Follow
Share

He is in the early stage of dementia.

This question has been closed for answers. Ask a New Question.
Certain insurance companies (ie Aetna and UHC) have made arrangements with the US government (Medicare) that they would insure people under what is called a "Medicare Replacement Policy" or "Medicare Advantage Plan" if the government pays them the $104.90 per month that we pay for Medicare. You get most of the same benefits as with Medicare plus usually a drug plan is included. If you did not sign up for Medicare in the beginning and opted for an HMO instead, my understanding is that, in order to qualify for a Medicare supplement, you have to pass a physical. Things may have changed in the last few years, but I opted for a Medicare Advantage Plan through Aetna and should I want to change to simple Medicare with a supplemental plan and Part D coverage, it would be difficult and I don't even have any pre-existing conditions. I have learned (the hard way!) that it is better to sign up for Medicare and get a supplemental plan from the very beginning. You can always get a Medicare Advantage Plan (HMO or PPO) easily, but not the other way around.
Helpful Answer (9)
Report

I have a Medicare Advantage Plan. I am still signed up for Medicare, just not the version where you have Part A, Part B and Part D. I still have everything that is covered by traditional Medicare and still have the monthly deduction from my Social Security payment. What I have is known as a "Part C" plan which covers medications, too, with a very low monthly premium. I have a Medicare card, but chose to go with a "replacement" plan that is administered by Aetna. My plan is a PPO, so I can choose my docs as long as they are "in network" meaning I don't have to have a referral. If I had to do it all again, I would choose to go with the more expensive option: basic Medicare with a supplemental plan and Part D coverage. 20/20 hindsight!!
Helpful Answer (7)
Report

you can change back to regular medicare if you have what is called a life changing event. For example, you have a severe health problem and you need to go to rehab for therapy, ie: broken hip or something like that. If you just move into the nursing home or assisted living that is also considered a life changing event. You need to go to your local social security office and explain what "life changing" event your dad has had and they can switch him over. You do not have to wait for any enrollment period since you have had the life changing event. If you don't have a life changing event, you can still switch him back during the open enrollment period which usually starts Oct 15th. As far as supplements, you will need 2, one for the medical portion that Medicare doesn't cover, and one to cover medicines. (part D) A good place to look is at AARP. Their plans are administered by United Health Care and give good coverage at a reasonable price. He should be able to get coverage, but you can always call them to make sure. BE aware that the 3 plans together are going to be more expensive than the HMO he previously had! BUT overall the coverage will be much better and more comprehensive. I worked with patients and insurance for many years and the HMO's were fine until you needed to cover a rehab stay or something like that, then they fell short.
Helpful Answer (4)
Report

At annual enrollment, you are allowed to switch from Medicare Advantage to Original Medicare. However, you have to apply for a supplement plan and be medically rated (they can turn you down). This is why most people stay with an Advantage plan once they go on it.
Helpful Answer (3)
Report

Latie, I believe that the Medicare Advantage option would fulfill the requirement to sign up for Medicare at age 65. Where I have seen confusion is when a person retires, the employer has a qualified medical plan that covers employees, a spouse continues to work for that employer and thus the retiree spouse is covered. So at that point it is cheaper to delay Medicare enrollment, but you really have to watch eligibility issues in this kind of situation, as well as changes in the law.
Helpful Answer (3)
Report

if you are approaching age 65 - you are best off to sign up for a Supplemental plan in addition to Medicare. Down the line, you can switch to Advantage plan. My understanding from broker is that IF you have Medicare + Supplement at the beginning (age 65), you can always return to Supplemental plan (after Advantage) + can't be denied by underwriting. Whereas, if you start with Advantage plan at age 65, you go through underwriting + can be denied to the Supplemental plan in later years.

Do your homework at age 64 before signing up for Medicare at 65.
Helpful Answer (2)
Report

I am sorry - do not take ANY of this at face value. It is so complicated, that it could be mis-stated or misconstrued. You are automatically signed up for Part A at age 65, you can not NOT have it. Part B is optional, the ONLY penalty is if you don't get Part D a drug plan, and the penalty will kick in when you decide you DO want it, and it will increase that cost for the rest of your life. If you get an advantage plan, you have insurance using specific providers only, and you have co-pays and deductibles and it often includes the drug plan. The only other choice is a supplemental (also called gap) plan, which may pay EVERYTHING for you (you choose your coverage), and may include Part D. There are enrollment periods and I don't know if any require an exam, but you are ENTITLED to a free "wellness" exam when you first start Medicare. The enrollment periods don't overlap, which to my mind would prevent one from switching, I don't understand it. One enrollment is based on your birthday, the other on the first of the year. For me it is irrelevant since the time frames coincide. There is also a 3-month sign up period when you turn 65 (to choose the additional insurance coverage), and an 8-month grace period (not sure about that one) to change your mind. My town has a council on aging that presents workshops complete with handouts on this sh*t and you can go to medicare.gov for a lot of information also, especially about Part D. Since if you don't get it right away, when you want it, your rates will be higher, due to a penalty that increases over time.  (You can't have supplmental and advantage at the same time, and Supplemental is called Part C.)
Helpful Answer (1)
Report

Just to add to this discussion, not everyone will qualify for the free Part A because they haven't paid over 40 quarters of work coverage. It can be purchased and I think the going monthly rate now is $411.
You can opt out of Medicare B at 65 and may want to if still covered thru employment. But know what you are doing.
Helpful Answer (1)
Report

Thank you for all this information! My husband just turned 65 and went through the interview process over the phone. His Medicare card was sent Part A only. We don’t need supplemental yet or Part B as I work FT & cover us both. He is still working FT as well.
However, I have been researching what to do when I stop working (which I don’t plan to do until I can receive my full SS) & will opt not to get a Medicare Advantage plan thanks to all the insight you all have provided.
This is very confusing! It seems like you do really need to do your homework before choosing any plan. Thereisnotry I will go to the Medicare site & begin to read it, as it’ll probably take me years to figure out. 
Helpful Answer (1)
Report

I advise you to call Medicare directly or your local SHIP office. Medicare can give you the number and they a usually located in local Office of Aging. In answer to your question it really does depend on where you live. It varies from state to state. In NY for example there is a continues open enrollment to sign up for a supplement but you would also need to enroll in a part D plan at that time to cover medications and that can only be done during open enrollment. Open enrollment is only Oct 15th to Dec 7th of each year for coverage starting Jan 1. There are other ways to qualify for a special enrollment period. If this all sounds complicated, it is! I work in the local SHIP office and have to attend continues training. I strongly advise you to contact your local SHIP office and they will help you though this maze! I know in NY at least it is possible to switch a person from a Medicare Advantage (HMO or PPO or PFFS) to a supplement and a Part D plan even after Dementia has taken over, because I did it with my mother. Good luck.
Helpful Answer (1)
Report

See All Answers
This question has been closed for answers. Ask a New Question.
Ask a Question
Subscribe to
Our Newsletter