Hospice to Medicare Advantage

[WCMason]

Have husband and wife MS clients who go to Mayo Jax. I can also tell you they charge the Part B excess charge.
Although hospice care is covered under MAPD plans. I would have checked with the plan before just giving up an MS plan.

Hospice is not covered by any MA plan or Medigap policy, so there isn’t anything to check. It’s covered 100% by Medicare no matter what other coverage a beneficiary does or does not have.

 

[Chazm]

I hope that is a general rule to which there are some exceptions.

The Medica brochure for its 2018 Kansas ACA plans says members have access to Mayo Clinics through something called the Centers of Excellence Program for some complex medical conditions.

I’m not sure what you mean about a general rule but tons of places accept hmo and PPO’s and since this was posted in the senior forum I’m assuming we’re talking about Medicare plans and not the ACA

 

[sshafran]

I hope that is a general rule to which there are some exceptions.

The Medica brochure for its 2018 Kansas ACA plans says members have access to Mayo Clinics through something called the Centers of Excellence Program for some complex medical conditions.

Bunch of race car drivers, in a race car forum, talking about driving fast and how 150 MPH would be slow.

LostDollar comes in - "My conversion van doesn't even reach 150. It tops out at 105mph. Ya'll must be talking in general terms about 150 being slow...because 105 felt pretty fast to me."

or...

A bunch of senior agents talking about MAPD HMO's and PPO's & Med Supps - and LD comes in to talk Major Medical / ACA... gently correcting us by informing us that he found an exception.

 

[somarco]

I have not looked at all the claims but he had a bunch (200+) so far this year. I clicked on a few and did not see any hospice care claims so he is still receiving some kind of treatment. The claims I viewed were not paid 100% by Medicare, but 80%, so I presume they are not directly tied to hospice care.

As indicated earlier, he has been in hospice for a year and still here. Been over a year since I last talked with him. He was injecting morphine through a tube for the pain.

It's done. They have made their decision. They have to live with it.

And yes, this IS Medicare.

He had a supplement plan but will go on the HMO 1/1/18.

And yes, JAX Mayo does bill xs charges and they DO not accept MA plans.

 

[sshafran]

I have not looked at all the claims but he had a bunch (200+) so far this year. I clicked on a few and did not see any hospice care claims so he is still receiving some kind of treatment. The claims I viewed were not paid 100% by Medicare, but 80%, so I presume they are not directly tied to hospice care.

As indicated earlier, he has been in hospice for a year and still here. Been over a year since I last talked with him. He was injecting morphine through a tube for the pain.

It's done. They have made their decision. They have to live with it.

And yes, this IS Medicare.

He had a supplement plan but will go on the HMO 1/1/18.

And yes, JAX Mayo does bill xs charges and they DO not accept MA plans.

not that you'd want to write it, and I wouldn't blame you if you didn't, but if they really get stuck and it's his first time for his wife making a dumb decision and enrolling him in a mapd, at least he can decide that his "trial right" did not go as planned and come crawling back to the med supp...

I know you know that, but others may not...

 

[somarco]

Yeah Scott, I do know that. This crazy woman has pi$$ed me off too many times. Today when she called she got miffed because I told her I could not cancel his plan. They would have to call, not me.

Then she asked for the number.

When I didn't give it to her by memory she said "You don't know the number?". I could hear her talking to her husband "He doesn't even know the number".

Well no, but give me a second and I can look it up.

And no, I am not going to rewrite it. If they want to come back they can go direct to the carrier. I don't need this kind of drama in my life.

Glanced back through his claims and clicked a few. Got to be over 500 claims for 2016 and 2017. Didn't see any huge bills but I know they are in there. The few I looked at ranged from $40 to $600 paid @ 80% by Medicare.

Just clicked on one for Mayo (could be inpatient) for $12k+ paid @ 100% (of the approved amount).

Here is a rehab bill for $2800 paid @ 80%.

Another for a local (to him) hospital for $2,000 paid @ 80%.

 

[sshafran]

Yeah Scott, I do know that. This crazy woman has pi$$ed me off too many times. Today when she called she got miffed because I told her I could not cancel his plan. They would have to call, not me.

Then she asked for the number.

When I didn't give it to her by memory she said "You don't know the number?". I could hear her talking to her husband "He doesn't even know the number".

Well no, but give me a second and I can look it up.

And no, I am not going to rewrite it. If they want to come back they can go direct to the carrier. I don't need this kind of drama in my life.

Glanced back through his claims and clicked a few. Got to be over 500 claims for 2016 and 2017. Didn't see any huge bills but I know they are in there. The few I looked at ranged from $40 to $600 paid @ 80% by Medicare.

Just clicked on one for Mayo (could be inpatient) for $12k+ paid @ 100% (of the approved amount).

Here is a rehab bill for $2800 paid @ 80%.

Another for a local (to him) hospital for $2,000 paid @ 80%.

There is certainly an element of "let's see how well this works out for you, and don't ask for my help again as the door hits you on the way out" to all of it.

There is a (huge) difference between a client making an honest mistake and not understanding what they signed up for and a client who believes that you've ripped them off by giving them bad advice, when really, you did not.

The latter can find a new agent.

 

[midwestbroker]

Hospice is paid by Medicare 100%. If they have an MA plan, Medicare will bypass the plan and pay the hospice company direct. However, any claims not associated with the hospice condition (the main medical condition the client is on hospice for) will not be paid by hospice. Example: a client goes on hospice for cancer but also has COPD. If they go to a doctor appointment for COPD, they will pay like they did (MA plan or Medicare / Supp) prior to hospice.

Also, if the client goes to the hospital as an inpatient, more than likely regardless of why they are an inpatient, they will be discharged from hospice for the stay and then will go back on hospice once they are discharged. Hospitals are considered curative care and hospice is palliative care, and Medicare will usually not pay for both if the patient is in the hospital.

 

[GoPokes]

Yeah Scott, I do know that. This crazy woman has pi$$ed me off too many times. Today when she called she got miffed because I told her I could not cancel his plan. They would have to call, not me.

Then she asked for the number.

When I didn't give it to her by memory she said "You don't know the number?". I could hear her talking to her husband "He doesn't even know the number".

Well no, but give me a second and I can look it up.

And no, I am not going to rewrite it. If they want to come back they can go direct to the carrier. I don't need this kind of drama in my life.

Glanced back through his claims and clicked a few. Got to be over 500 claims for 2016 and 2017. Didn't see any huge bills but I know they are in there. The few I looked at ranged from $40 to $600 paid @ 80% by Medicare.

Just clicked on one for Mayo (could be inpatient) for $12k+ paid @ 100% (of the approved amount).

Here is a rehab bill for $2800 paid @ 80%.

Another for a local (to him) hospital for $2,000 paid @ 80%.

Honestly I would feel the exact same as you if I got this call. That's why I didnt bring up the trial right in my initial response.
Im guessing this lady is just so exhausted from slowly watching her husband die, that she is just emotionally torn up, and you just happen to be catching some of her frustration. Her anger towards you really has nothing to do with you, she is just communicating poorly. And even if she isnt dumb, she is likely not in a frame of mind to process things clearly. Im assuming when they got the supp, he was healthy, and they were able to weigh the benefits better. Either way, Im sure you'll have no problem forgetting about this and moving on.

 

[BeeSelective]

I believe Modernized supplement plans pay hospice, standardized plans do not. ( Rather than posting what I think I know, I should research it first...lol)

However, if I’m wrong, there will be no shortage of those who will let me know.

Doing this will help others learn!