Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

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Nutmeg
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Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by Nutmeg » Mon Jun 29, 2020 10:34 pm

A relative who is a nursing home resident has received an offer from his medical insurance company to switch from his current Medicare Advantage plan to a different plan for medical insurance that is offered only to nursing home residents. [Note that he is already a nursing home resident and this is not LTC insurance, but coverage for medical needs such as medications, ambulance costs, doctors, and hearing aids.]

The new plan tends to offer more coinsurance coverage rather than his current copay coverage, which means that his costs wouldn’t be limited to the copay amount. I plan to compare anticipated costs under both plans.

The plan also entails having a physician’s assistant or similar person employed by the insurance company visit him frequently, perhaps three times a week. My first thought is that this person doesn’t represent him or work for him, but represents the insurance company. As we cannot visit him in the locked-down nursing home but can only talk by phone, it is hard for us to assess how he is doing, and I don’t know whether having an insurance company representative who is medically trained visit him would be a good thing or a bad thing.

What factors should I consider in assessing this? Has any reader switched from a Medicare Advantage plan to a nursing home medical policy, and if so, what was your experience?

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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by Cubicle » Mon Jun 29, 2020 10:55 pm

This is a salesman trying to sell a product. I don't know anything about it, but if they are soliciting, they aim to turn a profit. At what cost is unknown. Bad benefits. Paying the doctors less (which could end up in doctors not wanting to see the patient as often as they would have). I hate all insurance companies. I'd be leery, assess how difficult it would be to switch back to the original Medicare Advantage Plan, & if there would be any penalties.
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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by cheese_breath » Tue Jun 30, 2020 3:03 pm

Nutmeg wrote:
Mon Jun 29, 2020 10:34 pm
..... coverage for medical needs such as medications, ambulance costs, doctors, and hearing aids.....
Hospitals?
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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by Nutmeg » Tue Jun 30, 2020 4:15 pm

cheese_breath wrote:
Tue Jun 30, 2020 3:03 pm
Nutmeg wrote:
Mon Jun 29, 2020 10:34 pm
..... coverage for medical needs such as medications, ambulance costs, doctors, and hearing aids.....
Hospitals?
Yes, it is essentially comprehensive health care coverage when viewed together with Medicare, similar to a Medicare Advantage plan.

I was trying to make clear that the topic is medical insurance, not long term care insurance, which applies to those anticipating entering a nursing home in the future. The fact that it is a nursing home medical plan makes it hard to search this forum or the internet in general, because searches pull up only LTC insurance results.

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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by 123 » Tue Jun 30, 2020 4:33 pm

I think you should ask the agent to mail you a copy of the "Evidence of Coverage" for the Medicare plan they are suggesting. If it looks like it might be appealing you may want to ask the administrator at the nursing home what their opinion of the plan is. (The administrator may also know of competing plans offered by others to also consider.) Have other residents have it? Did it work for them? There have been a number of efforts to broaden Medicare benefits in recent years (Such as Medicare Advantage/Plus) and the plan offered may be promising.

It would be a good idea to find out who provides the services (physicians, medical groups, etc) under the plan, it would seem to be somewhat like an HMO for nursing home residents. Perhaps the Medicare benefits are similar to that provided by home health care agencies to qualifying Medicare enrollees. It can be difficult to arrange medical care for nursing home residents and care options are often limited to providers that periodically visit the facility, so being aware of more options could be advantageous.

The cost of some Medicare Advantage options can vary quite a bit based on geography. In some areas they are practically free, whereas elsewhere there are charges. In many cases the services are funded primarily from Medicare and out-of-pocket costs are low.

The plan sounds like it could be variation of Hospice care under Medicare. Under Hospice care the patient generally gets visited by an RN a few times a week and there are other providers that visit as well. An outside focused care team, seperate from care provided by the nursing home, could be helpful and an advantage.
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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by auntie » Tue Jun 30, 2020 4:46 pm

The people at my dad's memory care facility recommended that for him. We used it for his last years. They covered all his medical needs including 2 hospitalizations. In the end we got a bill for $100 for one of his ambulance rides. We were pleased with what they did for him. This was in 2017 and 2018.
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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by FIREchief » Tue Jun 30, 2020 5:40 pm

Nutmeg wrote:
Mon Jun 29, 2020 10:34 pm
A relative who is a nursing home resident has received an offer from his medical insurance company to switch from his current Medicare Advantage plan to a different plan for medical insurance that is offered only to nursing home residents.
Just to clarify, would this mean reverting to basic Medicare part B and buying this Nursing Home policy to cover certain other items/costs not fully covered by Medicare A/B? It sounds similar to Medigap policies and certain employer Medicare supplement plans.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.

