Hospice to Medicare Advantage

[somarco]

Got a call today from the wife of a (soon to be) former client. Husband has battled esophogeal cancer for probably 3 years. Several trips to Mayo in JAX (they live across the line in Georgia).

Plan F Medigap.

All of his bills and xs charges have been paid,

Last year the folks at Mayo told her to change his plan to a G to save money.

Had to explain to her that was not possible given his health.

Today she called and said she wanted to cancel his plan. He has been in hospice for a year and is still here. The $200/mo is a drag on their budget.

I have no idea how much the carrier has spent on him but it is probably a lot more than $2400 per year. He had over 200 claims so far in 2017, not including Rx.

She told me they got a "free" supplement plan from Medicare.

She enrolled him in Humana HMO.

How will Humana "treat" his hospice claims? I assume copay's, coinsurance plus probably a bunch of denials for using a non-par provider.

Mayo does not typically accept HMO plans.

At this point even if there is a way to save the case I am not going to push it. Just looking for some insight from folks that sell Advantage plans.

Sometimes you just want to SCREAM!

 

[Todd King]

If they can't afford the $200 per month for his Med Supp they are going to crap their pants over the copays and deductibles he'll have to pay now!

 

[somarco]

Yeah, no sheet . . .

 

[TN_agent]

Doesn't original Medicare cover all costs once in hospice anyway, even if on an MAPD?? This is assuming that they actually have stopped actively treating it and are doing palliative only, not seeking anything curative. I seem to remember reading that somewhere? Like, if he fell and broke his hip, his MAPD rules would apply, but if he is just in a hospice at a hospital somewhere, I don't think it is treated the same as inpatient confinement with owing deductible and coinsurance.

 

[rousemark]

This statement is on the Medicare.gov site:

Once your hospice benefit starts, Original Medicare will cover everything you need related to your terminal illness. Original Medicare will cover these services even if you choose to remain in a Medicare Advantage Plan or other Medicare health plan. If you were in a Medicare Advantage Plan before starting hospice care, you can stay in that plan, as long as you pay your plan’s premiums.

If I understand that, original medicare will pay all hospice costs even if they have an advantage plan...
However, even if that si right, that is not going to protect them from all the out of pocket costs he may receive for conditions for conditions other than one for which he is receiving hospice.

 

[Chazm]

Mayo doesn’t accept HMO or PPO’s in network. That’s about all I can contribute here

 

[LostDollar]

Mayo doesn’t accept HMO or PPO’s in network. That’s about all I can contribute here

I hope that is a general rule to which there are some exceptions.

The Medica brochure for its 2018 Kansas ACA plans says members have access to Mayo Clinics through something called the Centers of Excellence Program for some complex medical conditions.

 

[WCMason]

Hospice claims will be paid by 100% Medicare when on an MA or a Medigap, or neither. I’ve had clients drop their Medgap when moved to hospice (I don’t recommend that, but advise of the risks). As log as he won’t need any other medical care the gamble pays off with premium savings. With the MA plan he’s gambling as well, adding network restrictions to the OOP he doesn’t have with the Medigap. He’s probably fine. Unless he’s not.

 

[germanwine1]

Have husband and wife MS clients who go to Mayo Jax. I can also tell you they charge the Part B excess charge.
Although hospice care is covered under MAPD plans. I would have checked with the plan before just giving up an MS plan.

 

[GoPokes]

He will probably die in the first week of having the plan, and you will get a call from spouse claiming she was right, and they didn't have any bills, and wishing you would have helped them switch sooner, haha