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I think lot of this has to do with the states’ own standards for Advantage companies
So different states have better standards to adhere to than others
Didn’t really read all article cause I don’t do Advantage
But wonder if it breaks down by state the changes in ratings of companies
Not all companies offer Advantage plans in all states either as far as I know
I'm 44 but my mom turns 65 in 3 months and 1 week.
I'll be helping her apply for her Medicare coverage.
I'm still researching options but I can say off the bat I really prefer she have as much flexibility as possible. She's one year post stroke and prior to that event she never had any established PCP or care team ever. So it's highly possible she may go through a 'trial and error' period of docs for a bit as we find who to establish future care with.
I'm currently thinking Part A/B + D + G.
I know no one individual can advise me as to exactly what to do, but any tips on how to select the right plan for her?
Of note, she is pending both Medicaid and disability fyi which I do (prayerfully) believe she will eventually get.
Is your mom special needs? Why would you need to "help her" sign up?
I was not able to enroll my mom in Medicare in August as planned. Long story short, there was a hold up due to applying for Medicare already actually during the recent disability 'appeal' process. We were in this situation where I couldn't apply for her online due to this - kept getting rejected as the disability process was on hold which was somehow tied to the Medicare application.
(Disability is still pending by the way - DDS and SSA keep going back and forth with DDS appealing/fighting for her disability and SSA saying she's not disabled. We have decided to just go ahead and 'give in' and start her early retirement as I finally feel like this could go on for another several years.)
At the end of the day, we applied two weeks ago and got notification of her A/B enrollment this week. So I'll turn focus next to D & G soon.
Some of the biggest news - Medicaid was finally approved. I didn't even believe it when they called and verbalized it because I've gotten so much misinformation on things from SSA. I believed it when we got the cards in the mail a few days ago. Thank God.
SK, I just have to say that the devotion to your mother has been inspiring. It seems like you have hit so many roadblocks and you have managed to get through all this red tape (and I hope that continues).
I just wanted to mention you might want to start calling around to see what primary care doctors will accept new Medicaid/Medicare patients so you will be informed.
We live in quite a “doctor rich” area and many still are not accepting new Medicare primary care patients although they will keep their former patients. I have no knowledge of the Medicaid situation but that may be even more challenging. If you have a doctor in the area yourself that might be a good starting point.
Best of luck to you and your mom and hope she is doing well ~
SK, I just have to say that the devotion to your mother has been inspiring. It seems like you have hit so many roadblocks and you have managed to get through all this red tape (and I hope that continues).
I just wanted to mention you might want to start calling around to see what primary care doctors will accept new Medicaid/Medicare patients so you will be informed.
We live in quite a “doctor rich” area and many still are not accepting new Medicare primary care patients although they will keep their former patients. I have no knowledge of the Medicaid situation but that may be even more challenging. If you have a doctor in the area yourself that might be a good starting point.
Best of luck to you and your mom and hope she is doing well ~
Thank you so much.
I should mention that my mom was just enrolled into the PACE prgoram (Program for All Inclusive Care for the Elderly).
If you are not familiar with it, you can take a look. They are adult day centers and when enrolled you get assigned a care team (included but not limited to a PCP, rehab specialists, social worker, nurse, etc.) and you are 'locked' into the PACE network of doctors (which I am fine with). I had contacted them a while back and kept them updated on my mom being Medicaid pending. The day her Medicaid cards came in the mail I emailed them, they sent a nurse out the same day to assess her, and she is on site today doing her last rounds of assessments prior to enrolling.
As today was her first day at PACE, I really hope she liked it and decides to be/stay in the program.
I have a doctor that I took her to a few weeks ago that did not accept Medicaid but does accept Medicare, so if she does not stay in PACE I prefer she see my PCP fyi. I took her to my PCP so she could get her meds filled and PT/OT ordered who have already started working with her per the MD's recent orders fyi. You raise an excellent excellent point and I really appreciate you mentioning it.
And I appreciate the sincere well wishes as well.
Thank you!
Last edited by southkakkatlantan; 10-16-2023 at 02:34 PM..
Is your mom special needs? Why would you need to "help her" sign up?
What's wrong with you?
Consider for a moment... that some people actually want to help their parents with difficult or confusing tasks. Running the gauntlet of Medicare qualifies.
You can switch from G to G with no underwriting if you enroll in Medicare Advantage for a month and use your Medicare Advantage trial right- one time only. This assumes that you were stuck in a super expensive G that closed the book and is no longer available.
It is a once-in-a-lifetime guaranteed issue right that is available if you quit your first Advantage plan within 12 months of joining.
Once you exercise your trial right, you will not get another chance. The next Advantage plan you join would be your second plan, so you would no longer have a trial right. You will have to go through medical underwriting or move to another state.
The regulation governing the trial right is 42 CFR §422.62 (b)(8):
(8) The individual terminated a Medigap policy upon enrolling for the first time in an MA plan and is still in a “trial period” and eligible for “guaranteed issue” of a Medigap policy, as outlined in section 1882(s)(3)(B)(v) of the Act.
(i) This SEP allows an eligible individual to make a one-time election to disenroll from his or her first MA plan to join original Medicare at any time of the year.
(ii) This SEP begins upon enrollment in the MA plan and ends after 12 months of enrollment or when the individual disenrolls from the MA plan, whichever is earlier.
I have a question about the red bold font above....
Is there a guaranteed issue period for choosing a Medigap plans when someone is on Traditional Medicare A/B plus they already have a medigap plan in their old state, but they move to a different state? What kind of rules apply when moving to a different state, regarding choosing Medigap plans in the new state?
Go to a broker who deals only with this. They will take your mother’s particular information, and search the best options for her. There is no extra charge for this. She will want a plan D and aPlan F, N or G. Not an Advantage Plan.
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