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Memory Care Insurance Concerns
I'm just starting with some very concerning memory issues with my mom. I'm not getting any guidance from her PCP, so no Dx. There's been no referrals yet, and I'm just hanging out to dry right now.
Since we are in insurance decision time to select what kind of Medicare supplement, I'm wondering if a change in her coverage is warranted. She's currently in a BC Medicare Advantage plan, but I'm thinking a better plan might be a good idea.
Can anyone offer ideas on what to look for in a plan that would help with memory care? Anything else I should be aware of? I'm very green here on establishing a plan on what she needs.
Please take a good look at Long Term Care insurance. You will not be able to get this post diagnosis.
Re medicare and AD; I do not think there is any real benefit in Medicare. I would look at the plans hard and decide if you want to be able to choose your Drs in the future.
You can be expecting more frequent office visits in the future, so it makes sense to get something less bare bones than an Advantage plan, although those plans are different too. Plain old Advantage makes sense for otherwise heslthy people who see their doctor once a year, with maybe the occasional bad cold or sprained ankle.
My mother ended up seeing a lot of specialists. The extra cost in premiums was outweighed by the savings on the co-pays. Unfortunately, there is no Medicare benefits for the custodial care a dementia patient might need. No home aides, no residential facilities. Until a patient qualifies for hospice. Then some home nursing help is provided along eith respite csre in a hodpice facility every teo months, I think it was.
I was very grateful to have traditional Medicare for my LO, with a secondary as well.
Medicare Advantage plans usually have the gatekeeper PCP a severe disadvantage. They promise lots of free stuff that isn't free.
You will be evaluating policies with an eye to healthcare, doctor visits, labs, diagnostic services, etc. Not long term care.
Somebody can correct me if wrong, but IME, as others said here, there is no Medicare plan or supplement that pays for MC facilities. For that, you need specific long term care insurance, which can be impossible to get once they need it, and/or reach senior age.
If you get a Dx it really is impossible to get Lon-term care insurance. Otherwise, the hurdle is pre-existing conditions that many if not most people have after age 65. Actually, you can technically get it, but the monthly cost is what you would pay for MC facility regardless, IME.
Medicare and/or the supplementals can pay for many doctor visits, and may pay for drugs you need. But not the MC help that most people need. And yes, that is a problem.
I agree with King Boo and Unforgiven that traditional Medicare with supplements are the best way to go. My mom has VD and is starting to deteriorate. She currently has traditional Medicare plus a supplement (plan F) and prescription drug coverage. Between the primary doctor (PMD) and specialists we have had 10 doctor visits this year, plus four major procedures. Yes, this insurance coverage is expensive. We pay the co-pays for the drugs, and only 300.00 out of pocket for any of the MD visits and procedures.
Realize that you will have to make a decision whether to pay upfront in monthly insurance coverage versus the back end costs of what Medicare Advantage decides not to pay. Due to opaque billing procedures from hospitals, MDs, etc., you will not be able to budget accurately what you will be required to cover with Medicare Advantage. Your actual initial savings with Medicare Advantage maybe less than what you think.
Long term care coverage (LTC) is screamingly expensive. Many insurance companies are dropping or selling off their LTC portfolios because it's become a major money pit (less profits!) for them. Make absolutely sure that it's a reputable company because there are many scammers in this type of insurance.
If your current circumstances suggest that you could not care for mom yourself should she turn out to have Alzheimers or similar, you want to get good financial planning advice from an elder law attorney. Medicaid (different from Medicare) does generally cover memory care and nursing homes. The rules for Medicaid vary by state and are strict, so you want to make sure you have things done properly. This involves spending down her assets on her care and then the program would pick up the cost of her care when her own resources run out. You can start by googling Medicaid your state 2019 to get an idea. Even if mom has decent resources now, they can go fast. A residential care facility can cost $80,000 or more per year. A good elder law attorney will be able to guide you and give advice on this. Hope this helps.
The idea behind getting a specific diagnosis is that there are numerous diseases that can cause memory loss and dementia. Alzheimers is one, others include vascular dementia, Lewy Bodies, Parkinsons disease, and there are others. Not all respond to the same medications, whether that be Donepezil or if she started taking something for delusions down the line etc. It's best to get a diagnosis if possible which often involves a neurologist, neuro psychologist, and imaging such as an PET scan or MRI. It can be challenging for some to do, and they just stick with the PCP and basic treatments working on the assumption of the PCP.
However, if you feel unsupported by her current doc I would shop around. You are going to need someone you can work with. Eventually things will come up and you want someone who listens and is available and is willing to try trial and error etc.