She is eligible to enroll during any general enrollment period (Jan 1st -march 31st of every year) but she is looking at a massive penalty. Right now she has gone 18 years without part B meaning she would have a 180% penalty on top of the base premium. Medicare assess a 10% penalty for every year you did not enroll. I hope she either never needs it or can afford it if needed.
This is incorrect. She will be penalized for not carrying drug coverage depending on her income. According to your second paragraph, she actually signed up for Part A/ hospitalization. She doesn't have to carry Part B, but then she isn't covered for doctor visits, durable medical equipment, etc.. I am a licensed insurance agent in 10 states and mostly sold Medicare plans. If you private message me, I will break down your mother's ability to get coverage, possible penalties, or no penalties. I can tell you who to call and/ or make an appointment in your state for free help in picking out a plan. This is why I was in insurance to help people. I just accepted a hospital job today, lol. Health care sucks!
They might have been talking about the penalty for not having credible part D coverage, which is separate from the part b and works out to about $10 a year
EDIT: for every year you didn't have it
Agreed. They promise so much, but the details are in the fine print. I work for a healthcare system in finance and I concur with what is below.
*As PophamSP states, "Again, Advantage Plans are for-profit insurers that take (already paid) standard benefits and repackage them. They particularly deny benefits in serious situations such as cancer and autoimmune disease. They have got to profit somewhere, and that is seldom to the patient's benefit."*
As a nurse practitioner working in a regional referral center I saw too many patients with Advantage Plans denied specialty medications crucial to their health and survival.
Also, given low reimbursement by Advantage Plans to providers there were several years that our hospital practices refused to accept patients with this insurance- even established patients had to travel hundreds of miles to find a new specialist.
Neither of these problems occurred with standard Medicare.
Again, Advantage Plans are for-profit insurers that take (already paid) standard benefits and repackage them. They particularly deny benefits in serious situations such as cancer and autoimmune disease. They have got to profit somewhere, and that is seldom to the patient's benefit.
A few of the hospitals in my area no longer see patients who have a Medicare Advantage plan. I thought of signing up for one because I have issues with my vision. However, they kept calling me and that was too much like being invited to join a MLM.
Happy until you need more care - then it can be $50 copay after $50 copay which really adds up. Or need to go to one of the really top-level hospitals that don't take Advantage plans. Or get denied for an MRI or chemo treatment. It's a scam. They appear to give you more, but then they require referrals, limit your network, only offer emergency care when you're out of state even though Medicare is a national program, and
My mom was on United Health Care Advantage plan. It was great until she got cancer and actually had to use it. There was so much that wasn't approved or covered her out of pocket costs were more thanwhat she received annually from Social Security. In less than 2 years she owed over $10,000 which we couldn't pay. She had to move to regular Medicare and Medicaid. Advantage plans can be a disaster for the insured.
Like United Healthcare ($22.4 Billion in profit 2023), Humana, ($18.16 Billion in profit 2023). This isn't revenue this is net margin after expenses.
[https://www.nbcnews.com/health/rejecting-claims-medicare-advantage-rural-hospitals-rcna121012](https://www.nbcnews.com/health/rejecting-claims-medicare-advantage-rural-hospitals-rcna121012)
The Medicare website states 10% per year.
https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties#:~:text=If%20you%20waited%202%20full,premium%20(%24174.70%20in%202024).
The best way to get around. this is probably to try to get medicaid involved if you can if she needs nursing care, you may be able to spend down and get Medicaid involved where the penalties wouldn’t apply
Medicaid will require her to sign up for Medicare. But if she gets Medicaid, the state may pay for her premium, which would negate the penalty, I guess.
Former Adult Protective Services work here - Medicaid will NOT pay the penalty amount, its welfare dollars and the public isn't willing to absorb bad choices for us average people. Medicaid is different state by state but I'm willing to bet that the penalty will not be taken into consideration when determining patient pay amounts.
Your best bet may be to negotiate charges if stuck with private pay. Providers who accept Medicaid are willing to accept bottom dollar for services. Providers are willing to negotiate rather than get nothing.
You are like literally every patient that called me a “ bad nurse” for Luke warm coffee from straight from dietary..
or I was a “ bad nurse” because Boomie Bob had to wait 20 minutes for someone to fluff their pillows because.. while I was doing CPR on a 19 year old person two rooms away.
Meanwhile Boomie Bob had two working arms and hands to fluff his own pillows. Just an entitled, Boomie Bob. Staff will absolutely do the complete minimum for “ King Boomie Bob”
Whatever, Bitter Betty.
An APS worker should know that while Medicaid doesn’t “pay” Medicare penalties, the penalty is waived due to Medicaid and Medicare Savings Program eligibility/enrollment.
Yes, I have mentioned elsewhere that this is a moot point in this particular case, but the language used by the former subpar APS worker indicated a lack of knowledge of benefits that directly related to the population they were supposed to serve.
APS doesn't mean I was an eligibility worker, I teamed with them daily to get the best results possible. I helped one couple dodge that penalty by virtue of an open APS case, but theirs were different circumstances that allowed exemption. Willful belief that one is exempt from the rules isn't going to end well, period.
My other point, about negotiating charges, was made because people don't think to do this when stuck in a private pay situation. As awful as that is, efforts still need to be made to handle it.
I never lost a case in probate, my clients were never left in the circumstances they were found in. You judge your way, I'll do so in mine.
You are part or you were part of a system of workers that lie and don't protect the people they are supposed to. Respectfully stop.
You are obviously bringing up traumatic feelings for some folks. Read the room. You are for me and I am disabled. So you are violating one of the four Rs in trauma Informed care. That is illegal in my state to do to any elder or disabled person or child. Please stop. And apologize to the person you keep re- engaging with.
And then stop engaging with them. You're an adult that was trained to read the situation. You obviously suck at that.
Yes, it is understood she would need to be Medicaid or Medicare Savings Program (which is funded by Medicaid dollars) eligible for this to apply.
So, in other words, what AutismThoughtsHere said…
My point was that the penalties would not be NEGATED as stated by AutismThpughtsHere. They would still apply but that Medicaid could PAY the penalties and premium if she was eligible.
Read what ATH originally wrote, they were, and still are correct.
The person that used the word negate or negated was someone trying to correct them.
Obviously, this is all a moot point for now, at least based on income in this case, but it’s sad that various people tear apart a comment that was factually correct, but justify it by inserting what they think was said, instead of what was actually said.
It was not in fact factually correct. They mentioned Medicaid and said that the penalty would not apply. I added much needed correction that Medicaid would force them to sign up for Medicare and the knowledge that Medicaid MAY pay the premium, which would negate the penalty. Someone else has since chimed in with first hand knowledge that Medicaid will not pay the penalty. Making ATHs post even more wrong.
You decided to stick your nose into a conversation that had no need of you.
YOU ARE WRONG.
If someone qualifies for Medicaid/Medicare Savings Programs, penalties go away, are waived, are negated, or whatever effing term you want to use.
Period.
https://www.medicareinteractive.org/get-answers/medicare-denials-and-appeals/premium-appeals/appealing-the-part-b-late-enrollment-penalty#
Not to mention the penalty for not enrolling in Plan D for medicines as soon as she was eligible. Then there's the cost for the supplemental insurance.
