My mom is currently in the hospital, since May 5th. She just cm home 4/6/24, from rehab. She changed her insurance, her condition is worse. Mom had fallen the day before she went into the hospital. The next day, she had no strength in her limbs, core, and she no control of her bladder. The hospital is saying she had a bladder infection or UTI, too weak for inpatient rehab. The rehab center she was at in March, doesn’t accept her current insurance. Most of the rehab centers are not in Network now. Insurance active as of May 1st and mom is 78 yrs old. She also to have a catheter possibly indefinitely.
I'd see if she's within the time frame where she can switch back.
They are independent counselors that are not beholden to any company.
SHIP stands for Senior Health Insurance Program
the service is free
they assess what the needs are and find a plan that works
I agree it sounds like she possibly went from supplemental gap plan to an Advantage plan. We can't give you guidance without confirming what actually happened and why.
and that mom owns a Home, correct?
Do NOT - again DO NOT - let the discharge planner at the hospital
1. talk you into ever coming to the hospital to take your mom home
OR
2. that mom can be discharged to go back into her home.
Tell them it is a totally unsafe discharge for mom to do either. Stick to that as your answer. You do not have to elaborate as to why it’s unsafe. The hospital will eventually find a place that will take her. This is what the discharge planners do (most are Social Workers). Their first step is pretty much always is to pressure family to come & get their mom or dad as that totally get rid of the problem for them. Again for those in the back seats, DO NOT PICK YOUR MOM UP!
My guess is it will be she gets transferred to a NH as a custodial care resident and the SWs will file a LtC Medicaid application for her. It will be an incomplete filing but the NH is betting she will be eligible or if not they can place a lein on the home she owns to eventually be paid from.
I agree with the others that the issue is your mom switched from Original Medicare to a Medicare Advantage Plan. Why mom did it is probably because it meant mom did not have to pay the Part B premium each mom of $175. But she did not realize the problem with Advantage Plans is they are extremely narrow as to who & what is including in network. NHs even with a rehab sector will not be in network. If she cannot switch back (what Barb suggested) or coverage is zero (what Guest thinks is happening), then once she has a significant change to her life she can switch to Original Medicare and if she is in a NH as a long term care resident, she will go onto Original Medicare and Medicaid as health insurance along with LTC Medicaid for room&board costs once she’s impoverished enough for program’s requirements. The NH she is in by this time will shepherd all these to happen.
Please pls realize…. if mom stays in the hospital, she will be getting care. Again if in the hospital = she will be getting care.
But what you can do during this is go through mom’s paperwork at her house to see exactly what her financial situation is. Why you are doing this is because for her to be ok for LTC Medicaid it will involve a 5 yr lookback. So anything financial back to 2019, set aside in a binder. Find her house documents - like her Release of Deed of Trust which shows mortgage paid off. Find her SSA letter from Nov 2023 that states what $ is being paid to her for 2024. Xerox all of this as you will eventually need them for LTC Medicaid application and its renewals.
If you are a signatory on her bank account or CCs, use that ability to pay for utilities and property taxes and insurance on her home while you can. Do not pay for her property related stuff from your own wallet if you can help it unless you absolutely have your own financials such that you don’t necessarily ever need to be repaid. By this I mean…. say it costs $18,000 to deal with moms house annually, then you have 18large to pay to do this without it crimping your own living expenses. I’d that is not yiur situation pls realize it will be beyond quite difficult to get repaid easily if ever. So if you don’t have the $, don’t pay for stuff. If water gets shut off, it is what it is.
If there is a house, can be a difficult reality for families to deal with. Often they don’t realize that the folks were living on just 2K Social Security income and there is all sorts of debts / maintenance. Hopefully that is not your mom’s house. But Whatever the case, get all the paperwork you can find, get all clothing / shoes / glasses that she might need, then close the house up as secure as feasible; otherwise house and property problems will overwhelm you.
MomCG27, again do NOT allow your mom to return to the apt you share. Mom stays at the hospital and they will figure something out. That you are disabled should be enough in and of itself to be a reason why you cannot have her move back to the apt.
please reread Guests post…. If any of moms $ & your $ is commingling, that has to stop. Hopefully btw your SSDI and pension, you have your rent covered. So you don’t have to worry abt moving atop everything else. But you do want to give some thought once things settle down as to what happens to your finances once you personally reach full retirement age as your SSDI will stop and then you go onto regular SSA monthly retirement income. Like you might want to be proactive and start to put your name on better low income housing waiting lists that are disabled friendly.
It would be worth talking to someone at Social Security about.
I'm actually sort of confused about how she was able to change insurance May 1, outside of the annual enrollment period. But then, I'm still pretty new to Medicare.
In April, she got a phone call about her insurance, she talked to the guy over an hour. She told me she'd changed her insurance, she thought it was a good thing. Unfortunately not.
Yes, mom is currently in the hospital, we’re in Michigan.
they have a list
dementia is one of them
Someone posted that if you have a preexisting condition, you can’t go back to Original Medicare once you’ve signed up for a Medicare Advantage plan. This is not true. Your mother CAN return to Original Medicare, even with a preexisting condition.
However, it’s important to note that while she can switch back, enrolling in a Medicare Supplement (Medigap) plan might be challenging since she has a preexisting condition. Medigap plans help cover the 20 percent of costs that Original Medicare doesn’t pay, so without one, she might have to pay that 20 percent out of pocket.
On the positive side, with Original Medicare, she’s not restricted to a network; she can see any provider in the United States that accepts Medicare. Additionally, she will need to purchase a standalone prescription drug plan (Medicare Part D) to cover her medications.
For more detailed information and guidance, it’s best to contact Medicare directly at (800) 633-4227.
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