What to do about a Medicare Advantage Plan that's being terminated

In My Humble Opinion
1

My father is a 77 year old man with numerous serious health conditions, none of them imminently fatal. They include: kidney stones, reduced kidney function, uncontrolled type 2 diabetes, Myasthenia Gravis, cataracts, moderate hearing loss, and heart disease with a history of strokes and heart attacks. He falls regularly and can only sometimes pick himself back up. He barely has the strength to walk 50 feet. Sadly, he’s been in this state for a couple of years. At this moment, he’s staying in a rehab facility after becoming disoriented while driving and crashing his car. He was not badly injured but all the underlying problems are still there, so he’s in rehab.

He told me that Blue Cross Blue Shield of Massachusetts is terminating the Medicare Advantage plan he currently has. I understand that he also has part D drug coverage. Some person (case worker? billing department?) at the rehab facility told him that he has until February 28 to change health plans because of the termination. The rehab facility has recommended that he switch to Medicare. I have no idea what his other options are, if any. I don’t know what happens if he doesn’t choose to switch. The rehab worker told him that Medicare will cover more of his rehab stay, and I’m not sure how long he’ll be there. The rehab worker was uncertain about what coverage would be like for his other health care needs. I am not his health care proxy; that’s my niece. She’s wonderful in many ways but I don’t know what she knows about Medicare or insurance.

What are his likely options? What should he consider before he makes a decision? Thanks in advance.

2

A mid-year termination of a Medicare plan is really strange, especially from a big, established insurer like a Blue. I think you need to get the full story from BCBSMA here, especially since you’re also being told that has to pick a different plan RIGHT NOW (which is also very strange).

Normally, if an insurance company decides to stop offering a particular supplemental Medicare plan, that change takes effect on the 1st of the year, and someone who has been on a plan that’s being terminated would be notified well ahead of time, and have months to choose a new plan. (That said, the information you shared above doesn’t say when your father was informed of this.)

My strong suspicion is that there’s more to this story than the information which you currently have.

3

Is this the plan he has - https://medicare.bluecrossma.com/member-resources/plan-information/PPO-saver-discontinuation#:\~:text=The%20Medicare%20PPO%20Blue%20SaverRx%20plan%20is,\*\*Medex%20Supplement%20plans\*\*%20\*%20\*\*Prescription%20Drug%20plans\*\* ?

It seems that he should have been notified before now, as the plan was not available as of Jan 1.

According to the website , if he doesn’t enroll in a new Advantage plan , he will be enrolled in original Medicare which does not have prescription coverage.

4

Thank you. I’m not certain that’s the plan but it seems likely. Based on what he has told me about his plan, it’s a PPO plan. I know it’s BCBS of Massachusetts.

He probably received notice but he has been in denial for a long time about how badly his vision has deteriorated, so I doubt he’s reading his mail closely. He also has sufficient health problems to interfere with his cognitive function and, if I may be blunt, he was never the sharpest tool in the shed. Hhe has never been able to admit he doesn’t understand something and seek help, so I doubt he understood what was happening. Presumably, he has no coverage now at all.

My niece tells me he may be eligible for Medicaid but she hasn’t completed the application. He was only admitted to the rehab on Sunday (hospital on Saturday), and since then his portion of the state was buried under two feet of snow.

So it seems like his options are pick a new Medicare Advantage plan with drug coverage (which he will almost certainly need given the rainbow cocktail of drugs he needs) or he can switch to Medicare with no drug coverage. If he has no drug coverage, he won’t pay out of pocket and, frankly, I don’t think he’ll last very long.

Does Medicaid come with drug coverage? i believe it does, right?

5

Unfortunately, I’m many hundreds of miles away and I have no legal authority to help manage his affairs. There’s nothing I can look at and BCBS isn’t going to tell me anything.

6

Yeah, I think that those are the options: switch to a new Medicare Advantage plan which covers his prescriptions, or go back to “base Medicare,” which does not cover prescription drugs. My educated guess is that he has a two-month “grace period” after his old Advantage plan ended to get on a new one, and that ends on the 28th.

Medicaid varies quite a bit by state. It’s fundamentally coverage for very poor people. My sister is on Medicaid in Wisconsin, and it does cover some prescriptions, but she’s 57, and not on Medicare; there may be some interaction between Medicare and Medicaid for a senior that I’m not familiar with.

If he needs to be in rehab/skilled nursing for an extended period, that’ll be another issue: Medicare plans won’t generally cover that on an ongoing/permanent basis. Medicaid generally covers long-term care, but only once the patient’s financial resources have been spent.

What he and your niece really need is a navigator or guide who specializes in Medicare, and is in Massachusetts.

7

He will likely be in the rehab facility for one to two months. My personal feeling is he will need skilled round-the-clock nursing care forever after that but he will refuse it.

This is probably true but I don’t know how to find such a person, and he needs to have an informed consultation with that person while in a rehab facility within the next 76 hours. And everyone in his county is still buried under two feet of snow.