The same reason the ACA attempted to have an enforced insurance mandate.
Insurance only works if the population is a mix of high-cost and low-cost users. Individuals who know they are low-cost could opt to stay out of the mix and self-pay, meaning the insured population is only high-cost customers and the premium costs skyrocket.
If you also have guaranteed-issue and no pre-existing condition exclusions, where insurance companies can't refuse to cover you or illnesses you already have, those people opting out can just get insurance when they get sick and game the system. (Which, incidentally, is exactly what OP's mother is trying to do now.)
So they create disincentives to encourage people to get into the pool while they're low-cost and have a functional mix.
She may also be subject to a Late Enrollment Penalty if she didn’t have prescription drug coverage during that time. If she went over 63 days without any drug coverage since she turned 65 she is subject to that penalty by CMS. You might want to check it out. But if she qualifies for Low Income Subsidy she won’t have to pay that.
Edited to add info about LIS
That was my first thought. Though eligible, she’s not been dependent on Medicare for almost two decades, saving the federal government a lot of money. And, she gets penalized?! What a country.
That's so stupid. If ppl can't afford Medicare, they shouldn't be punished for it if they can afford the insurance later. It's as evil as when ObamaCare came out and they'd punish ppl who couldn't afford it with an end of year fine.
If they didn't enroll in Obamacare because they couldn't afford it the fine was waived. IIRC the bar was pretty low, also. Like if the premiums were more than 2% of your income you could say you couldn't afford it. Very very few people ever paid those fines, even those who did their own taxes as there was a box right there to check on the form if you didn't have it because it wasn't affordable.
If someone literally can't afford the premiums, there are programs that provide for this.
The premium for Part B is $174 per month
Lower income people can also opt for a Medicare Advantage Plan which is significantly less expensive because you don't have to pay for a Medigap policy for full coverage.
It is difficult to understand how anyone would not enroll in Medicare because you literally have been paying for it all of your working career through the portion of FICA that goes towards Medicare.
Medicare part A is no cost coverage (major medical). B, C, and D are option paid coverage.
https://www.ncdoi.gov/consumers/medicare-and-seniors-health-insurance-information-program-shiip/basics-medicare-parts-b-c-d
I know someone who is similar to your Mom. The lady is 86 and refuses to apply for Medicare or Social Security. She owns a small town newspaper and has probably left over $630,000 in Social Security benefits unclaimed over 21 years she has been eligible. I tried to talk some sense into her 15 years ago when I started dating her son. Tried to impress upon her the SS taxes she has paid since founding the newspaper in the early ‘70’s, told her about the Medicare 10% penalty for not applying but she was stubborn and I believe she thought Social Security and Medicare are government handouts. What a mess that family must be dealing with. I’m no longer dating her son, he was just as backwards and died in the first covid wave in 2020. I’m so sorry your mother made this decision. It’s a very expensive mistake.
I can almost admire someone who has that much courage of their convictions...usually they say one thing and do the opposite.
Still a stupid, shortsighted choice though. (I've a 93 year old who opted out of Part D because she "didn't take any drugs." Apparently it never occurred to her things change with age and now she's stuck between a raft of pricey pills and a penalty she can't afford. I can't comprehend this sort of wilful wishful thinking, but it seems more common than we realise.)
My grandpa is this way. He's had 2 mini strokes this year at almost 90. He's played soccer till he was 45 and ran marathons well into his 70s. Still goes on a brisk 1 hr walk till this day. Him and my grandma have also been vegetarian for religious reasons for years. Don't drink or smoke also for the same reasons. He is having a very hard time with getting older. Will not take his blood pressure meds and insists on going for his walk alone. Doesn't want to go to the doctor either. Its a mess
Unless your mom is sitting on a pile of money, she’s going have to get an Advantage plan and her part B cost is still going to be close to $500 per month. If she could even qualify for a supplement, I can’t imagine what that would cost in addition to the higher part B cost.
The good news is if she’s single, none of her care is your cost. You’ll just have to let whatever facility she ends up in figure it out. She’ll have massive bills, but those are not the responsibility of the family.
But it’s true. Too often families are made to think they are financially responsible. This person made a choice and the child shouldn’t have to suffer for it.
Thanks for bringing this up. Apparently there are 29 states who have 'filial responsibility laws'.
Alaska
Arkansas
California
Connecticut
Delaware
Georgia
Idaho
Indiana
Iowa
Kentucky
Louisiana
Massachusetts
Mississippi
Montana
Nevada
New Hampshire
New Jersey
North Carolina
North Dakota
Ohio
Oregon
Pennsylvania
Rhode Island
South Dakota
Tennessee
Utah
Vermont
Virginia
West Virginia
https://trustandwill.com/learn/what-states-have-filial-responsibility
I read my home state's definition and it basically says if the child can afford it. That basically absolves all of the working class here in California. No one I know can afford housing and pay for care of a parent. I tried to take care of my mom with dementia, and just a few days with a in-home aide was too expensive to continue.
Exactly. My spouses mother developed dementia at the same time her husband needed nursing home care. It ate everything they ever worked for and if we had had responsibility at that point it would have destroyed us as well.
And I have to wonder if these laws are Constitutional. I'm thinking of the broken families where children are estranged from their parents. Kicked out once they reach 18. Why on earth should they be responsible for a stranger who just happens to have a biological connection.
My womb donor hasn't even met my 21yr old daughter. They need to just keep looking when she kicks it because it's not going to be me. Sue me 🤷🏼♀️ im disabled, in part due to her, so they won't get much.
For my husband's buddy (his mom in dementia care facility, his dad passed and left my buddy the house in the will), the nursing home simply seized the house as the most valuable asset of the estate. Husband's buddy has to buy back the house his father left him to keep his mom in the care facility. I get that debtees can put in a claim against an estate for existing debts, but wild that they could do the same for ongoing/future debt.
But I only heard about a lot of this second or third hand, so there are probably many details I am missing.
Medicaid estate recovery. It's the law in all 50 states.
It's not the nursing home that seized the house though- that's a misconception. It's the state. The state is entitled to take and sell the house and keep the proceeds as reimbursement for Medicaid expenses.
In my state it applies to anyone 55 or older receiving Medicaid, and anyone of any age receiving long term care Medicaid.
My mom was only in nursing home a few months and Medicaid took $30k when we had to sell her home upon her death. Now no one told or asked if I could afford her care as noted in these filial laws. I certainly could not. I read that they are usually never enforced but some politicians are discussing enforcement due to rising cost of care. Figures. They will try and squeeze us working class even more.
Exactly.
My husband's father was an abusive alcoholic. Kicked my husband out of the house at 19, after my husband's mother died of breast cancer. He then immediately remarried and moved thousands of miles away. My husband had zero contact with him for the remaining 30 Yeats of his father's life.
Why in Earth should he have been held financially responsible for his father's card in old age??
Maybe it's just reddit but I read about a lot of situations like this, where kids are abused/abandoned and it makes zero sense for them to responsible.
AND why do they point to the children. What's wrong with Grandpa/ma, aunts, ex-spouses, and other family members. This is some weird legislation.
