My Dad, who was recently diagnosed with frontotemporal dementia, lives in rural southern Oregon, where there is a breathtaking shortage of doctors who will take Medicare. He's currently on a Medadvantage plan, but I suspect this may be making his healthcare provider access issues worse ... because not only have I struggled to find him a primary care provider who will take new Medicare patients at all, but I also have to find one who is inside his Medadvantage network. I finally found one in his small town early this year (and it took me literally 4 months to get a "new patient" appointment with that clinic), but my Dad really dislikes him and is resistant to going to see him. So I'm back to square one. Since my Dad's on a Medadvantage plan, he has to have a GP-type doc in order to get referrals to specialists -- such as the referral earlier this year to the neuropsychologist I knew we needed to see for extensive cognitive testing.
So now it's Medicare Open Enrollment period (Oct 15 - Dec 7 this year), and I have an opportunity to change plans. I'm leaning toward switching to a Medicare supplemental policy (Medi-Gap) and adding prescription drug (Part D) coverage, because I've read that Medi-Gap plans will be accepted by any doctor who takes Medicare patients (as opposed to only doctors within a provider network), and because I've read that if you have Medi-Gap coverage, you can see a specialist directly without first needing a referral from your GP. It looks to me as if Medigap + Part D will, on average, cost more than my Dad has been paying in monthly premiums for his Medadvantage plan, but I would be willing to pay more for more flexible/better coverage than he's had.
I wanted to ask those of you who have been managing this for parents with dementia for awhile ... what did you decide to do in terms of coverage, and how has it worked for you? My Dad is not yet on any prescription meds for his condition, but that may well be coming down the road ... are there any hidden "pitfalls" for a dementia patient, in terms of choosing Medadvantage or Medigap + Part D, that I should be aware of?
Thanks so much in advance for any advice or pointers ...
Ross, thank you in particular for info that was completely new (and not good news) to me. I'm now feeling completely responsible for the situation my Dad is in ... :-( Two years ago, his former employer switched all retirees completely to Medicare, and they had to pick a plan. They could choose between various MedAdvantage or MediGap + Part D plans available in the states where they lived. We were encouraged to talk to advisors at the "partner" company the employer had selected to manage the plan selection and enrollment process. No one told us, either on the phone or on the partner company's website (and this information is STILL not there; I checked today after reading your answer) that selecting a MedAdvantage plan would make it impossible to switch back to original Medicare + a Medigap policy. We were just told that we'd have the opportunity during open enrollment every year to pick a different plan if we were unhappy for any reason. I selected the MedAdvantage plan I did because the provider directory showed a large number (something like 27?) in-network doctors in my Dad's small rural southern Oregon town that were described as "general practitioners," "family practitioners," or "internal medicine specialists." This seemed like a healthy number of choices to me, and I anticipated no problem finding a doctor from that set that my Dad would like.
In actuality, when I actually tried (this year) to find Dad a doctor, it turned out that most of the doctors listed in the provider's directory as "accepting new Medicare patients" (both the printed directory and online) were not. A large number of the general practitioner docs listed all work for the same clinic in town. The receptionist there tells me that not only is the clinic not accepting new Medicare patients, but it has not done so in four years.
I chose this plan for my Dad based on the provider directory's indicating a large number of "in-network" and available doctors. Does the fact that this has turned out not to be the case qualify as the sort of "untrue representation" that I can use to get my Dad guaranteed coverage under a Medigap policy?
Very frustrated. I appreciate the advice to talk to a licensed agent ... is there still value in doing this even though my Dad's employer only seems to "offer" specific MedAdvantage and MediGap plans?
Thank you again for your help. I am frankly horrified by the complexity of this system, and all of the ways you can take a blind turn, make a bad choice (just out of not understanding all the complexities), and get completely cut off from fixing the problem. I am 45 and fairly sharp, and I missed this information when I was researching policies for my Dad 2 years ago. There's no way in a million years he would have understood any of this even then. The whole thing is just frightening, and I can't help wondering what it's going to be like when I "age in." :-(
The major concern I have for you is that if your father has not been on a Medicare Supplement (MedSup or MediGap) plan in the last 12 months, he may not qualify.
A few states have "open enrollment" for MedSup, but when I checked Oregon's web site for you it appeared that they do not: http://www.oregon.gov/DCBS/SHIBA/docs/2012_guide.pdf?ga=t
There is a table on page 7 you can look at.
Medicare's Annual Enrollment Period only applies to Medicare Advantage and Medicare Part D drug plans.
In most states, MedSup plans are only "Guaranteed Issue" (no medical underwriting, can't be declined) during a person's initial enrollment period in Medicare.
Now, if he went from Med Sup to Medicare Advantage last year, he should be entitled to something called a Medicare Advantage "trial right" where-in he can try it for a year and if he doesn't like it he can go back to his old MedSup plan.
It's also worth noting that if your father has dementia he may qualify for a Medicare Advantage Special Needs Plan (also called a SNP). I'd highly encourage you to seek help from a licensed agent.
You can go to our web site (PlanPrescriber.com) and call the number there to reach a licensed agent, or you can call 1-800-MEDICARE or go to your local social security office.
Your Medicare Advantage plan should have an accessible network of doctors, but if the plan your father is on does not, talk to someone and look at other plans available in your area. There may be another insurer that has a better network where you live.
I don't know anything about that Medi-gap you're talking about but I've read a little about it through the documents/package information that Mom and Dad receives directly from Medicare. You may want to contact Medicare directly to get the full information documents mailed to you so that you can read directly what it all means for your Dad.
But I do know that my Mom and Dad have Medicare and Medicare Part D and it covers medications, and all doctors visits, surgeries, ER visits, etc.... They only pay 5.00 per rx and that is really cheap since they were on a lot of medications--which can be astronomically expensive as you already know.
About being referred to a specialist for your Dad to see the neuropsychologist: when your Dad is sick doesn't he have to see his PCP first to find out what is wrong and then the PCP must refer him to a specialist anyway? I mean, you or Dad don't know what is wrong with his brain, if it really is his brain or something else anyway, and cannot see a neurophychologist on your own cause you cannot diagnose him properly to see the neuro-psychologist anyway. My dad had to see a neuro-surgeon too and before he could see him, we didn't know what was wrong with him and had to take him to see his PCP first and then the PCP had to refer him to the specialist because he knew that it was his brain and not his ankle or his stomach or his neck, or anything else that had nothing to do with his brain. They also sent Dad to the Sleep Disorder clinic two times and you cannot just make the appt with them and have anybody just come, make the appt, and and want a sleep over disorder diagnosed. The neuo-surgeon put Dad on meds and Medicare Part D covered it--we only paid 5.00 for the rx, as usual. Get the information directly from Medicare and have them mail you all the packaged information that describes what Medi-gap is and what Medicare part he needs and if he truly needs the Medi-gap part.