[affald]

I have an 82 year old friend, spends 7 months in Westchester NY, now has an opportunity to spend 5 months in Florida. He is eligible in NY for Medicaid as well. (Dual Eligible Special Needs Plans (D-SNPs)

He is getting mixed messages from different sales people about which advantage plan would work best in both NY and Florida. The Florida smile associate association does not give any NY advice.

Does anyone have information or can point him to a trusted source of honest info?

Thank you.

[JMintzer]

Originally Posted by affald

I have an 82 year old friend, spends 7 months in Westchester NY, now has an opportunity to spend 5 months in Florida. He is eligible in NY for Medicaid as well. (Dual Eligible Special Needs Plans (D-SNPs)

He is getting mixed messages from different sales people about which advantage plan would work best in both NY and Florida. The Florida smile associate association does not give any NY advice.

Does anyone have information or can point him to a trusted source of honest info?

Thank you.

Have him set up a meeting with SHINE... It's free, they have no affinity with any insurance plans...

[blueash]

Originally Posted by JMintzer

Have him set up a meeting with SHINE... It's free, they have no affinity with any insurance plans...

Pretty sure that when he said the smile people he meant the shine people would/could not help him with this issue.

[rustyp]

SHINE is a Florida based organization. In order to get an Advantage plan you must first be enrolled in Medicare part A and B. Then you can pick a part C (Advantage plan).

You must enroll in Medicare in your state of primary residence which in his case is NY. He will have to find an organization similar to SHINE that is NY based.

At the risk of making too many assumptions here it sounds like he has an Advantage Plan now. He could go back to Medicare A and B but at 82 yrs old would probably find the supplemental too expensive or impossible to procure. The most portable Advantage plans are usually PPO's not HMO's. The insurance company most likely with the widest network is AARP United Health. My Florida AARP United Health PPO plan works seamlessly for me in reverse - Fl my main residence NY my seasonal residence.

[villagetinker]

Originally Posted by affald

I have an 82 year old friend, spends 7 months in Westchester NY, now has an opportunity to spend 5 months in Florida. He is eligible in NY for Medicaid as well. (Dual Eligible Special Needs Plans (D-SNPs)

He is getting mixed messages from different sales people about which advantage plan would work best in both NY and Florida. The Florida smile associate association does not give any NY advice.

Does anyone have information or can point him to a trusted source of honest info?

Thank you.

Have him (or you) call his current ADVANTAGE plan supplier and ask them specifically what options he has and if necessary can he convert to a PPO option that typically has a lot more options. NOTE: the villages health system only accepts 3 or 4 advantage plans so odds are he will not be able to get into that system, however he should be able to get into other local doctors. I would also suggest he gets copies of the most important (and recent) medical records to hand to the new doctor here, could save a lot of time.

[JMintzer]

Originally Posted by blueash

Pretty sure that when he said the smile people he meant the shine people would/could not help him with this issue.

If he did mean that, I find it odd...

When I was ready to enroll in Medicare, the wife and I set up an appointment with SHINE.

We explained that our primary residence was still in MD, and they pointed us in the right dirction to sign up for UHC in our home area. They explained that one FL becomes our primary residence, we'll have to inform Medicare, UHC and our Plan G of the changes...

[golfing eagles]

Originally Posted by affald

I have an 82 year old friend, spends 7 months in Westchester NY, now has an opportunity to spend 5 months in Florida. He is eligible in NY for Medicaid as well. (Dual Eligible Special Needs Plans (D-SNPs)

He is getting mixed messages from different sales people about which advantage plan would work best in both NY and Florida. The Florida smile associate association does not give any NY advice.

Does anyone have information or can point him to a trusted source of honest info?

Thank you.

So, this person can afford to live in WESTCHESTER for 7 months and FLORIDA for 5 months, yet he is MEDICAID eligible????? Our tax dollars at work again. Plus these "dual eligibility" plans cover things such as rent, utilities, and groceries----yet another form of welfare that got snuck in the back door.

[bowlingal]

Affald....speak with the people at SHINE. They are Medicare people NOT insurance people. Since Medicare is a FEDERAL program, they will give you the correct answers to your questions. They are available at several rec centers at different days and times. Lake Miona, Eisenhower, Chula Vista are a couple of places.

[ChrisTee]

Originally Posted by golfing eagles

So, this person can afford to live in WESTCHESTER for 7 months and FLORIDA for 5 months, yet he is MEDICAID eligible????? Our tax dollars at work again. Plus these "dual eligibility" plans cover things such as rent, utilities, and groceries----yet another form of welfare that got snuck in the back door.

Ok. Well we don't know the whole story so that's just unfounded, lame snark. There are examples of people gaming the system all over but no way is there enough info here to call this 82 year old dude out as a gamer. Save rants for real examples of government welfare abuse when you have ALL the facts - you don't need to look hard, just smart.

[virtue51]

Whatever plan he selects, he really needs a plan in which he is not limited to a network of doctors located in Florida or New York. The majority of Medicare Advantage plan have a network of hospitals and doctors -- often out-of-network providers are only available in emergency situations. Given his age and the fact that he will be spending months in New York and Florida, he needs a plan that allows him to go to a hospital or provider without restrictions of a network in a geographic location. The option that provides him access to health providers in the United States is Medicare Parts A and B with a supplemental plan.