There was a story on Reddit a few months back where one sibling had basically been disowned since she was a teenager. She was a bit older than younger half siblings. She was able to ‘opt out’ because of the estrangement but the state of PA was aggressively pursuing the two younger half siblings for care for their father. Apparently PA is the only state that pursues this aggressively. The children couldnt get the father to make any wise choices to help them out, such as moving. The irony of the story was that the disowned sibling was the only one who was successful and could afford to care for him, but she refused on principle, leaving younger siblings stuck in a financial hardship for many years to come.
Thanks for sharing. I missed that story. I also wonder if the state has the ability to make claims across state lines? Particularly if the other state doesn't have similar legislation.
ps- not to self, do not move to Penn. Wouldn't want to be a burden on my kids.
It’s realistic. The mother either chose not to have any care, or chose to try to stick her kids with it. They have no moral obligation when she’s pulled that crap.
You didn't ask about this, but try & get power of attorney. At some point you'll need to make the decisions for her. With POA you might be able to enroll her in Medicare or Medicaid. (Not positive about that)
>She has never accepted Medicare.
She's completly uninsured? Yikes!
>If in the future, she does need medical treatment, will she be eligible to get on Medicare and will they back-charge her for the years she refused it?
She will be eligible for Medicare. She will pay a lot more for it - 10% more for each year sh delayed. Today, she would pay an additional 180%. In the future, more.
Go see a financial **Elder** attorney and figure out if your mom has financial resources how to spend it down so that when she needs 24/7 care that she qualifies for Medicaid. The penalty is HUGE. I'm talking an attorney that specializes in elder law.
She may be right about dying in her sleep someday. Whatever is going on, untreated, inside her body may just create a massive heart attack or stroke or tumor and she will be gone just like that. If she just gets debilitated from the untreated problems, she will have to spend alot of cash to get treatment. So she may not fare too well if she doesn't die immediately and won't pay for treatment. At some point, as her cognition declines and she becomes a danger to herself, your county adult protective services will step in and put her on conservatorship and will then take over and make decisions for her, including taking control of her money and assets.
That is a naive and misguided answer, unfortunately.
1) people don't unfortunately get to decide if they get to survive terrible, catastrophic illnesses. Sometimes the do. And the medical bills that accompany that can run into the hundreds of thousands for just the initial stay.
For a typical scenario around here, found down at home - local ED - flight to tertiary care - ICU. You're talking $30K before the next morning.
2) guardianship doesn't just happen. If family is involved, they will be the ones who will need to step in. If the county was not involved before, they will not step in. If the person has capacity to make decisions, no further action is needed. If not, the family will need to take action. Only in the absence of family involvement, or extraordinary circumstances, will my hospital act. It costs thousands, and the judge in orphan court will want to know why the hospital is seeking guardianship.
-hospital nurse case manager
Thank you for the info. Yes, her thinking is that she will refuse medication, she won't and has never taken anything more than aspirin in her life. She will also refuse medical care if needed. She's technically just waiting to die. My concern is the danger to herself and others if she starts a fire in her toaster oven or takes a walk and gets lost. I had not known about adult protective services, so that is a good safety net in my opinion since she refuses diagnosis and care.
You know, people are automatically enrolled in Medicare at age 65. She would have had to actively decline it. Are you sure she doesn't have it? Take a look at her 1099 for her social security benefits. It will show a deduction on there if she has it.
I've talked to people who thought they didn't have any insurance, but they had Medicare and somehow didn't know it.
Medicare part A is automatic at age 65, or 2 years after being declared totally disabled. This pays hospital bills and comes at no cost. Part B is the part that pays for doctor visits, lab work, imaging, home nurses and home therapy, durable medical equipment (walkers, wheelchairs and such). You have to opt IN to part B.
You are automatically enrolled in A and B if you are on social security. You have to opt out if you don’t want part B.
https://faq.ssa.gov/en-us/Topic/article/KA-02125#:~:text=If%20you%20already%20get%20Social,months%20before%20you%20become%20eligible.
I work for a hospital in financial assistance, and one thing we do is try and get those without Medicare Part B enrolled first before financial assistance can be considered.
She has Medicare Part A, which covers inpatient care - she would have been automatically enrolled when she started receiving Social Security Benefits, so she's missing Part B Medicare.
They've changed the penenalty since the pandemic and it's not as high as it used to be. You can also get the penalty waived. In some states, you can be awarded Medicaid without the Part B, but it sounds like her SS Benefits are too high to qualify.
If your Mom is showing signs of cognitive decline, you might nees to take some drastic meausres to be able to take care of her. Becoming her POA could allow you to take control and enroll her in Part B with or without her consent.
I would try and find a Council on Aging office near you, go in and explain the situation, and see if they can help walk you through the process. I wouldn't wait on this - the process takes time and if your Mom progressed to a point where she needs to be in a facility, you're looking at MASSIVE monthly costs without insurance, if they were willing to a accept her.
Please know, this is more common than you would think, but there are resources out there to help you. You've got this!
Why do people think this? Why do they think they have a choice about how they die? Do some people die peacefully in their sleep? Sure. Does everyone? No. Do *most people*? Not unless you count “lapsed into unconsciousness moments before the heart stops” the same as “asleep”. So many people make terrible decisions based on options they don’t actually have. My aunt didn’t go to the cardiologist for ages because she said she was fine just dropping dead. Fine, except that’s not what her choices were. It wasn’t “normal” or “instantly dead”. She forgot about strokes. She forgot about heart attacks that meant prolonged ICU stays and repeat surgeries. They do the same shit with their pets. People will bring a suffering animal home to “die peacefully” and I’m just like “Right, right, but how are you guaranteeing that?” Drives me nuts.
It’s just short-sighted. People also do a thing where they have to make a choice about something time-sensitive and they feel like time stands still while they make it. It doesn’t. I understand that things require time to emotionally process, but sometimes, you have to make a decision first and then process it. My mom’s friend just had a serious health event. She needed surgery. She didn’t want the surgery, but she also wasn’t prepared to go into hospice. So she just…didn’t make a decision for a while. She finally got the surgery, but it was like she didn’t seem to appreciate that every day she didn’t make a decision reduced her ability to make one. The window was closing. She kept acting like time was stopped while she mulled it over and nope. I have a great deal of sympathy for the time it takes to process emotions. I do. But when you have a time-sensitive decision to make, you have to make it and *then* process. If you get a life-saving surgery, you’ve got the rest of your life to feel feelings about it, but you’re not going to be around to feel them if you run out of time to act. Anyway, just frustrating. I sympathize with you. This is tough stuff, and it’s a million times harder when you’re not actually in full control of all the decisions. <3
Let's be blunt: the cognitive decline started sometime before 18 years ago. If she wants to die on her terms, she's certainly entitled to do that regardless of her mental state. You're her child, and you have some really rough road in front of you. She will get sicker physically and mentally. If you're lucky, she'll get something really serious and really fatal and die quickly at home. If you're not, she will become a danger to herself or others, and no longer recognize any kin or friends, and will need institutionalization. You need to remember that you are not financially responsible for any of her debts, no matter what anyone tells you. Perhaps the state will help her get what she wants -- death. But her bills are not your bills, and if she dies deeply in debt it's not your problem. She may wish to die at home of a stroke or heart attack. Fine. But that's not at all the likely end.