8

What you want is the State Health Insurance Assistance Program for Massachusetts

https://www.mass.gov/info-details/serving-the-health-insurance-needs-of-everyone-shine-program

9

I forgot to mention - if he ends up with original Medicare , he can get prescription coverage through a Medicare supplement (also called Medigap). I think he has to enroll on that within 60 or so days after his Advantage end or else the plans can reject him/charge him more due to his health.

10

Most states have companies that offer Part D prescription coverage, in addition to original Medicare. All the Medicare Advantage plans left my state, so that was my only option. I have a plan from Wellcare.

11

If he can get on original Medicare with a Medigap plan without underwriting, he should absolutely do so. Advantage plans are a scam cooked up by the insurance companies to wreck Medicare.

12

ETA: multi-ninjaed while pecking at my phone.

If he switches out of an advantage plan he is eligible to get part D drug coverage as separate insurance from any of many providers. As a separate matter he’s eligible to get a medicare supplement = medigap plan to cover all the stuff basic medicare doesn’t cover. Many companies offer those too.

Both cost money, but not necessarily stupid money.

For his overall situation a different advantage plan is probably the simplest & cheapest option. But don’t make the mistake of assuming it’s just Advantage or nothing.

13

I think that’s right, too.

My semi-educated understanding is that a Medigap plan only covers the portions of doctor and hospital bills that Original Medicare doesn’t cover; Medigap plans do not cover prescriptions. To continue drug coverage without an Advantage plan, he’d need to sign up for a standalone Part D drug plan from a third-party insurer. There, too, he’d need to do it by the 28th.

14

Also, based on @Tired_and_Cranky 's additional posts, what I now suspect happened is:

  • Their dad got notices about his Advantage plan going away on 1/1/26, and either ignored them, couldn’t read them, or didn’t understand them.
  • When dad got admitted to the rehab facility, they ran his Advantage insurance card, and saw that it was invalid (as the plan no longer existed).

In a sense, it’s a good thing this happened last week, and not next week (i.e., after the grace period), or Dad would be even more stuck.

15

I will call tomorrow.

Thanks for the tip. I hope the deadline for that is coterminus with the health care decision.

I confirmed with my mother that that is definitely his plan. Fortunately, my mother has a different plan, so I have only one health care emergency to deal with.

From doreen’s link, I see that there are still Medicare Advantage plans in his state.

I don’t know but at least I have a question to ask. It’s not clear to me whether he is eligible a Medigap plan. Pointing back to Doreen’s link, it simply says the options are to enroll in a new Medicare plan by 2/28 or be enrolled in original Medicare and lose prescription drug benefits. It does not mention Medigap or Part D options.

Thanks for clarifying for me the difference between Medigap and Part D. I had only a vague notion of either and at least now I understand they are distinct.

Which is good, because that’s exactly what he has.

There seems to be a difference of opinion here. My general, very poorly informed impression, is that original Medicare with Part D (and maybe Medigap?) is the option that best serves most people. I’m less than 100% sure that’s possible. Thoughts from the caring hive mind?

Following up with my mother, apparently my father did understand that the plan was going away and he planned to go back to regular Medicare. I don’t know whether he has already made an affirmative decision to do that or if he was just counting on the “default” return to Medicare that is created by the termination of his plan. I also don’t know whether he looked into Medigap or Part D plans, whether he opted into or out of them, or even if those are still options for him. I’m not confident he made the best decisions for himself but he didn’t entirely drop the ball.

He also didn’t articulate that decision to me even though, at the moment, he’s as lucid as he ever is when I talk to him on the phone. When I spoke to him, he seemed to suggest that he still had BCBS. I’m not sure if he was momentarily confused, thoroughly confused, or simply misunderstood when he was returning to Medicare.

16

I kinda-sorta work in the industry – I work in advertising, but for the last decade, my main client has been a state-level Blue company.

That’s my take on it, as well. When you’re on an Advantage plan, AIUI, you effectively now have private insurance, and you have to deal with in-network / out-of-network and all of that. Advantage plans are, generally, where insurers make their money, and a lot of the “added benefits” (dental, vision, Silver Sneakers, etc.) which are bundled into Advantage plans aren’t even used by a lot of their subscribers.

Medigap (Medicare supplemental insurance) “fills the gaps” in Original Medicare, and covers the out-of-pocket things which Original Medicare doesn’t cover (co-payments and deductibles).

17

Yes, generally with Original Medicare you also get a Part D plan for medications; which you have to sign up for separately. And you can have both Original Medicare with a Part D and also Medicaid if eligible; Medicare/Part D pays some and Medicaid picks up most of the rest. (Cite of sorts: I do. NY State.)

18

I think this is what my niece is working on. However, I don’t think he will be eligible for Medicaid, based on my googling about the eligibility standards and what I understand are his resources.

19

@JohnT can probably help here

20

If not, he might want a Medigap plan.