My Mom’s Experience with Medicare

As I’ve mentioned, Medicare and Medical expenses can be one of your largest expenses in retirement so it is critical that you choose the correct plan  when you turn 65.  This is my third article  in a series on Medicare. I want to make sure you understand the differences between Original Medicare (from the federal government) and Medicare Advantage (from for profit insurance companies). To help you really understand the differences I will share my mother’s personal experience with Original Medicare plus a Medigap Plan plus a Drug Plan vs Medicare Advantage.

My Mother’s Experience Choosing a Medicare Plan

My mother was a very healthy woman who walked and biked everywhere. She didn’t have a driver's license.  It was amazing how healthy she was considering she smoked for 50 years. When my father passed away, I moved her closer to me and she lived in Connecticut. Since she moved, she had to choose a new Medicare Plan. I tried to help her select a plan but it was incredibly confusing. I would call up Medicare.gov and ask questions and they would read me a script. I would ask another question and they would read me the same script. Rephrase the question, get the same useless script for a response. I had no idea the difference between Original Medicare and Medicare Advantage. I chose Anthem Blue Cross Blue Shield since I was familiar with them. If you go to their website they steer you toward a Medicare Advantage plan - “convenient, low cost, with additional benefits vision, dental, gym”. Who wouldn’t want the Medicare Advantage plan vs a more costly confusing plan.

My mother’s Experience with Medicare Advantage

The Medicare Advantage plan initially worked well for her when she was relatively healthy. Then she went into an Assisted Living Facility - Sunrise in Stamford Connecticut. None of the doctors, podiatrists, physical therapists who came to her facility would accept any Medicare Advantage Plans because they get paid a lot less. I had to find doctors that would take a Medicare Advantage Plan and drive her to her appointments. Since she smoked for almost 50 years, and although she quit for 20 years she developed COPD (Emphysema) and I had to get her an oxygen concentrator. Unfortunately the Medicare Advantage Plan would only pay for a huge oxygen concentrator and not a portable oxygen concentrator. This meant if she wanted to breathe well, she had to stay in her room and couldn’t go anywhere unless she wanted to go without oxygen. The Pulmonary Specialist and I appealed and appealed this decision by the Medicare Advantage plan. I finally got the portable oxygen concentrator approved, but the only company that would accept Medicare Advantage was this poorly run Medical Supply company. After calling every executive at this Medical Supply company, I got her a portable oxygen concentrator. If she had Original Medicare, Original Medicare would have authorized the portable oxygen concentrator much earlier and I could have dealt with better Medical Supply companies to acquire the portable oxygen concentrator.

My Mother’s Experience in the Hospital

My mother developed pneumonia and the assisted living facility sent her to Stamford Hospital.  Medicare Advantage did a good job of covering her hospital expenses. Since she was in bed for over a week, she needed to go to a Rehab Facility to avoid being wheelchair bound for the rest of her life. She was transferred to a Rehab Facility that took Medicare Advantage. The Rehab Facility and I had to keep calling Anthem Blue Cross Blue Shield Medicare Advantage  to get her stay extended. Eventually her time ran out and she was transferred back to assisted living. Unfortunately the physical therapist who worked out of her assisted living, and that my mother would work with would not take Medicare Advantage because of the low payments. My mother wouldn’t work with any of the other physical therapists who took Medicare Advantage. My son Jake had recently graduated and wasn’t starting his job for a few months. He went every day to visit his grandmother to get her walking. He was the only one who could get her out of her wheelchair. Eventually my mother returned to walking with a walker which was a miracle. This wouldn’t have happened if Jake hadn’t gone every day. But I still didn’t really understand the differences between Original Medicare and Medicare Advantage. I thought she had Medicare and told all the doctors that she had Medicare. She didn’t. She had Medicare Advantage. Big Difference.

The Final Straw of Medicare Advantage

The final straw was when I was notified by Anthem that the Medicare Advantage plan would no longer pay for her COPD inhaler that she needed daily to breathe. By pure dumb luck, she lived in one of the four states (NY, CT, MA, ME) that required a Medigap plan to accept her without regard to her preexisting conditions. In any other state, there is no way that a for profit insurance company that sold a Medigap plan would accept a woman in her 90s with COPD. We had to wait a number of months for the annual enrollment period. I switched her to Original Medicare, plus a Medigap plan from Blue Cross, plus a drug plan. Big Difference. Any doctor that came into her facility was thrilled to take Original Medicare. Instead of driving her to the nail salon to get her toe nails trimmed (and tipping exorbitantly), the podiatrist who came weekly to her assisted living took care of this. The GP doctor who came into the assisted living now saw my mother when he came to the assisted living facility and I didn’t have to drive her to appointments.

What Did I Learn?

I was fortunate that I was able to get my mother the healthcare that she needed because Jake and I were so actively involved in her healthcare and I had the time and tenacity to appeal Medicare Advantage decisions. I was also lucky that she was in a state (Connecticut ) that allowed her to buy a Medigap plan without penalty after the initial enrollment period at 65.

What Medicare Plan Am I Going to Choose When I’m 65?

I know that the plan that I choose during the initial enrollment period at 65 is the plan that I will have for the rest of my life. My priority is to choose a plan that will allow me to choose the best facilities and doctors if I’m really sick. I’m willing to forgo the Medicare advantage extras such as Dental (few dentists take it), Vision, and Gym Memberships. I’m also willing to pay a higher premium  to ensure that I have the best medical and drug coverage.

First I will schedule an appointment with Medicare Consultant  Gene Ranney (941-716-4348) to do an analysis of which is the best Medigap Plan for me. Gene Ranney helped my brother and sister-in-law pick the best Medigap and drug plan for them. I will pick the best Medigap category (currently G) and choose the company that he recommends. He will also do an analysis of the best drug plan for me based on my medications and where I like to buy it from. I know that unlike the Medigap Plan, I can switch drug plans every year.

NOT FINANCIAL ADVICE

The information contained in this article is for informational purposes only and shall not be understood or construed as financial advice. I am not an attorney, accountant, or financial advisor, nor am I holding myself out to be.  I do not accept any fees or commissions from anyone or any financial institution. 

I’d love any feedback on these articles.