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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by Nutmeg » Tue Jun 30, 2020 7:48 pm

FIREchief wrote:
Tue Jun 30, 2020 5:40 pm
Nutmeg wrote:
Mon Jun 29, 2020 10:34 pm
A relative who is a nursing home resident has received an offer from his medical insurance company to switch from his current Medicare Advantage plan to a different plan for medical insurance that is offered only to nursing home residents.
Just to clarify, would this mean reverting to basic Medicare part B and buying this Nursing Home policy to cover certain other items/costs not fully covered by Medicare A/B? It sounds similar to Medigap policies and certain employer Medicare supplement plans.
That is a good question. The summary of benefits for the proposed new plan doesn’t say Medicare Advantage on it as the summary of benefits for the current plan does, so I don’t know how to characterize it. I will ask.

Someone tried to convince my relative to convert from Medicare Advantage to Medicare at year-end. That would have been a colossal mistake, as Medicare would not have covered the thousands of dollars of SNF costs during the continuing rehab period as the Medicare Advantage plan did, because my relative hadn’t met the qualifying inpatient hospital stay requirement that Medicare imposes but Medicare Advantage doesn’t. Once Medicare Advantage is dropped in favor of Medicare, one cannot go back on Medicare Advantage [edited to add:] until the next annual open enrollment period. As a result, I want to make sure that I investigate this thoroughly.
Last edited by Nutmeg on Tue Jun 30, 2020 11:24 pm, edited 1 time in total.

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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by FIREchief » Tue Jun 30, 2020 9:02 pm

Nutmeg wrote:
Tue Jun 30, 2020 7:48 pm
Once Medicare Advantage is dropped in favor of Medicare, one cannot go back on Medicare Advantage. As a result, I want to make sure that I investigate this thoroughly.
Are you certain about this? I thought a person could switch back to medicare advantage at the next annual open enrollment.
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.

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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by Nutmeg » Tue Jun 30, 2020 9:22 pm

FIREchief wrote:
Tue Jun 30, 2020 9:02 pm
Nutmeg wrote:
Tue Jun 30, 2020 7:48 pm
Once Medicare Advantage is dropped in favor of Medicare, one cannot go back on Medicare Advantage. As a result, I want to make sure that I investigate this thoroughly.
Are you certain about this? I thought a person could switch back to medicare advantage at the next annual open enrollment.
You are absolutely right, and I thank you for your correction! When our decision was being made, we were many months away from the annual open enrollment period, and I forgot that we could have gone back after waiting many months. Here is the correct statement:
Once Medicare Advantage is dropped in favor of Medicare, one cannot go back on Medicare Advantage until the next annual open enrollment period.

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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by Eagle33 » Tue Jun 30, 2020 10:23 pm

FIREchief wrote:
Tue Jun 30, 2020 9:02 pm
Nutmeg wrote:
Tue Jun 30, 2020 7:48 pm
Once Medicare Advantage is dropped in favor of Medicare, one cannot go back on Medicare Advantage. As a result, I want to make sure that I investigate this thoroughly.
Are you certain about this? I thought a person could switch back to medicare advantage at the next annual open enrollment.
That was my understanding also. I thought it was the other way around going from MA to original Medicare was a problem if you want to get a Medigap plan to supplement Medicare.
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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by Nutmeg » Tue Jun 30, 2020 11:22 pm

Eagle33 wrote:
Tue Jun 30, 2020 10:23 pm
FIREchief wrote:
Tue Jun 30, 2020 9:02 pm
Nutmeg wrote:
Tue Jun 30, 2020 7:48 pm
Once Medicare Advantage is dropped in favor of Medicare, one cannot go back on Medicare Advantage. As a result, I want to make sure that I investigate this thoroughly.
Are you certain about this? I thought a person could switch back to medicare advantage at the next annual open enrollment.
That was my understanding also. I thought it was the other way around going from MA to original Medicare was a problem if you want to get a Medigap plan to supplement Medicare.
I will go back and fix my initial erroneous statement.
Your last statement is also true, in my understanding. This underlines the importance to me of not making any switches until I am sure of the result!

Edited to change „undermines“ to „underlines“ as I had originally intended!
Last edited by Nutmeg on Wed Jul 01, 2020 9:19 am, edited 1 time in total.

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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by cashmoney » Tue Jun 30, 2020 11:58 pm

Nutmeg wrote:
Mon Jun 29, 2020 10:34 pm
A relative who is a nursing home resident has received an offer from his medical insurance company to switch from his current Medicare Advantage plan to a different plan for medical insurance that is offered only to nursing home residents. [Note that he is already a nursing home resident and this is not LTC insurance, but coverage for medical needs such as medications, ambulance costs, doctors, and hearing aids.]

