Question about Medicare

[TieKitty]

My mother had a pretty severe stroke 4 years ago and started living with my sister in another state. She was fairly ambulatory at the time and my sister would drive her to her home in Albuquerque, NM to visit her doctors.

Well, now 4 years later she can barely get out of bed and the doctors in my sister's town (Alamogordo) don't accept her insurance. It's a local plan (in Albuquerque) that's backed by Medicare. The doctor at the urgent care center in Alamogordo suggested she get a different Medicare plan.

My sister called last night and told me that she doesn't have the time to investigate the different programs. And having gone to the Medicare website I can understand why. I'm at a complete loss. I think I'm going to see if there's a plan that is similar to the one she has, but I hate being in a position to make such a drastic decision regarding my mother's health care.

Any suggestions? Any ideas would be greatly appreciated.

[boisewinesnob]

From what I can recall, there are 2 different options she will have. She can buy a supplemental policy (like AARP) which would be billed secondary to Medicare. This might not do her any good though, if no doctors in that town will take new Medicare patients.
Her other option is to buy a policy which is billed in place of Medicare. Usually BC/BS will offer these and maybe a few other companies (I think Sterling has one). They are generally not cheap, but she might have more luck getting care that way.

[LakeMartinGal]

Walgreens and other pharmacies bill themselves as helping with medicare planning -- can you ask there?

[DmOrtega]

On this page, http://www.medicare.gov/MPPF/Include/DataSection/Questions/Welcome.asp?version=default&browser=IE%7C7%7CWinXP&language=English&year=2008&PDPYear=2008&MAPDYear=2008&defaultstatus=1&pagelist=MPPFHome&MPDPF%5Fzip=&type=ZIPCOUNTY&ExternalSourceID=&MPPF%5FPDP%5FIntegrate=N , you will find in the lower left a box to Learn More About Health Plans in Your Area. Select New Mexico and click on view plans. I found 92 participating plans listed on a simple grid which shows what is covered and contact information. You may need to click on Show plans, if you don't see any listed below.

Here's a simple explanations of the medicare coverage options.

Original Medicare Plan

This fee-for-service plan covers many health care services. You can go to any doctor or supplier that is enrolled and accepts Medicare and is accepting new Medicare patients, or to any hospital or other facility.

Medicare Health Plans (like HMOs and PPOs)

These plans are approved by Medicare and run by private companies. When you join one of these plans, you are still in Medicare. Some of these plans require referrals to see specialists. They provide all of your Part A (hospital) and Part B (medical) coverage. They generally offer extra benefits, and many include prescription drug coverage. These plans often have networks, which means you may have to see doctors who belong to the plan or go to certain hospitals to get covered services. In many cases, your costs for services can be lower than in the Original Medicare Plan, but it is important to check with the plan because the costs for services will vary.

Medicare Prescription Drug Plans

These plans add prescription drug coverage to the Original Medicare Plan, some Medicare Cost Plans, some Medicare Private Fee-for-Service Plans, and Medicare Medical Savings Account Plans.

Medigap (Medicare Supplement Insurance) Policies

These policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If you are in the Original Medicare Plan, you could get a Medigap policy to help cover the extra health care costs.

[TieKitty]

Thank you all for your input.

DmOrtega, I found that site this AM and it was pretty overwhelming for me due to all of the choices.

My mother is also covered by Tricare for Life which is a military benefit and her coinsurance. When I looked into that today there was a note to not change insurance until they were contacted.

I called the Dept. of Defense. They couldn't give me much information because I'm not her Power of Attorney...my sister is. But she talked in circles (deliberately to help me out) enough so that I confirmed that my mother has to be on Medicare Parts A & B to even be eligible for Tricare for Life. Why the doctors there didn't accept her insurance I don't know, unless she didn't have her medicare card.

The next step is calling the Social Security Administration for more information but I think my sister will have to do that or add me to the POA.

Thank you all for your input. Once again my confidence in this BB is confirmed.:)

[MinEaston]

TieKitty, good luck!

I don't know if the New Mexico Quality Improvement Organization (QIO) can help you out, but it's worth giving them a call. These QIOs are contracted by Medicare to monitor Medicare quality of care, and part of their work is beneficiary complaints, etc. I don't know if their beneficiary coordinators can help with choosing a plan, but they might. Here's the link (http://www.nmmra.org/beneficiaries/) to their beneficiary page.

(Disclaimer: I work for the MD/DC QIO, so while I know above, I can't refer you to our beneficiary people, because your mom isn't a MD/DC beneficiary)

[sararosalie]

Based on experience I had with my parents, it is hard to find many doctors who are taking on new Medicare patients. Medicare (and Medicare health plans) don't pay as much as non-Medicare insurance. So, maybe the thing to do is to call some doctors and see if they are taking new Medicare patients. If they are, ask them which plans they accept.

You might try calling community organizations that support the elderly in your mom's area. They might have a health care person who can help you through this.

[DmOrtega]

The next step is calling the Social Security Administration for more information but I think my sister will have to do that or add me to the POA.

You are right. You will not be given any more then general information unless you have the power of attorney. The plans that I found vary. It all depends on what issues your dm is dealing with as to which plan will be best for her situation, at her location. We cannot make that decision any easier for you. You're sister needs to be in on this as she is the primary care giver to your dm and holds the only power of attorney. Also, you are getting some information and that will be helpfull.

I hate these kinds of issues, I've dealt with similar things with my dm. I urge everyone to put your own plans on paper. Always have a backup power of attorney in the event the primary cannot or won't do it. Also, a medical directive is important. Keep them current to where you live. We can all avoid this sitution if we do this.

[TieKitty]

I hate these kinds of issues, I've dealt with similar things with my dm. I urge everyone to put your own plans on paper. Always have a backup power of attorney in the event the primary cannot or won't do it. Also, a medical directive is important. Keep them current to where you live. We can all avoid this sitution if we do this.


This is very good advice. After my dad passed away my DS and I were reviewing my DM's papers. She has a DNR and a medical directive. When it came to the POA I suggested to my sister and DM that I be added to the POA as a successor in case something happened to her. My sister was very adamant about not adding me. Control issues, maybe?

I've been concerned about something happening to my DS since she is a heavy smoker, is very overweight and has already has a mild heart attack. She doesn't have a POA or any medical directives. (But, I digress).

[boisewinesnob]

it is hard to find many doctors who are taking on new Medicare patients. Medicare (and Medicare health plans) don't pay as much as non-Medicare insurance. So, maybe the thing to do is to call some doctors and see if they are taking new Medicare patients.

This is so true! The Medicare reimbursement rate is horrible for providers.
ie: on a $90 visit, they will pay about $20. So it's no surprise that a lot of doctors aren't taking new patients.
I'm not sure if it's a federal law or only state, but I've heard that once you are an established patient and then you later qualify for medicare (or medicaid) they have to take you. So depending on how important this issue is to you/your mother, it might be better for her to live where she has doctors who have already treated her. But again, I don't know if this is only true in the states I'm familiar with or all states.