Do I change Medicare Advantage plan when entering Medicaid?

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Do I change Medicare Advantage plan when entering Medicaid?

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We are in the process of applying for Medicaid for my mother. When that goes through, will I (should I) be able to change her Medicaid Advantage plan?

If so, is it better to go back to straight Medicare/Medicaid, or should I research a dual plan?

Medicaid Medicare Medicare Advantage Plans

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This is something u need to talk to with the caseworker because each state is different. Once Mom is on Medicaid the health part is automatic. With my Mom, she had traditional Medicare and once Medicaid took over I dropped her supplemental. Since Mom will be on Medicaid, she will have no xtra money to pay for supplemental insurance. It will be Medicare and Medicaid. Some States want u to keep the supplemental and will allow the premium to be taken out of ur SS. You as her daughter will not be responsible for healthcare premiums. Again, a good question for the caseworker handling Moms application.

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Thanks, JoAnn29. I have asked the case worker... she is kind of useless. I will ask again, maybe she may have an answer for me this time. I will post results.

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It differs by state. In MN, where I live, my MIL on Medicaid has to choose a plan through an insurance provider every year. They are only for Medicaid recipients: Minnesota Senior Health Options (MSHO). Once your LO is approved to receive Medicaid, they will probably start getting calls or mail pertaining to this (or if your name is on the application they will contact you).

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My experience is similar to Geatons in that once you become a “dual” eg eligible & enrolled on a governmental program, so on MediCARE (federal) and MedicAID (State) for health insurance; the Medicaid part will be from select group of plans for “duals” & usually prior health insurance doesn’t merge so gets dropped.

How many plans to choose from will totally be interdependent on how your State administers (& its reimbursement rates) Medicaid. What States now do is have MCO aka Managed Care Organizations contracted with the State to provided insurance that bridges between the M&Ms and covers Medicaid benefit parts for all services (hospitals, docs, clinics, therapists, etc). MCO are similar to Advantage in that they too have it that you need to stay “in network” to have coverage. The old Medicare Advantage Plan will get dropped in favor of the new Medicaid friendly MCO insurer.

If your mom, (who is in AL, right?) is still ambulatory and still going out to clinics, doctors offices for her medical appointments, you imho kinda need to just flat go thru the provider listing for the different insurers to see which of her docs are “in network” best.
If mom is in a custodial care facility, like she’s in a NH, that’s a bit different for “duals” as there is a MD/medical director for the facility who becomes the overseer for coordinating her healthcare. What has happened/ is happening with custodial care, is MCOs are having an MD within their system be the medical director at a NH and all the residents at the NH who are “duals” will need to be on that MCO cause should any outside care be needed, they are going to go to the ER/ED, hospital, clinic that is in the same “in network” as the NH MD and the MCO they are in network & under contract for. Unthreading how health insurance works is notoriously convoluted…..

The big player in MCO is Molina Healthcare. If Molina is in your State, they tend to be the default placement for those who become a “dual” when it’s not open season for you to on your own select the “dual” Medicaid plan side for insurance. Your mom can select her insurer but it’s a narrow window and if she doesn’t then State does default MCO plac,ent, Molina does a pretty good job of explaining what they do in their various different State websites. They have all sorts of MCOs depending on what type of “at need” State program you are eligible for.

If y’all are in a big city that has actual competitive health science centers with teaching hospitals, there will be several MCOs to choose from. Otherwise it’s probably Molina and another 1 or 2 MCO groups.

If your mom is real “BuT i wANt my oLd doCtOr” (this very much was my mom), having to switch providers, etc. may be challenging to do and explain and accept. If the AL is part of a tiered system or part of a big group so that the residents of this AL almost always go to a kinda predetermined affiliated NH that has LTC Medicaid beds, you might want to find out which dual MCO/ health insurance is the one they use. Perhaps have your mom enroll on that one as just will make things easier as she ages and needs a higher level of care.

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I worked in a nursing home for many years. If your mom has the option to keep traditional/original Medicare, do that. It will be the best thing for her if/when she needs rehab. Every managed care that I worked with, worked to discharge their patient by day 21 or sooner. With original Medicare, the doctors and therapists that work with the patient get to make the decision of when to discharge.

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Medicare determines when a person is discharged. The doctors and therapist file there reports with Medicare. If Medicare feels the person has hit a plateau or is not progressing, they say discharge. That is why there is an appeal process if family does not agree. Medicare is paying the bill so they get to decide.

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Look at this NC Medicaid site: https://medicaid.ncdhhs.gov/

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If dunazee is not in NC, it is not the answer she needs. Each state has their own variation of Medicaid. That being said, I read whatever is thrown my way to help me find questions to ask when I do get to speak to someone.

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dunazee: Perhaps you should speak to your Medicaid caseworker.

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just an additional thought, do you know absolutely that your mom will be able to get direct placement into a NH? That she does not need to be coming in from a hospitalization discharge to skilled nursing care or from a PACE program referral to skilled care?

Make sure that NC is totally ok on this and that she will meet the “at need” medically requirements without a discharge or referral. LTC Medicaid is really making eligibility challenging otherwise for a lot of States.

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Folks, great answers, thank you. @VKPWCSC, yes my mother and I are both in NC.

She was finally approved for Medicaid, and it's active now, so my questions now revolve around what I need to do next. I will post a separate question on the forums, different topic slightly...

Thank you!

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Do I change Medicare Advantage plan when entering Medicaid?

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