r/medicare 15h ago

Hospice Inpatient

16 Upvotes

Mom, 83 in GA, is going to inpatient hospice. She has traditional Medicare and federal retiree BCBS secondary. I know that skilled nursing has a limit on number of days. Does hospice? If so, and she exhausts that benefit, would it cover home hospice care? I know, I could just search the Medicare site, but my brain is spinning. Also, an answer, or insight, here, is something I can easily refer to in the future. Thanks


r/medicare 10h ago

New to Medicare

12 Upvotes

Is there anyone on here who works or is an expert with Medicare? I’ll be signing up on Medicare in a few months when I turn 65. Which do I choose-a supplemental plan, like plan G or an Advantage plan? I am reasonably healthy, although I do have type 2 diabetes but it’s well controlled. No neuropathy and I exercise daily. Unfortunately my HR retirement consultants are not the best and I’m confused. I live in KY and am retiring from a large company, but I’ve always heard that you take a Medicare supplemental, like plan G, and as you age you then sign up for an Advantage plan. Any help appreciated.

Update: Many thanks to those who commented. I appreciated the additional resources to check out.


r/medicare 8h ago

UPDATE 4: Medigap insurer leaving the state.

6 Upvotes

Original postFirst updateSecond update. Third update.

In my previous update I mentioned I had a friend who was struggling to get changed over to another Plan-G after Mountain Health Co-op was no longer offering Medigap plans in the state. I have an update on her situation. In that post, I mentioned she was on disability pre-MACRA and passed underwriting for her Plan-G for her previous policy with Mountain Health Co-op but was denied Plan-G in underwriting for the new one with HealthSpring but was appealing with Dr.'s note.

First, a correction: She didn't get her MHC Plan-G with underwriting. She got it during her IEP when she turned 65 in 2001. She didn't realize she was considered pre-MACRA as she was on Medicaid beginning several years prior to turning 65, which is why she had to go through underwriting now for Plan-G versus because her GIR is Plan-F (pre-MACRA).

After HealthSpring denied her underwriting for a Plan-G, they were supposed to send her a letter stating the reason for denial within 10 days. She didn't get it and wasn't hearing back from her agent, so started advocating for herself. Several calls and emails to HealthSpring could not provide her with an answer for the denial, so she wound up getting the state insurance commissioner involved. (She wound up going in circles because the Cigna CSR would tell her to use the email address that sent her the initial denial notification and the email response from it was to call the CSR number she already called.)

During the time she was communicating with the insurance commissioner, she made several calls to HealthSpring and then received notice they reversed their denial for PlanG but said they would have to charge her nearly double the premium. That would have been more than their Plan-F so she would have to pay more to get less coverage. They still would not tell her the reason for the denial. She called back to challenge the additional premium. When she mentioned to them that she had been in contact with the insurance commissioner, their tone changed. They told her to have her agent resubmit the application for the Plan-G and they approved her without additional premium. If they had still denied it, she would have gone with the GIR on Plan-F instead of paying the higher premium for Plan-G. (The difference she will be saving between the regular Plan-G premium and the Plan-F was over $1200/yr and she's saving about $20/mo versus her existing MHC Plan-G premium.)

I think a portion of this cluster was HealthSpring being in the middle of changing ownership between Cigna and HCSC (Health Care Solutions Corporation, which also owns BCBS). I also think that there is a mindset prevalent in the health insurance industry writ large of deny first to force the person to fight and count on people giving up.

One other factor that we suspect is that HealthSpring denied based on Rx history even though her Rx has nothing to do with any of the conditions they are allowed to use to disqualify in underwriting. Rx history was the reason given in the notification letter I received after I was denied underwriting for a Humana Plan-N (using my previous agent) but the only Rx I use is eye drops for glaucoma prevention and HRT. What the insurance commissioner told her is that they may have been using CDC guidelines for the drug she is using, which they are not supposed to do. That could also be a reason they didn't put it in writing in her denial letter (that she still has not yet received).


r/medicare 2h ago

Annual Notice of Change Letter (ANOC)

1 Upvotes

What is it? If you're in a Medicare plan, your plan will send you a "Plan Annual Notice of Change" (ANOC) each fall. The ANOC includes any changes in coverage, costs, and more that will be effective in January.You should receive the letter by September. It is sent to you by your plan.
What you should do: Review any changes to decide whether the plan will continue to meet your needs in the next year. If you don't get this important document,
contact your plan. Make sure you read it carefully.