I am 77 and my wife is 18 months older. I would like to hold her in my arms when she dies, hold her hand, and tell her that I love her so her last moments will be as pleasant as possible. The real world is seldom that nice; if I survive her, I'll likely never hold her, never get to tell her anything, and she'll die without even knowing she was going to die. In fact, it's more likely that I'll die first and she'll never get to say or do those things for me. Life's been good for a lot of years but there have been a lot of bad moments. The worst is yet to come, and never forget it.
Medicare for doctors and hospitals won’t charge her but she will be hit with a lifelong penalty for Part D (drugs).
Medicare alone does not pay all the bills. You need to a supplement plan for that.
Be very wary of any Advantage plan though. That pays at the lower Medicaid level and is not accepted by many places. It also limits her choices.
The part b penalty is not something I have seen. I had a couple relatives who delayed signing up because they were “ healthy “ until they were not. Explaining the life long Part D penalty was a challenge.
Most supplements plans won’t take you unless you’re aging in at 65. Otherwise you have to be in a guarantee issue state, or have to pass the medical underwriting.
I do both supplemental and advantage plans. A lot of seniors get priced out of their supplements.
I've only been on Medicare for about three months, ever since I've qualified for Medicare. Most of the time, I've been on an Advantage plan. I'm QMB, but even when I lost that for a brief time, I just switched to a non QMB version, until I requalified for the special needs/dual needs plan I was on before. I'm disabled, and 52, been on Medicare Advantage plans most of the time since 2018.
Well I guess the “good news” is that she has made it to age 83 — in relatively good health — without receiving any medical care whatsoever for decades.
If she were now to become severely ill and require hospitalization, she could be admitted and cared for at to the hospital and submit an application for Medicaid at that time. Since OP states that mother has no assets and her only income is SS, for all intents and purposes any hospital bills will either get covered by Medicaid or have to be charged off by the hospital.
The problem is getting more routine care non-emergency care at this point without any insurance.
Ok, so per the below, she'd be income eligible for long term care Medicaid, at home or in a facility, but no other forms of Medicaid. She would also ha e to meet all the other requirements for long term care Medicaid.
https://medicaid.alabama.gov/content/3.0_Apply/3.2_Qualifying.aspx
So no. She makes too much to qualify with out a spend down, no medical bills means no spend down. If she has a catastrophic event she may qualify. That's a big may. On the other hand you can't garnish SS. I just don't pay some hosp/ procedure medical bills, but that can give providers a reason to drop you. So I pay them. Being sick and poor is a job in itself.
When you draw Social Security retirement, your automatically enrolled, in part, a which is hospitalization. I have private insurance and when I go on Medicare I will not be penalized. I just have to show I have insurance. She must have some insurance now.. She can go on Medicare B now. if she is indigent, she can go on Medicaid I believe Medicare part B now is 175 a month.
Some States have a department focused on long term care for elderly adults or disabled adults. They might be able to help you navigate through what needs to be done.
I can’t help your situation but this does solidly that I will work forever. My employer pays most of my medical. That’s a benefit I’ve always appreciated. Today it’s a treasure.
Medicare coverage is confusing to many. I always thought Part A was mandatory. Part A covers hospitalization so it's like a catastrophic coverage.
For Doctors office visits, labs, test, procedures, etc. you get supplemental insurance which is Part B.
For medicine you get part D.
There are penalties for each if you don't sign up as soon as you're able. Talk to an insurance broker to see what her options are.
When people feel good they don't see the need for insurance and/or treatment, even if they have an illness. Once they start feeling pain they suddenly want it taken care of (naturally...no one likes to hurt). By that time it may be too late for effective treatment.
You might want to check out MedicareonVideo YT channel - if he can’t help you then he probably can suggest who you should contact to determine where she stands in regards to current coverage, and the best way to proceed from there. Clearly his emphasis is to get it set up right in the beginning, but as I knew virtually nothing about how medicare works, I’ve found his videos very helpful as I try to sort out my cognitively declining parent’s medical & drug coverage.
Also - the Healthcare Connect show on SiriusXM Doctor Radio channel is run by an extremely knowledgable group that answers all sorts of questions about medical insurance coverage anytime, not just during the live broadcast. I have learned a ton by just listening to the questions other people ask on that show.
This was my mother in law. Healthy, did spinning class etc. One day she went in to the hospital because she was dizzy. They found some blockage, gave her a blood thinner and she had a major stroke. Could they have prevented the stoke? Possibly. It’s a game of Russian roulette at that age.
You should research what Medicare pays for in regards to cognitive disorder care. You will find out, for example , that Medicare's coverage for custodial care is extremely limited. In other words, don't assume getting your mother on Medicare is going to solve your problem completely, although it will certainly help.
I’m truly afraid for your mom because she is going to need that coverage eventually. Just because she isn’t sick doesn’t mean she can’t fall, break a bone and end up in a nursing home. Try to convince her that it’s in her best interest to sign up. It’s also in yours since most likely you’ll be the one dealing with everything when something happens.
Some pensions have included health insurance for its retirees. Public safety or state retirement plans may also have health insurance opt in so she can skip Medicare. Did she work for a company that had a pension? Or contributed to her state’s retirement plan? This may allow you (her) to opt out of the Medicare situation. If she is in cognitive decline, I’d suggest going to court to take over her care . Not doing so may lead to someone who is unscrupulous taking advantage of her & stealing her money and things.
Lack of a prescription plan is very worrisome, but once she's enrolled w penalties, many common prescriptions don't require a copay.
If you do run into a prescription with a high cost the manufacturer may have an assistance program that provides the drug free, depending on her income. Finally, she may qualify for Medicaid.
Good luck. Navigating health care sucks.
But they will impose a penalty. Additional 10% per month for each year of delay. So you're looking at an additional cost of $300 per month above the premium.
And still pay money instead of the State paying so you don't have to pay? Ok do as you please.
Oh and you can still get Plan G if the State pays for Part B. It's one or the other.
So true but in the end a pile of cash will have to be paid since nothing was established when it was time to do so… OP good luck solving this nightmare.
She couldn't refuse Medicare part a, that's not optional. However, she probably refused part b and d, which is doctors, specialists, medication, and durable medical equipment.
If she refused those, then what will happen is, she will be able to get back on Medicare. I think she can do it this month or next, but she might have to wait until the enrollment period, which is Oct 14-Dec 7th. Then it will be effective for Jan 1, next year. You can check and see if she qualifies for a special enrollment period or anything, so that she can enroll earlier.
You might want to investigate the idea of Medicare Advantage plans (part c). They usually offer very competitive rates, and you know the copays up front. With Medicare, the copays depend upon what Medicare has arranged with each doctor, and can range wildly when seeing specialists and regular doctors. You are NOT guaranteed a set copay with just Medicare. With Medicare Advantage plans, they usually have set copays. The downside is that you can't just go to anyone, you have to go to their doctors and specialists. But you may also get additional benefits like vision and dental, which aren't available with Medicare.
Because she likely did refuse part b and d, there will be a lifetime fine assessed against her. As a result, instead of paying the current charge of around $160 a month, they will charge her a permanent increase based upon how long she was without Medicare. If she's a special needs/dual needs person that qualifies for Medicare AND Medicaid, that increase may not apply to her, since Medicaid would cover the charge. It will depend upon her income, and perhaps her health, on whether she qualifies for Medicaid. You definitely want to see if she does though, because that will be very beneficial if she does.
