Changing Medicare: Which plan is most benefitial for my dad's situation?

When you say your dad is on a Humana supplement, do you mean he's on a Humana Medicare Advantage plan? Plans G, K, N and J are different levels of coverage provided under what are sometimes called "medigap" or "supplement" policies that people take out to combine with traditional Medicare coverage; and part D would be a separate policy to cover prescription drug costs for people on traditional Medicare. There are major disadvantages to Medicare Advantage plans compared with traditional Medicare + supplement, though the MA premiums are often much lower.

The Medigap plans cover everything traditional Medicare does, there are no limitations based on networks, no need for preauthorizations, etc. I may be prejudiced, but I think if someone has a lot of medical needs traditional Medicare + supplement is the way to go. However, there can be real difficulties in switching to that option from a MA plan. A switch from Medicare Advantage to Medigap can make a lot of sense, but is not guaranteed. In many states the person needs to qualify medically to be approved for a supplement plan once they are beyond the initial sign-up period. People with a history of critical or expensive chronic conditions may not be able to easily make a change. The supplement insurance company can charge higher premiums for certain preexisting conditions, or might deny the application altogether. "Medical underwriting" is the technical term for this. However, there are 12 states that provide guaranteed issue protections at least once per year to switch to Medigap from Medicare Advantage plans or to change Medigap plans: California, Connecticut, Idaho, Illinois, Maine, Massachusetts, Missouri, Nevada, New York, Oregon, Rhode Island and Washington.

I think this article will help you make a decision:

https://www.aarp.org/health/medicare-qa-tool/does-medicare-cover-assisted-living.html

My MIL's experience with Humana advantage plan (back a few years) was that it was terrible. Literally medical staff would sigh out loud when they learned that was her insurance.

Basically, advantage plans are great as long as you are well. But when you're sick you want a supplemental plan (medigap). Medigap plans cover what original Medicare doesn't. If one goes to the doctor often, these plans can offer $0 copays. But you'll have to buy Rx, vision and dental separately.

You would need to call each carrier to see if your Dad's meds are covered on their formulary.

There is a window of enrollment for medigap plans so make sure you know what it is for your Dad.

Zsky
The usual open enrollment begins in Oct of each year. I’m not sure how your dad qualifies for an option to change insurance. Perhaps he just signed up for Medicare recently, was under private insurance, still working and didn’t take Medicare until recently? If that is the case he may be in luck. (He would have had Part A from age of 65 but not Part B unless he signed up for it then as well). If he was taking an insurance through his employment, make that part clear to us. It matters.

I just read your other post and I’m concerned you are on an Medicare Advantage plan which if so can make it difficult, not always impossible, but difficult, to switch from an Advantage plan to a original Medicare for the purpose of adding a supplement.
You can switch to Medicare Part B and if you have B, you can add D for drugs but the supplement is the iffy part. Since he didn’t go with Medicare A. B, D and a supplement from the beginning, a supplement doesn’t now have to take him. The supplement is private insurance much like your Humana Medicare Advantage (if that’s what you have) and they have more leeway to make changes to contain their costs. You can’t assume anything. There is a one time opportunity to get a supplement w/o preexisting conditions coming into play. But states and plans may have exceptions and since his employer is involved there may be some nuance that allows him to escape the advantage plan limitations. My husbands employer pushed that when he turned 65, but DH stayed with the employer supplied insurance until he left that position. He just had to show proof that he had always had insurance when he finally went on full Medicare coverage. So you may have an out if he was employed. Being on this forum we learn we have had different experiences across the country.

If you can find a supplement that will take him then the choice between supplement plan G, K, etc depends on his needs and pocketbook. Some have higher deductibles and you pay a lower monthly premium. My husband has about six specialist and uses expensive meds. He has AARP plan G for a supplement and a part D for drugs through AARP. You can go on Medicare.gov/plan and put in dad’s zip code and it will pull up the plans available. Each year you have to check to find if there are changes to the formulary etc that influence your decision to stay with the Part D you may choose.

The supplement pays the 20% of things like doctor visits, out patient procedures etc and can even pay deductibles depending on the one you choose.
Part A of Medicare covers the rehab for when he is being discharged from the hospital. Part B of Medicare covers therapy and home health assistance for the home bound. They can come to ALFs. I think that is what you are trying to insure at this point, the ability to have ongoing therapy as needed.
You have to know before you buy with health insurance and most of us don’t know unless we have helped our parents with their insurance and have a reason to know. Truly my mom understood it very well and I saw how easy it was for me to help her vs my friend who had a regional Medicare Advantage plan and then an aunt and uncle who had been healthy all their lives, played senior Olympics, had deep pockets, LTC policies and then their daughter had a horrible time getting them the medical attention they needed because of their choosing plans that cost nothing and delivered the same.
My mom’s premium for her supplement which was top of the line was $4,000 at the age of 97 (passed in 2015). My DH aunt, who was 97 last Oct pays not quite that much. So the supplement cost when I compare my aunt and my mom over 9 years is actually pretty stable. Your dad’s policy being almost 30 yrs younger would be less.
Good luck on getting him on a great supplement. You can input his prescriptions on the Medicare.gov and it will give you the comparison of costs for all the plans you choose to consider. You will need name of drug, quantity and strength.

Some time when the next open enrolment starts make an appointment with a Medicare insurance broker. Bring a list of all medications to find a better plan. Also choose what pharmacy he wull be using. Ask AL what pharmacy they order his meds from. Choices are based on his zip code and the state. The broker gets paid by the plan you enroll him in. You can compare advantage and supplement plans.
Right now you can look at current 2024 plans on the Medicare.gov website to the link " find a plan". Do this as a guest and compare 3 plans at a time. Many parts will be similar until you look at drug costs. You cannot change plans this year but you can practice before that appointment.

What your Dad has insurance wise does not effect the AL if your talking about a private pay facility. The Nurse only handles his prescriptions. She has nothing to do with the doctors he goes to and who they bill. Even if the AL has a doctor associated with them, he probably does his own billing.

First determine what Dad has, straight Medicare with a supplimental or a Medicare Advantage plan. I suggest you make an appt to talk to someone at your County Office of Aging. Besides knowing about insurances available in your state, they know Medicaid too. This isca free service.

I'm going to assume here that you are too young to have much experience with Medicare. I would suggest you can make this process much easier by working with a broker. They can help you compare options, both traditional Medicare + Medigap, and Medicare Advantage. I turned 65 recently and have just been through this process. The company I use is called Medicareschool.com and they are fantastic. I don't know which type of coverage your father has, but they will be able to help you figure it out. You would want to have a list of all the medications he takes. If you'd like more information about this group, the CEO does lots of educational videos on YouTube - just search on the name and you'll find them. He does videos on all sorts of Medicare-related topics. Another option would be to search for their Facebook group, MedicareSchool.com Community. Their social media person is just wonderful, very knowledgeable and responsive.

Good luck to you in sorting this out.

The problem with Medicare Advantage and supplimentals is they are State based. When my Mom had to change her employers insurance, there were only 3 insurance companies writing policies in NJ. My MIL in Fla had 10. MAs work the same way, they need to have permission to write policies in that State.

So your question "which plan would be most beneficial" can't be answered by a forum of people living all over the US. So, as said, you need a broker or Office of Aging.