The new plan tends to offer more coinsurance coverage rather than his current copay coverage, which means that his costs wouldn’t be limited to the copay amount. I plan to compare anticipated costs under both plans.

The plan also entails having a physician’s assistant or similar person employed by the insurance company visit him frequently, perhaps three times a week. My first thought is that this person doesn’t represent him or work for him, but represents the insurance company. As we cannot visit him in the locked-down nursing home but can only talk by phone, it is hard for us to assess how he is doing, and I don’t know whether having an insurance company representative who is medically trained visit him would be a good thing or a bad thing.

What factors should I consider in assessing this? Has any reader switched from a Medicare Advantage plan to a nursing home medical policy, and if so, what was your experience?

This is an Institutional Special Needs Plan (SNP) Medicare Advantage plan .The MA carrier will contract with specific Medicaid LTC facilities .The SNP MA plans will cover the Medicare covered services and part D.The majority of people who enroll in these plans will have have Institutional State Medicaid and will not pay copayments but for those who don't have medicaid then copayments are similar to non SNP MA plans but the extra non medicare covered benefits such as dental,OTC products,vision,hearing aids etc are usually much much more generous .There is a network of providers but the PCP that visits the facility will be in the network but you want to make sure that any outside specialist providers are in network.For those with Medicaid sometimes having a network is a good thing because many medicare specialist dont take medicaid but they may contract with a medicare advantage plan.

The PA is an extra pair of eyes and ears on the patient that coordinates with the PCP ,NH and family which is really the best feature of these plans.The other good benefit is the MA plans do not require a prior 3 day hospitalization before nursing home can transfer patient to a SNF room.If it is the same insurance company they have MA plan with now there is really no downside to switch to their SNP Plan as long as they are ok with using the PCP that visits the facility and the network is the same or acceptable.


disclosure I am an licensed agent.

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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by Stinky » Wed Jul 01, 2020 7:33 am

cashmoney wrote:
Tue Jun 30, 2020 11:58 pm
Nutmeg wrote:
Mon Jun 29, 2020 10:34 pm
A relative who is a nursing home resident has received an offer from his medical insurance company to switch from his current Medicare Advantage plan to a different plan for medical insurance that is offered only to nursing home residents. [Note that he is already a nursing home resident and this is not LTC insurance, but coverage for medical needs such as medications, ambulance costs, doctors, and hearing aids.]

The new plan tends to offer more coinsurance coverage rather than his current copay coverage, which means that his costs wouldn’t be limited to the copay amount. I plan to compare anticipated costs under both plans.

The plan also entails having a physician’s assistant or similar person employed by the insurance company visit him frequently, perhaps three times a week. My first thought is that this person doesn’t represent him or work for him, but represents the insurance company. As we cannot visit him in the locked-down nursing home but can only talk by phone, it is hard for us to assess how he is doing, and I don’t know whether having an insurance company representative who is medically trained visit him would be a good thing or a bad thing.

What factors should I consider in assessing this? Has any reader switched from a Medicare Advantage plan to a nursing home medical policy, and if so, what was your experience?

This is an Institutional Special Needs Plan (SNP) Medicare Advantage plan .The MA carrier will contract with specific Medicaid LTC facilities .The SNP MA plans will cover the Medicare covered services and part D.The majority of people who enroll in these plans will have have Institutional State Medicaid and will not pay copayments but for those who don't have medicaid then copayments are similar to non SNP MA plans but the extra non medicare covered benefits such as dental,OTC products,vision,hearing aids etc are usually much much more generous .There is a network of providers but the PCP that visits the facility will be in the network but you want to make sure that any outside specialist providers are in network.For those with Medicaid sometimes having a network is a good thing because many medicare specialist dont take medicaid but they may contract with a medicare advantage plan.

The PA is an extra pair of eyes and ears on the patient that coordinates with the PCP ,NH and family which is really the best feature of these plans.The other good benefit is the MA plans do not require a prior 3 day hospitalization before nursing home can transfer patient to a SNF room.If it is the same insurance company they have MA plan with now there is really no downside to switch to their SNP Plan as long as they are ok with using the PCP that visits the facility and the network is the same or acceptable.


disclosure I am an licensed agent.
Very interesting. Thank you for posting such complete details. I had not heard of this before.

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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by FIREchief » Wed Jul 01, 2020 12:48 pm

cashmoney wrote:
Tue Jun 30, 2020 11:58 pm
Nutmeg wrote:
Mon Jun 29, 2020 10:34 pm
A relative who is a nursing home resident has received an offer from his medical insurance company to switch from his current Medicare Advantage plan to a different plan for medical insurance that is offered only to nursing home residents. [Note that he is already a nursing home resident and this is not LTC insurance, but coverage for medical needs such as medications, ambulance costs, doctors, and hearing aids.]

