places AARP has them, I think they don't pay commission.
However I could be wrong about the commision as I don't write them.

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Also for med supp you might be referring to moved outside the service area of MAPD
You have a guaranteed issue right (which means an insurance company can’t refuse to sell you a Medigap policy) in these situations:

Collapse You’re in a Medicare Advantage Plan, and your plan is leaving Medicare or stops giving care in your area, or you move out of the plan's service area.

You have the right to buy Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in your state.

You only have this right if you switch to Original Medicare rather than joining another Medicare Advantage Plan.

You can/must apply for a Medigap policy as early as 60 calendar days before the date your coverage will end, but no later than 63 calendar days after your coverage ends. Medigap coverage can’t start until your Medicare Advantage Plan coverage ends.

 

[yogooglethis]

I have a client that had to put their 93 year old mother in a nursing home. She put her in the same nursing home as her mother-in-law and father-in-law because it was more convenient for her.

She is on a Medicare Advantage plan and the doctor's at the facility do not take the HMO of the MAPD.

My understanding is that she can disenroll from the MAPD and enroll in a Med supp when she goes into a nursing home as a special enrollment? Am I missing anything?

Most people in nursing homes have ICP medicaid paying for it therefore don't really need anything except a PDP. If they they are private pay then you may want to find out which doctors in MA network visit that nursing home.I wrote a case last week where the client living in nursing home lost Medicaid because he inherited money so we found out which doctors in community visit that nursing home and put them down as pcp. nursing home residents don't always have to use the facilities recommended pcp. if this doesn't work then recommend a limited underwriting med supp like bcbs or aarp/uhc that will accept someone already in nursing home if available in your state.

 

[UFAMStan]

It has been my experience, nursing home facilities encourages original Medicare and standalone PDP; although, there may be a MAPD’s specifically designed for Nursing Homes in that area.

She has the option of enrolling into a MAPD or revert back to OM. If she eligible for State assistance, she could enroll into a Dual SNP. In order to have the coverage of a Med Sup, should would have to apply and qualify.

Med Sup’s do not have service area, as far as I know, only MAPD’s.

 

[EltonHCP]

What level of care is being delivered in the nursing home?

Do these doctors take any MAPD plans at all?

 

[yogooglethis]

What level of care is being delivered in the nursing home?

Do these doctors take any MAPD plans at all?

nursing homes provide custodial care not healthcare however they often have SNF wings in the facility .it definitely makes things easier if the NH's SNF is in network on a mapd plan but patient can still be sent to outside SNF.Also a patient can use any doctor that's willing to visit them in NH but they are few and far between so that's why it's best to find out from NH which pcp's are already visiting the facility and then determine what mapd plan they are par with.

 

[SusieQ2]

She has some money so not on Medicaid. They do not take any MAPD.

So she can be guarantee issue when she goes into a nursing home? I didn't see that in Medicare and You.

 

[yogooglethis]

She has some money so not on Medicaid. They do not take any MAPD.

So she can be guarantee issue when she goes into a nursing home? I didn't see that in Medicare and You.

No there is no GI for going in NH but entering or leaving a NH can trigger a SEP for getting in or out of a mapd or pdp .It's best to refer them to a med supp carrier with limited underwriting such as BCBS or UHC in some states that will accept current NH residents - as long as they are not currently or about to be in skilled care.

Neither Original medicare or MA plans pay for LTC so it really doesn't matter what the NH accepts accepts other than for SNF services provided in facility