[DrHitch]

Originally Posted by golfing eagles

So, this person can afford to live in WESTCHESTER for 7 months and FLORIDA for 5 months, yet he is MEDICAID eligible?

This person may be living under somebody else's roof (no fixed cost) in both places, so it's judgemental to criticize his Medicaid eligibility IMHO.....

[golfing eagles]

Originally Posted by ChrisTee

Ok. Well we don't know the whole story so that's just unfounded, lame snark. There are examples of people gaming the system all over but no way is there enough info here to call this 82 year old dude out as a gamer. Save rants for real examples of government welfare abuse when you have ALL the facts - you don't need to look hard, just smart.

Originally Posted by DrHitch

This person may be living under somebody else's roof (no fixed cost) in both places, so it's judgemental to criticize his Medicaid eligibility IMHO.....

Thank you for your "replies". Rest assured, after I respond, I will file them where they belong, which is convenient since my dog just did #2.

To the second part first: These dual eligibility plans are a crock. They are shoveling out welfare through the back door in the guise of health insurance. Just another way to reach into everyone's (meaning net tax payers) pockets.

As far as not knowing the details, you guys are right, perhaps he is in an unusual circumstance. I never said he was a "gamer", but I don't see people who can afford to be "snowbirds" qualifying for Medicaid, in general. Perhaps he is on hemodialysis, in which case that's fine. But for the other 99%, it leaves a question.

[DollyL]

Originally Posted by affald

I have an 82 year old friend, spends 7 months in Westchester NY, now has an opportunity to spend 5 months in Florida. He is eligible in NY for Medicaid as well. (Dual Eligible Special Needs Plans (D-SNPs)

He is getting mixed messages from different sales people about which advantage plan would work best in both NY and Florida. The Florida smile associate association does not give any NY advice.

Does anyone have information or can point him to a trusted source of honest info?

Thank you.

I do have a UHC Advantage plan that is deducted from my Social Security check every month. I do not pay extra for a supplemental plan as I do not have one.
When I travel out of state, all I have to do is call UHC and activate my “passport” that is in my plan & I can see any doctor or hospital in the state I am visiting. You just inform UHC of the dates & states you are going to. I know that this is a Florida plan, but maybe other states have the same plan with a “passport “. And it doesn’t have to be for emergencies only. The doctor just has to be a participant with UHC.
As to Medicare & Medicaid, my father qualified for both. If he had lived long enough, I would have made him a snowbird. He would have lived with me during the winter, and he would have lived with my other siblings in New York during the summer. My dad had outlived his savings & only relied on his Social Security & Pension from month to month as his Rx’s were expensive, besides food, clothing & diapers.
Going to “Shine” is a great idea because I’m sure they can plug in the specialists & primary doctor & all the meds & any health problems. The computer will generate the “best” plans to look into. Be sure that the plan has an affordable “out of pocket maximum. The reason I state that is because my “out of pocket maximum” is only $2400. Because I receive Chemotherapy, once I have paid my $2400, all my future doctors appointments & MRI’s & CT scans & X-rays have no co-pays for the rest of the calendar year.

[wlasowicz]

This person should find a health insurance broker in their primary home state. They should be able to explain all the plans and try to find one that fits their needs. There is no cost to the person as with any health insurance broker are paid by the insurance companies indirectly.

[biker1]

If you had a supplemental plan instead of an advantage plan, your premium costs would probably be around the same $2400 out-of-pocket you are paying now. Everyone pays the Part B premium of $174.70, sometimes more depending on whether you have an IRMAA penalty. However, typically the only additional cost over the supplemental premium you would incur would be the $240 Part B deductible. Therefore, it is pretty much a wash financially.

Originally Posted by DollyL

I do have a UHC Advantage plan that is deducted from my Social Security check every month. I do not pay extra for a supplemental plan as I do not have one.
When I travel out of state, all I have to do is call UHC and activate my “passport” that is in my plan & I can see any doctor or hospital in the state I am visiting. You just inform UHC of the dates & states you are going to. I know that this is a Florida plan, but maybe other states have the same plan with a “passport “. And it doesn’t have to be for emergencies only. The doctor just has to be a participant with UHC.
As to Medicare & Medicaid, my father qualified for both. If he had lived long enough, I would have made him a snowbird. He would have lived with me during the winter, and he would have lived with my other siblings in New York during the summer. My dad had outlived his savings & only relied on his Social Security & Pension from month to month as his Rx’s were expensive, besides food, clothing & diapers.
Going to “Shine” is a great idea because I’m sure they can plug in the specialists & primary doctor & all the meds & any health problems. The computer will generate the “best” plans to look into. Be sure that the plan has an affordable “out of pocket maximum. The reason I state that is because my “out of pocket maximum” is only $2400. Because I receive Chemotherapy, once I have paid my $2400, all my future doctors appointments & MRI’s & CT scans & X-rays have no co-pays for the rest of the calendar year.