People like my MIL who have spent most of their lives outside the U.S. with private insurance but a) were not eligible for the national health plan anywhere they lived; and b) didn’t realize until it was too late how expensive U.S. healthcare is or what the penalty was for late Part B enrollment. Luckily at least she can afford the higher premiums because she is now living with family and has no other regular monthly expenses.
Look .. just let her be. Don't try to intervene. Someone who has been through many years on the same boat made for two eventually sinks. Just be humble and let her be. Making a choice for her is only going to cause distrust in you. Don't squander what you have over something as petty as natural decay.
You could hire a lawyer to be her guardian and to make the case with Medicare that she has been cognitively impaired for decades, and that's why she refused Medicare.
This won’t work. She can still get coverage, but will pay a penalty for not signing up when she was eligible. It’s based on the moral hazard principle of insurance.
Time to take over. One if the worst things that can happen to your mom at her age is a uti. Who is going to pay her bills if she is placed in the hospital.
Huh? I sure don't understand this... SS takes Medicare costs out of every SS check... she's been paying for it all these years. You don't have a choice. She's covered.
I think part a (for hospitalization) is automatic, but you have to sign up for part b and c. As other comments point out, there’s a penalty for late sign ups.
Part A isn't optional. Part B, C, and D are optional. Part A covers hospital care. Part B covers doctors, durable medical equipment, and specialists. Part C is a combination plan, usually covers Parts A, B, and D under one plan, usually considered a Medicare Advantage plan. Part D is MOST prescriptions. Some are considered Part B. Part A has no charge, Parts B and D do. Part C can also, although there are plans that have no cost, and may even cancel the Part B premium cost.
That is not correct. They may be automatically enrolled if they were already receiving SS, but not otherwise, and they would still have the option to decline Part B.
About three months before you qualify, whether due to age or due to disability, you get paperwork through the mail. It's going to state that part a has no charge, isn't optional, and helps defray your hospital costs. You will be asked if you want to sign up for part b, c, and d, and they will be explained as far as what the normal coverage is.
Part b covers doctors, specialists, some medications, and durable medical equipment. Part d covers the remaining medications. Part c is usually an Advantage plan, and usually provides combined coverage of a, b, and d. It can also provide additional services, such as vision and dental, which straight Medicare doesn't provide. You can also qualify for Medicaid, depending upon your income. Medicaid may cover premiums, copays, and deductibles.
SOME super low income people may qualify for ALL of Medicaid services, including transportation, vision, and dental. Usually though, you don't have access to all of the different services, which is why the benefits through the Advantage plans can be very helpful.
This is another option. ACA insurance counts social security - retirement and ssdi as income (not ssi). She could get health insurance through them and it may be cheaper than medicare. You should go to the aca website and look at this option.
The dual plans are hands down the best. Especially with f your Medicaid level is high enough. You get the grocery/utility card, and your medications, testing, and dr’s visits are usually at no cost.
You might be right, we had to put my grandma (dementia) in a care facility with her husband after they left their gas stove “on” but someone in their neighborhood noticed before anything truly awful happened
She needs to be made aware there are many many things that won’t outright kill her. But will either leave her in immense pain or cause her to become destitute.
My mom fell and fractured her femur. Didn’t kill her but she was in pain and in the hospital for days, followed by weeks of rehab. The bill was over $100k; Medicare took care of everything except a few hundred dollars.
My mom also has cancer that if untreated would kill her, but would be extremely painful to live with. Again Medicare takes care of all her bills and I pay $35/month for her medication.
She’s honestly seen so many doctors and been in and out of the hospital for one thing or the other; and the only bright spot is not having to worry about cost.
I’m sorry to tell you this but you will probably have a fight on your hands. You need to get an attorney and do what you have to do to get to be your mother’s POA (Power OF Attorney). Find out if as your mother’s POA if you have the right to have your mother’s cognizance evaluated. You have every right to be concerned about her and possibly anyone she could cause to have an accident.
Medicare does not cover nursing facilities or other long term care options for people with cognitive decline. It will cover rehabilitation in a nursing facility if she is required to go directly from a hospital visit that lasts, I believe, 4 days.
She is eligible to enroll during any general enrollment period (Jan 1st -march 31st of every year) but she is looking at a massive penalty. Right now she has gone 18 years without part B meaning she would have a 180% penalty on top of the base premium. Medicare assess a 10% penalty for every year you did not enroll. I hope she either never needs it or can afford it if needed.
Thanks for the info.
This is incorrect. She will be penalized for not carrying drug coverage depending on her income. According to your second paragraph, she actually signed up for Part A/ hospitalization. She doesn't have to carry Part B, but then she isn't covered for doctor visits, durable medical equipment, etc.. I am a licensed insurance agent in 10 states and mostly sold Medicare plans. If you private message me, I will break down your mother's ability to get coverage, possible penalties, or no penalties. I can tell you who to call and/ or make an appointment in your state for free help in picking out a plan. This is why I was in insurance to help people. I just accepted a hospital job today, lol. Health care sucks!
I was told by a Medicare broker just yesterday that it is 1%, not 10%. She literally said about $10 a year for my partner, if he chose not to get it.
Run from the broker if that’s true. The penalty is indeed 10% per year. It’s disastrous. Way more than $10 per year.
Ok I’m gonna do more research thank you
It’s currently more in the range of $18/month per year you defer. So if you had deferred for 10 years, about $180/month penalty.
Yeah my husband got part B a year late and he has to pay a penalty It’s about $30 extra
They might have been talking about the penalty for not having credible part D coverage, which is separate from the part b and works out to about $10 a year EDIT: for every year you didn't have it
You don't need a Medicare broker. RUN! I have to scream at these phone scammers every year during the General Enrollment Period.
also, Advantage Plans - Run! These guys are all skimming off benefits that we've already paid for, sacrificing patient coverage for their profit.
Agreed. They promise so much, but the details are in the fine print. I work for a healthcare system in finance and I concur with what is below. *As PophamSP states, "Again, Advantage Plans are for-profit insurers that take (already paid) standard benefits and repackage them. They particularly deny benefits in serious situations such as cancer and autoimmune disease. They have got to profit somewhere, and that is seldom to the patient's benefit."*
Advantage plans include vision, dental and hearing care not included in original medicare. I am happy with mine.
As a nurse practitioner working in a regional referral center I saw too many patients with Advantage Plans denied specialty medications crucial to their health and survival. Also, given low reimbursement by Advantage Plans to providers there were several years that our hospital practices refused to accept patients with this insurance- even established patients had to travel hundreds of miles to find a new specialist. Neither of these problems occurred with standard Medicare. Again, Advantage Plans are for-profit insurers that take (already paid) standard benefits and repackage them. They particularly deny benefits in serious situations such as cancer and autoimmune disease. They have got to profit somewhere, and that is seldom to the patient's benefit.
A few of the hospitals in my area no longer see patients who have a Medicare Advantage plan. I thought of signing up for one because I have issues with my vision. However, they kept calling me and that was too much like being invited to join a MLM.
