I'm trying to find a guaranteed issue situation for a client who has an advantage plan, and recently moved into a memory care facility. They didn't move out of the service area of the advantage plan. I've looked through the standard ways that a guaranteed issue policy might be obtained, and none seem to fit this guys scenario. He's well over 65. Thanks for any advice!
Guaranteed issue when moving
- Thread starter keith365
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Unless you can locate a carrier in your state that includes admittance to a memory care facility as a GI situation, your client will be stuck with the MA plan you sold him.
Or, if they live in one of the 12 states with GI provisions such as a birthday or anniversary rule.
Or, if they live in one of the 12 states with GI provisions such as a birthday or anniversary rule.
Unless he’s on Medicaid he’s already spending 8500.00/month for Alzheimer’s unit so why would you want to burden him with a Med Sup premium and a worse drug plan? Chances are he has. 0.00 copay when primary Dr sticks his head in the room and no reason to do all the therapies on an Alzheimer’s patient. Worse case he ends up in the hospital and that copay will likely be less then the Med Sup premium. If he does go on Medicaid then you write him a D-SNP.
This really isn't surprising, considering the number of agents who have no clue how Medicare plans work when it comes to claims.
Imagine an agent who does not know that memory care is generally considered a SNF and those claims are reimbursed differently from inpatient (acute care) hospital claims. Also, SNF coverage only works as long as the care is considered medically necessary AND they continue to show improvement.
And who has been sleeping under a rock and is not aware of the OOP cap on Part D claims in 2024 and 2025?
Reading comprehension is a real challenge for some agents.
Imagine an agent who does not know that memory care is generally considered a SNF and those claims are reimbursed differently from inpatient (acute care) hospital claims. Also, SNF coverage only works as long as the care is considered medically necessary AND they continue to show improvement.
And who has been sleeping under a rock and is not aware of the OOP cap on Part D claims in 2024 and 2025?
Reading comprehension is a real challenge for some agents.
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If only you were half as fricken smart as you think you are. If you think Alzheimer’s patients are covered under SNF you should probably retire. They are in a nursing home which you may or may not know is not covered by Medicare.
- 2,110
First of all, @somarco is correct. But so is @Midlevel. It all depends on your definition of an SNF.
But the OP asked about moving from MA to GI. My question would be why? If his client is in some type of memory unit it's already too late.
Medicare does pay if a beneficiary is in a nursing home or some type of memory facility. But very little. Medicare does not cover room and board. And that's by far and away the most expensive part. And it doesn't matter if you have MA or OM. Doesn't pay means doesn't pay.
@Midlevel stated earlier that one month in a nursing home was around $8,500. Down here in South Georgia the going rate is $6,500. Comes down to where you're at.
What's the Difference Between Memory Care & Skilled Nursing?
Memory care is considered a specialized form of skilled nursing senior care. Learn what memory care is and when to switch over from assisted living.
advancednursing.care
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