Medicare Advantage Plan vs traditional Medicare and a Supplement?

Frugal1SBM,
So sorry for your recent loss!

It would be rare to be able to see a chiropractor under an HMO Medicare Advantage Plan, for example. But some plans pay your Medicare premium to get your business. What you get will be the Standard of Care protocol that everyone gets. imo.

With stand alone Medicare, you choose your doctor, do not need to be referred to physical therapy or a specialist.

However, I do not know how this computes for a nursing home patient.

Call H I C A P, which stands for Health Insurance Counseling........keep dialing.

Yes, I used an insurance agent pro bono to me to set up Medicare and Medicare Supplemental.

Problems of this kind I believe talking to you Medicare provided SHIP/HIICAP in the Office for Aging. They know the ins and outs of insurance and are unbiased. They are trained by Medicare and also work closely with Medicaid.

For my father-in-law in nursing home on Medicaid, our elder law attorney said that if we drop his extra insurance, his patient liability amount (what he has to pay the nursing home each month) will just increase by the amount of his current premium. So, if that is the same in your state, it wouldn't save any money to change plans unless the new one would pay for something Medicaid isn't covering under your current plan.
It sounds like you are happy with the plan she has, so I'd be making the NH convince me exactly why Mom would be better off to change before I'd even consider it. Could be just for them to get more of her monthly payment sooner and no benefit to her at all--especially if it's a PPO and she uses providers outside their plan.

I was so confused when the "donut hole" was introduced that I finally just contacted Medicare directly. They have a website.

I got a very knowledgeable 'agent' who asked me what coverage my dad & hubby had and I told him the VA supplies their medicines and we have that really old BC&BS plan. He said to hang on tight with both hands as in Medicare, they called it the "Oldie but Goodie Plan." I later learned it is an advantage plan. He said his own father is on it and he advised him to hang on tight.

I turned 65 last year and after doing much research, I realized I had to find an agent. An agent has access to multiple companies and will look for the best plan to fit your needs.

The advantage plans cost more but there is no deductible. But you pay more per monthly premium to have no deductible. I got the figures and my calculator out and I opted for the plan with the deductible and saved a couple hundred $$ for the year. I am not on any medications. I then took the $17 month Humana Drug plan and I guess I break even on the costs. At 65, I hopefully will not be facing anything major.

My DH has kept the BC & BS Advantage plan even though it costs about $50 more per month but the VA supplies his medicines and BC & BS picks up the cost the VA would be charging us ($9 per med per month). We come out a little ahead this way and it all gets mailed to us. The VA comes out ahead because BC & BS actually pays more than they would be charging us, or they accept the BC & BS payment as "paid."

Ask friends and relatives, neighbors what agent they are using and if they're satisfied. That's what I did for myself. I was very pleased with the results. The agent doesn't care which company you prefer and will do the paperwork.

Yes, it is all very confusing but when the determination went out that you MUST have supplemental, I knew I needed help as did millions of seniors.

P.S.  I did learn last year that the coverage is the same!  By law I guess, but every plan has to offer you the same protections and cover the same procedures.  So whichever company and plan you choose, it's basically the same coverage but with a different envelope.

P.P.S.  I hadn't heard of the "Medicare Advantage Plan" so I will ask my agent when I call him next week.  He said that all I have to do is call him the first week in November and he will make sure I am on the best available plan.  Just another reason to find an agent.  BTW, even Medicare suggested finding an agent on their website. 

I agree with vegaslady. Contact your local Area Agency on Aging. See if they have a SHINE person that you can meet with. Ours has volunteers that can meet with people in their main office or at your local Council on Aging.

I bought a Medicare Advantage plan associated with my husband's Assisted Living and the Nursing care home he had to be transferred to this year. It was the best decision I could have made. We had an Insurance provided Nurse Practitioner which provided continuity of care and proactive investigation. They ensured my husband did not go to the hospital for treatment. He had two strokes this year and they provided palliative care instead of my switching to hospice. He passed away Oct 7th.