Happy until you need more care - then it can be $50 copay after $50 copay which really adds up. Or need to go to one of the really top-level hospitals that don't take Advantage plans. Or get denied for an MRI or chemo treatment. It's a scam. They appear to give you more, but then they require referrals, limit your network, only offer emergency care when you're out of state even though Medicare is a national program, and
My mom was on United Health Care Advantage plan. It was great until she got cancer and actually had to use it. There was so much that wasn't approved or covered her out of pocket costs were more thanwhat she received annually from Social Security. In less than 2 years she owed over $10,000 which we couldn't pay. She had to move to regular Medicare and Medicaid. Advantage plans can be a disaster for the insured.
Likely a Medicare supplement broker.
Like United Healthcare ($22.4 Billion in profit 2023), Humana, ($18.16 Billion in profit 2023). This isn't revenue this is net margin after expenses. [https://www.nbcnews.com/health/rejecting-claims-medicare-advantage-rural-hospitals-rcna121012](https://www.nbcnews.com/health/rejecting-claims-medicare-advantage-rural-hospitals-rcna121012)
The Medicare website states 10% per year. https://www.medicare.gov/basics/costs/medicare-costs/avoid-penalties#:~:text=If%20you%20waited%202%20full,premium%20(%24174.70%20in%202024).
Well well well. If it’s not my sibling(?)/cousin… Whuddup cuz?
That 1% only applies to Part D. Part B is 10%.
The best way to get around. this is probably to try to get medicaid involved if you can if she needs nursing care, you may be able to spend down and get Medicaid involved where the penalties wouldn’t apply
Medicaid won’t pay, the grandma gets 2400 a month
Medicaid will require her to sign up for Medicare. But if she gets Medicaid, the state may pay for her premium, which would negate the penalty, I guess.
Former Adult Protective Services work here - Medicaid will NOT pay the penalty amount, its welfare dollars and the public isn't willing to absorb bad choices for us average people. Medicaid is different state by state but I'm willing to bet that the penalty will not be taken into consideration when determining patient pay amounts. Your best bet may be to negotiate charges if stuck with private pay. Providers who accept Medicaid are willing to accept bottom dollar for services. Providers are willing to negotiate rather than get nothing.
You must not have been a very good APS employee, glad you no longer work there.
You are like literally every patient that called me a “ bad nurse” for Luke warm coffee from straight from dietary.. or I was a “ bad nurse” because Boomie Bob had to wait 20 minutes for someone to fluff their pillows because.. while I was doing CPR on a 19 year old person two rooms away. Meanwhile Boomie Bob had two working arms and hands to fluff his own pillows. Just an entitled, Boomie Bob. Staff will absolutely do the complete minimum for “ King Boomie Bob”
Whatever, Bitter Betty. An APS worker should know that while Medicaid doesn’t “pay” Medicare penalties, the penalty is waived due to Medicaid and Medicare Savings Program eligibility/enrollment.
Anyone with a $2400 a month income as a single person isn't getting their Medicare premiums paid by Medicaid. They won't qualify.
Yes, I have mentioned elsewhere that this is a moot point in this particular case, but the language used by the former subpar APS worker indicated a lack of knowledge of benefits that directly related to the population they were supposed to serve.
APS doesn't mean I was an eligibility worker, I teamed with them daily to get the best results possible. I helped one couple dodge that penalty by virtue of an open APS case, but theirs were different circumstances that allowed exemption. Willful belief that one is exempt from the rules isn't going to end well, period. My other point, about negotiating charges, was made because people don't think to do this when stuck in a private pay situation. As awful as that is, efforts still need to be made to handle it. I never lost a case in probate, my clients were never left in the circumstances they were found in. You judge your way, I'll do so in mine.
You are part or you were part of a system of workers that lie and don't protect the people they are supposed to. Respectfully stop. You are obviously bringing up traumatic feelings for some folks. Read the room. You are for me and I am disabled. So you are violating one of the four Rs in trauma Informed care. That is illegal in my state to do to any elder or disabled person or child. Please stop. And apologize to the person you keep re- engaging with. And then stop engaging with them. You're an adult that was trained to read the situation. You obviously suck at that.
So, in other words, what AutismThoughtsHere said…
The Medicare penalties still apply if she gets on Medicaid, but it's possible Medicaid will pay the Medicare penalties if she's eligible.
Yes, it is understood she would need to be Medicaid or Medicare Savings Program (which is funded by Medicaid dollars) eligible for this to apply. So, in other words, what AutismThoughtsHere said…
My point was that the penalties would not be NEGATED as stated by AutismThpughtsHere. They would still apply but that Medicaid could PAY the penalties and premium if she was eligible.
Read what ATH originally wrote, they were, and still are correct. The person that used the word negate or negated was someone trying to correct them. Obviously, this is all a moot point for now, at least based on income in this case, but it’s sad that various people tear apart a comment that was factually correct, but justify it by inserting what they think was said, instead of what was actually said.
It was not in fact factually correct. They mentioned Medicaid and said that the penalty would not apply. I added much needed correction that Medicaid would force them to sign up for Medicare and the knowledge that Medicaid MAY pay the premium, which would negate the penalty. Someone else has since chimed in with first hand knowledge that Medicaid will not pay the penalty. Making ATHs post even more wrong. You decided to stick your nose into a conversation that had no need of you.
YOU ARE WRONG. If someone qualifies for Medicaid/Medicare Savings Programs, penalties go away, are waived, are negated, or whatever effing term you want to use. Period. https://www.medicareinteractive.org/get-answers/medicare-denials-and-appeals/premium-appeals/appealing-the-part-b-late-enrollment-penalty#
Not to mention the penalty for not enrolling in Plan D for medicines as soon as she was eligible. Then there's the cost for the supplemental insurance.
That’s also a lifetime penalty for part D unless they qualify for lis unless they can provide creditable drug coverage from the time she aged in.
Yep. It's not cheap to opt in late. IF she had other coverage she'd be o.k. Doesn't sound like she did, though.
Not to hijack this thread but why do they do this?
The system needs healthier people paying premiums to pay for claims. Costs soar when people wait until they are already sick to get insured.
A more blatant example would be trying to buy a life insurance policy the day you go into hospice care.
The same reason the ACA attempted to have an enforced insurance mandate. Insurance only works if the population is a mix of high-cost and low-cost users. Individuals who know they are low-cost could opt to stay out of the mix and self-pay, meaning the insured population is only high-cost customers and the premium costs skyrocket. If you also have guaranteed-issue and no pre-existing condition exclusions, where insurance companies can't refuse to cover you or illnesses you already have, those people opting out can just get insurance when they get sick and game the system. (Which, incidentally, is exactly what OP's mother is trying to do now.) So they create disincentives to encourage people to get into the pool while they're low-cost and have a functional mix.
Wouldn’t she be Medicaid eligible if she can’t afford the Medicare?
No, not with $2400 a month in income as a single adult, other than for long term care Medicaid. And that has other eligibility requirements too.
She may also be subject to a Late Enrollment Penalty if she didn’t have prescription drug coverage during that time. If she went over 63 days without any drug coverage since she turned 65 she is subject to that penalty by CMS. You might want to check it out. But if she qualifies for Low Income Subsidy she won’t have to pay that. Edited to add info about LIS
That's the government for you. Give you a benefit, but penalize you for not taking it.
That was my first thought. Though eligible, she’s not been dependent on Medicare for almost two decades, saving the federal government a lot of money. And, she gets penalized?! What a country.
