Medicare advantage costs with Parkinsons

[Anonymous]

If you have parent with Parkinsons do they generally meet the Medicare Advantage cap of 8k?

Obviously costs will vary but we are trying to figure out a tricky situation and it is difficult to determine how much average yearly costs are with Medicare advantage.

[Anonymous]

My Dad had Parkinsons with Medicare Advantage. I am not sure about an 8K cap. I do know they were very quick to stop paying for skilled nursing after a hospital stay...despite the fact that he could not stand up and needed a catheter. Took 4 appeals to get additional coverage but he was at end of life stage by then.l

[Anonymous]

Anonymous wrote:My Dad had Parkinsons with Medicare Advantage. I am not sure about an 8K cap. I do know they were very quick to stop paying for skilled nursing after a hospital stay...despite the fact that he could not stand up and needed a catheter. Took 4 appeals to get additional coverage but he was at end of life stage by then.l

This may have been a Medicare thing where you have to be improving to stay in skilled nursing. Medicare Advantage members are entitled to the same benefits as Original Medicare beneficiaries (might require an appeal, but they shouldn't be denying benefits that would be paid for under Original Medicare).

[Anonymous]

Is this person newly eligible for Medicare? There's not going to be a cost sharing cap in Original Medicare, so is his other option that + Medigap to cap his costs? Also make sure you are accounting for both in and out of network benefits in the MA plan, if applicable.

You should also contact his state's SHIP (State Health Insurance Assistance Program) for help choosing plans or remaining in Original Medicare.

[Anonymous]

Anonymous wrote:

Anonymous wrote:My Dad had Parkinsons with Medicare Advantage. I am not sure about an 8K cap. I do know they were very quick to stop paying for skilled nursing after a hospital stay...despite the fact that he could not stand up and needed a catheter. Took 4 appeals to get additional coverage but he was at end of life stage by then.l

This may have been a Medicare thing where you have to be improving to stay in skilled nursing. Medicare Advantage members are entitled to the same benefits as Original Medicare beneficiaries (might require an appeal, but they shouldn't be denying benefits that would be paid for under Original Medicare).

This is not true. There is no requirement that the patient is improving.

[Anonymous]

Anonymous wrote:Is this person newly eligible for Medicare? There's not going to be a cost sharing cap in Original Medicare, so is his other option that + Medigap to cap his costs? Also make sure you are accounting for both in and out of network benefits in the MA plan, if applicable.

You should also contact his state's SHIP (State Health Insurance Assistance Program) for help choosing plans or remaining in Original Medicare.

No, they already have regular medicare and tribal healthcare = so zero costs.

I think it is a bad idea to get out of that system but I am trying to ascertain what the extra costs would be and if I am being unreasonable. It seems ridiculous to me to give up the tribal healthcare.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My Dad had Parkinsons with Medicare Advantage. I am not sure about an 8K cap. I do know they were very quick to stop paying for skilled nursing after a hospital stay...despite the fact that he could not stand up and needed a catheter. Took 4 appeals to get additional coverage but he was at end of life stage by then.l

This may have been a Medicare thing where you have to be improving to stay in skilled nursing. Medicare Advantage members are entitled to the same benefits as Original Medicare beneficiaries (might require an appeal, but they shouldn't be denying benefits that would be paid for under Original Medicare).

This is not true. There is no requirement that the patient is improving.

This is something everyone should be aware of as there is lots of misinformation...

https://www.cms.gov/medicare/settlements/jimmo

[Anonymous]

If Medicare advantage isn’t working, my understanding is you can switch at the next open enrollment.

Overall, this is a difficult program since it’s run by companies and not the government. But they celebrities to promote it and people believe them.