Medicare.gov is a good website. Problem is that you are going to have to put all drugs in there and then they will display plans. You may have to call and find out what hospitals and Doctors the plan is affiliated with. Also an Advantage plan will pick up the deductible where just a supplement won't. I am confused this year myself and I was in the insurance industry. I need a plan that will work better on the prescriptions because I have to take so many.

Since Mom is under Medicaid I would check with them before doing anything. Why would you want to change, everything is paid for by Medicaid.

Since Mom is under Medicaid I would check with them before doing anything. Why would you want to

Call your local Area Agency on Agency to locate the state volunteer program in your area for insurance advisors. No sales, just help.

To: GardenArtist:
Thanks for the information you sent. Very illuminating! My m-i-l has Mutual of Omaha as her supplement, and they have done very well for her. I don't want to screw that relationship up by dropping and then reapplying when she doesn't have Medicaid any longer. It looks, from the reading I've done, that keeping her Medicare/Supplement/Medicaid separate is what we should do for now, at least, and certainly not make any decisions we feel pressured into.
I hadn't thought about a private insurance agent; I'll have to check into that. Thanks again for the help and information!

Another thought, although insurance related, is to contact a private insurance agent who helps place policies for individuals. But you're still dealing with the insurance industry.

We deal directly with BC; I purchased Medigap plan (C) for us years ago and have not been disappointed. It pays the 20% which Medicare doesn't pay, after Medicare approves payment.

Julea, I think the "horse in the race" is a reflection of growing affiliation and subsidiary or related entity expansion in the health care industry. One of the local hospitals formed a joint venture with another company to own and (mis)manage a nursing home. I recently learned it now has a private duty affiliate (or subsidiary - I haven't found out which) .

The nonprofit entity which owned a chain of hospitals in this area (and generally provided top notch care) was acquired first by one for profit health company (not a hospital), then another in the health care ownership community. Now it has a Medicare supplemental affiliate. It also has an ACO affiliate, which acts very quickly to get a foothold on someone just discharged from a hospital.

I think this could bode well or not for patients, IF the companies are reliable, provide good service and are well run. Unfortunately, not all of them are. I did notify Medicare though that we refuse to participate with any ACO. The one that contacted use is a for profit company, receiving some funding from Medicare for post hospital discharge follow-up work.

The questions the nurse asked were so basic they were laughable. I figured she was one of the ones who were let go after the company acquired the hospital, and was offered a nominal position with the ACO. I actually felt sorry for her.

But I refure to have our private medical information shared with a nonprofit affiliate, WITHOUT our permission.

These ACOs raise a whole 'nother issue about HIPAA protection. It irked me that the hospital gave information to its ACO affiliate.

One way I found out about the ACO affiliate was to bluntly ask one of the exec staff what the corporate affiliation was. I've checked out a few of those. I've also checked the Mich. department which requires corporate filings, and sometimes I've gotteon more information, but sometimes not. Some companies disguise their affiliation.

The only real way I know of beyond checking state corporate filings is to just ask the company about its past, corporate affiliation, and play dumb so they don't figure out what you're trying to determine.

Out of curiosity, I did a quick check and learned that SIMPRA is a PPO SNP (Special Needs Plan), but also found information on its recent trademark application. It does include insurance services as a part of its business lines. There's more description on the trademark website. I'm P'M'ing it to you so you can it out if you want to.

Simpra Advantage does underwrite health, dental, long term care plans. So, I would say it's definitely in the insurance company. The attorney who apparently filed the trademark app is in Alabama, the HQ for the company which owns it. I've also P'M'ed that info to you.

The trademark owner is SeniorSelect Partners, LLC. (This is public information from the trademark, so I'm not revealing any privileged information.)

It was incorporated in 2015, so it isn't a very old company. That would make me a bit nervous as it would have a limited, if any, track record.

https://www.bloomberg.com/research/stocks/private/snapshot.asp?privcapId=314766024

I have a feeling the LLC has other companies in the health care, or related industry. And I think there's more to this company being pushed by your MIL's current facility than just wanting business. Check out the links I sent you just now by PM, especially the criminal record link of the "organizer."

I'll bet that the place your MIL resides now is either affiliated with, owned by, or has a marketing rep pushing SIMPRA.