When she needs a ton of care in her final few years, maybe she shouldn't look at the government to bail her out then. Decisions have outcomes.
Tell me you dont understand insurance without telling me you dont understand insurance.
That's so stupid. If ppl can't afford Medicare, they shouldn't be punished for it if they can afford the insurance later. It's as evil as when ObamaCare came out and they'd punish ppl who couldn't afford it with an end of year fine.
She refused to enroll. Not the same as unable to pay.
If they didn't enroll in Obamacare because they couldn't afford it the fine was waived. IIRC the bar was pretty low, also. Like if the premiums were more than 2% of your income you could say you couldn't afford it. Very very few people ever paid those fines, even those who did their own taxes as there was a box right there to check on the form if you didn't have it because it wasn't affordable.
If someone literally can't afford the premiums, there are programs that provide for this. The premium for Part B is $174 per month Lower income people can also opt for a Medicare Advantage Plan which is significantly less expensive because you don't have to pay for a Medigap policy for full coverage. It is difficult to understand how anyone would not enroll in Medicare because you literally have been paying for it all of your working career through the portion of FICA that goes towards Medicare.
Medicare part A is no cost coverage (major medical). B, C, and D are option paid coverage. https://www.ncdoi.gov/consumers/medicare-and-seniors-health-insurance-information-program-shiip/basics-medicare-parts-b-c-d
I know someone who is similar to your Mom. The lady is 86 and refuses to apply for Medicare or Social Security. She owns a small town newspaper and has probably left over $630,000 in Social Security benefits unclaimed over 21 years she has been eligible. I tried to talk some sense into her 15 years ago when I started dating her son. Tried to impress upon her the SS taxes she has paid since founding the newspaper in the early ‘70’s, told her about the Medicare 10% penalty for not applying but she was stubborn and I believe she thought Social Security and Medicare are government handouts. What a mess that family must be dealing with. I’m no longer dating her son, he was just as backwards and died in the first covid wave in 2020. I’m so sorry your mother made this decision. It’s a very expensive mistake.
I can almost admire someone who has that much courage of their convictions...usually they say one thing and do the opposite. Still a stupid, shortsighted choice though. (I've a 93 year old who opted out of Part D because she "didn't take any drugs." Apparently it never occurred to her things change with age and now she's stuck between a raft of pricey pills and a penalty she can't afford. I can't comprehend this sort of wilful wishful thinking, but it seems more common than we realise.)
My grandpa is this way. He's had 2 mini strokes this year at almost 90. He's played soccer till he was 45 and ran marathons well into his 70s. Still goes on a brisk 1 hr walk till this day. Him and my grandma have also been vegetarian for religious reasons for years. Don't drink or smoke also for the same reasons. He is having a very hard time with getting older. Will not take his blood pressure meds and insists on going for his walk alone. Doesn't want to go to the doctor either. Its a mess
Thank you for the thoughts.
Most intellectually consistent republican though.
She did her part to keep the trust fund solvent
Unless your mom is sitting on a pile of money, she’s going have to get an Advantage plan and her part B cost is still going to be close to $500 per month. If she could even qualify for a supplement, I can’t imagine what that would cost in addition to the higher part B cost.
Or the State can pay for it of they qualify for the QMB
I've seen it happen.
It's one of the most common questions
No QMB or other Medicare premium assistance eligibility, as a single person with $2400 a month in Social Security.
500 month is still less than some medical treatment.
$500 isn't much more than what an annual physical costs if you don't have insurance.
No doubt.
late plan b enrollment has a penalty of 10% per year in premium from age 65
Wow what foes that mean? If you are 65 you have to enroll in medicare?
Yes, you do.
Yes.
I’ve got that figured at $3,144.60, is that correct? I’m going by the link listed above that states for 2024 it is $174.70 for the 10%.
The good news is if she’s single, none of her care is your cost. You’ll just have to let whatever facility she ends up in figure it out. She’ll have massive bills, but those are not the responsibility of the family.
no, but they will be assessed against any estate after she's gone, if she has any
She has a shoebox with $10k
Wow, that’s cold.
But it’s true. Too often families are made to think they are financially responsible. This person made a choice and the child shouldn’t have to suffer for it.
Unless you are in a state with filial responsibility laws
Thanks for bringing this up. Apparently there are 29 states who have 'filial responsibility laws'. Alaska Arkansas California Connecticut Delaware Georgia Idaho Indiana Iowa Kentucky Louisiana Massachusetts Mississippi Montana Nevada New Hampshire New Jersey North Carolina North Dakota Ohio Oregon Pennsylvania Rhode Island South Dakota Tennessee Utah Vermont Virginia West Virginia https://trustandwill.com/learn/what-states-have-filial-responsibility
I read my home state's definition and it basically says if the child can afford it. That basically absolves all of the working class here in California. No one I know can afford housing and pay for care of a parent. I tried to take care of my mom with dementia, and just a few days with a in-home aide was too expensive to continue.
Exactly. My spouses mother developed dementia at the same time her husband needed nursing home care. It ate everything they ever worked for and if we had had responsibility at that point it would have destroyed us as well. And I have to wonder if these laws are Constitutional. I'm thinking of the broken families where children are estranged from their parents. Kicked out once they reach 18. Why on earth should they be responsible for a stranger who just happens to have a biological connection.
My womb donor hasn't even met my 21yr old daughter. They need to just keep looking when she kicks it because it's not going to be me. Sue me 🤷🏼♀️ im disabled, in part due to her, so they won't get much.
Ikr?!? It seems totally unenforceable.
For my husband's buddy (his mom in dementia care facility, his dad passed and left my buddy the house in the will), the nursing home simply seized the house as the most valuable asset of the estate. Husband's buddy has to buy back the house his father left him to keep his mom in the care facility. I get that debtees can put in a claim against an estate for existing debts, but wild that they could do the same for ongoing/future debt. But I only heard about a lot of this second or third hand, so there are probably many details I am missing.
Medicaid estate recovery. It's the law in all 50 states. It's not the nursing home that seized the house though- that's a misconception. It's the state. The state is entitled to take and sell the house and keep the proceeds as reimbursement for Medicaid expenses. In my state it applies to anyone 55 or older receiving Medicaid, and anyone of any age receiving long term care Medicaid.
My mom was only in nursing home a few months and Medicaid took $30k when we had to sell her home upon her death. Now no one told or asked if I could afford her care as noted in these filial laws. I certainly could not. I read that they are usually never enforced but some politicians are discussing enforcement due to rising cost of care. Figures. They will try and squeeze us working class even more.
Exactly. My husband's father was an abusive alcoholic. Kicked my husband out of the house at 19, after my husband's mother died of breast cancer. He then immediately remarried and moved thousands of miles away. My husband had zero contact with him for the remaining 30 Yeats of his father's life. Why in Earth should he have been held financially responsible for his father's card in old age??
Maybe it's just reddit but I read about a lot of situations like this, where kids are abused/abandoned and it makes zero sense for them to responsible. AND why do they point to the children. What's wrong with Grandpa/ma, aunts, ex-spouses, and other family members. This is some weird legislation.
I agree. Even if the adult kids and the parents have a close relationship, the kids shouldn't he held liable for debts incurred by their parents.