The new plan tends to offer more coinsurance coverage rather than his current copay coverage, which means that his costs wouldn’t be limited to the copay amount. I plan to compare anticipated costs under both plans.

The plan also entails having a physician’s assistant or similar person employed by the insurance company visit him frequently, perhaps three times a week. My first thought is that this person doesn’t represent him or work for him, but represents the insurance company. As we cannot visit him in the locked-down nursing home but can only talk by phone, it is hard for us to assess how he is doing, and I don’t know whether having an insurance company representative who is medically trained visit him would be a good thing or a bad thing.

What factors should I consider in assessing this? Has any reader switched from a Medicare Advantage plan to a nursing home medical policy, and if so, what was your experience?

This is an Institutional Special Needs Plan (SNP) Medicare Advantage plan .The MA carrier will contract with specific Medicaid LTC facilities .The SNP MA plans will cover the Medicare covered services and part D.The majority of people who enroll in these plans will have have Institutional State Medicaid and will not pay copayments but for those who don't have medicaid then copayments are similar to non SNP MA plans but the extra non medicare covered benefits such as dental,OTC products,vision,hearing aids etc are usually much much more generous .There is a network of providers but the PCP that visits the facility will be in the network but you want to make sure that any outside specialist providers are in network.For those with Medicaid sometimes having a network is a good thing because many medicare specialist dont take medicaid but they may contract with a medicare advantage plan.

The PA is an extra pair of eyes and ears on the patient that coordinates with the PCP ,NH and family which is really the best feature of these plans.The other good benefit is the MA plans do not require a prior 3 day hospitalization before nursing home can transfer patient to a SNF room.If it is the same insurance company they have MA plan with now there is really no downside to switch to their SNP Plan as long as they are ok with using the PCP that visits the facility and the network is the same or acceptable.


disclosure I am an licensed agent.
Thanks! This is very useful information. :beer
I am not a lawyer, accountant or financial advisor. Any advice or suggestions that I may provide shall be considered for entertainment purposes only.

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Nutmeg
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Re: Should we Switch from a Medicare Advantage Plan to a Nursing Home medical policy (not LTC insurance)

Post by Nutmeg » Wed Jul 01, 2020 10:17 pm

cashmoney wrote:
Tue Jun 30, 2020 11:58 pm
Nutmeg wrote:
Mon Jun 29, 2020 10:34 pm
A relative who is a nursing home resident has received an offer from his medical insurance company to switch from his current Medicare Advantage plan to a different plan for medical insurance that is offered only to nursing home residents. [Note that he is already a nursing home resident and this is not LTC insurance, but coverage for medical needs such as medications, ambulance costs, doctors, and hearing aids.]

The new plan tends to offer more coinsurance coverage rather than his current copay coverage, which means that his costs wouldn’t be limited to the copay amount. I plan to compare anticipated costs under both plans.

The plan also entails having a physician’s assistant or similar person employed by the insurance company visit him frequently, perhaps three times a week. My first thought is that this person doesn’t represent him or work for him, but represents the insurance company. As we cannot visit him in the locked-down nursing home but can only talk by phone, it is hard for us to assess how he is doing, and I don’t know whether having an insurance company representative who is medically trained visit him would be a good thing or a bad thing.

What factors should I consider in assessing this? Has any reader switched from a Medicare Advantage plan to a nursing home medical policy, and if so, what was your experience?

This is an Institutional Special Needs Plan (SNP) Medicare Advantage plan .The MA carrier will contract with specific Medicaid LTC facilities .The SNP MA plans will cover the Medicare covered services and part D.The majority of people who enroll in these plans will have have Institutional State Medicaid and will not pay copayments but for those who don't have medicaid then copayments are similar to non SNP MA plans but the extra non medicare covered benefits such as dental,OTC products,vision,hearing aids etc are usually much much more generous .There is a network of providers but the PCP that visits the facility will be in the network but you want to make sure that any outside specialist providers are in network.For those with Medicaid sometimes having a network is a good thing because many medicare specialist dont take medicaid but they may contract with a medicare advantage plan.

The PA is an extra pair of eyes and ears on the patient that coordinates with the PCP ,NH and family which is really the best feature of these plans.The other good benefit is the MA plans do not require a prior 3 day hospitalization before nursing home can transfer patient to a SNF room.If it is the same insurance company they have MA plan with now there is really no downside to switch to their SNP Plan as long as they are ok with using the PCP that visits the facility and the network is the same or acceptable.


disclosure I am an licensed agent.
Very useful! This provided me with the information that I needed to conduct internet searches. Most of the info I found online is not geared toward consumers making this decision, though, so I would still be glad to hear of the experiences of others, or of good questions for me to ask about the proposal.

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