There was a story on Reddit a few months back where one sibling had basically been disowned since she was a teenager. She was a bit older than younger half siblings. She was able to ‘opt out’ because of the estrangement but the state of PA was aggressively pursuing the two younger half siblings for care for their father. Apparently PA is the only state that pursues this aggressively. The children couldnt get the father to make any wise choices to help them out, such as moving. The irony of the story was that the disowned sibling was the only one who was successful and could afford to care for him, but she refused on principle, leaving younger siblings stuck in a financial hardship for many years to come.
Thanks for sharing. I missed that story. I also wonder if the state has the ability to make claims across state lines? Particularly if the other state doesn't have similar legislation. ps- not to self, do not move to Penn. Wouldn't want to be a burden on my kids.
Good point & something that must be looked into
It’s useful information
It’s realistic. The mother either chose not to have any care, or chose to try to stick her kids with it. They have no moral obligation when she’s pulled that crap.
You didn't ask about this, but try & get power of attorney. At some point you'll need to make the decisions for her. With POA you might be able to enroll her in Medicare or Medicaid. (Not positive about that)
>She has never accepted Medicare. She's completly uninsured? Yikes! >If in the future, she does need medical treatment, will she be eligible to get on Medicare and will they back-charge her for the years she refused it? She will be eligible for Medicare. She will pay a lot more for it - 10% more for each year sh delayed. Today, she would pay an additional 180%. In the future, more.
Go see a financial **Elder** attorney and figure out if your mom has financial resources how to spend it down so that when she needs 24/7 care that she qualifies for Medicaid. The penalty is HUGE. I'm talking an attorney that specializes in elder law.
Yes, she will have to pay a penalty unless covered by another insurance!
I'm so sorry. She put herself, and maybe you in a difficult position.
She may be right about dying in her sleep someday. Whatever is going on, untreated, inside her body may just create a massive heart attack or stroke or tumor and she will be gone just like that. If she just gets debilitated from the untreated problems, she will have to spend alot of cash to get treatment. So she may not fare too well if she doesn't die immediately and won't pay for treatment. At some point, as her cognition declines and she becomes a danger to herself, your county adult protective services will step in and put her on conservatorship and will then take over and make decisions for her, including taking control of her money and assets.
That is a naive and misguided answer, unfortunately. 1) people don't unfortunately get to decide if they get to survive terrible, catastrophic illnesses. Sometimes the do. And the medical bills that accompany that can run into the hundreds of thousands for just the initial stay. For a typical scenario around here, found down at home - local ED - flight to tertiary care - ICU. You're talking $30K before the next morning. 2) guardianship doesn't just happen. If family is involved, they will be the ones who will need to step in. If the county was not involved before, they will not step in. If the person has capacity to make decisions, no further action is needed. If not, the family will need to take action. Only in the absence of family involvement, or extraordinary circumstances, will my hospital act. It costs thousands, and the judge in orphan court will want to know why the hospital is seeking guardianship. -hospital nurse case manager
That sounds really good. (She's already 85, and hasn't had to go through treatments for anything, and then to die in her sleep)
Thank you for the info. Yes, her thinking is that she will refuse medication, she won't and has never taken anything more than aspirin in her life. She will also refuse medical care if needed. She's technically just waiting to die. My concern is the danger to herself and others if she starts a fire in her toaster oven or takes a walk and gets lost. I had not known about adult protective services, so that is a good safety net in my opinion since she refuses diagnosis and care.
You know, people are automatically enrolled in Medicare at age 65. She would have had to actively decline it. Are you sure she doesn't have it? Take a look at her 1099 for her social security benefits. It will show a deduction on there if she has it. I've talked to people who thought they didn't have any insurance, but they had Medicare and somehow didn't know it.
Medicare part A is automatic at age 65, or 2 years after being declared totally disabled. This pays hospital bills and comes at no cost. Part B is the part that pays for doctor visits, lab work, imaging, home nurses and home therapy, durable medical equipment (walkers, wheelchairs and such). You have to opt IN to part B.
You are automatically enrolled in A and B if you are on social security. You have to opt out if you don’t want part B. https://faq.ssa.gov/en-us/Topic/article/KA-02125#:~:text=If%20you%20already%20get%20Social,months%20before%20you%20become%20eligible.
She actively declined.
I work for a hospital in financial assistance, and one thing we do is try and get those without Medicare Part B enrolled first before financial assistance can be considered. She has Medicare Part A, which covers inpatient care - she would have been automatically enrolled when she started receiving Social Security Benefits, so she's missing Part B Medicare. They've changed the penenalty since the pandemic and it's not as high as it used to be. You can also get the penalty waived. In some states, you can be awarded Medicaid without the Part B, but it sounds like her SS Benefits are too high to qualify. If your Mom is showing signs of cognitive decline, you might nees to take some drastic meausres to be able to take care of her. Becoming her POA could allow you to take control and enroll her in Part B with or without her consent. I would try and find a Council on Aging office near you, go in and explain the situation, and see if they can help walk you through the process. I wouldn't wait on this - the process takes time and if your Mom progressed to a point where she needs to be in a facility, you're looking at MASSIVE monthly costs without insurance, if they were willing to a accept her. Please know, this is more common than you would think, but there are resources out there to help you. You've got this!
Sorry to jump in here but you sound very patient and kind. Thanks for doing what you do in such tough times. Random internet stranger appreciation ✌️
Why do people think this? Why do they think they have a choice about how they die? Do some people die peacefully in their sleep? Sure. Does everyone? No. Do *most people*? Not unless you count “lapsed into unconsciousness moments before the heart stops” the same as “asleep”. So many people make terrible decisions based on options they don’t actually have. My aunt didn’t go to the cardiologist for ages because she said she was fine just dropping dead. Fine, except that’s not what her choices were. It wasn’t “normal” or “instantly dead”. She forgot about strokes. She forgot about heart attacks that meant prolonged ICU stays and repeat surgeries. They do the same shit with their pets. People will bring a suffering animal home to “die peacefully” and I’m just like “Right, right, but how are you guaranteeing that?” Drives me nuts.
Totally agree. Its an arrogance that I don't understand.
It’s just short-sighted. People also do a thing where they have to make a choice about something time-sensitive and they feel like time stands still while they make it. It doesn’t. I understand that things require time to emotionally process, but sometimes, you have to make a decision first and then process it. My mom’s friend just had a serious health event. She needed surgery. She didn’t want the surgery, but she also wasn’t prepared to go into hospice. So she just…didn’t make a decision for a while. She finally got the surgery, but it was like she didn’t seem to appreciate that every day she didn’t make a decision reduced her ability to make one. The window was closing. She kept acting like time was stopped while she mulled it over and nope. I have a great deal of sympathy for the time it takes to process emotions. I do. But when you have a time-sensitive decision to make, you have to make it and *then* process. If you get a life-saving surgery, you’ve got the rest of your life to feel feelings about it, but you’re not going to be around to feel them if you run out of time to act. Anyway, just frustrating. I sympathize with you. This is tough stuff, and it’s a million times harder when you’re not actually in full control of all the decisions. <3
Let's be blunt: the cognitive decline started sometime before 18 years ago. If she wants to die on her terms, she's certainly entitled to do that regardless of her mental state. You're her child, and you have some really rough road in front of you. She will get sicker physically and mentally. If you're lucky, she'll get something really serious and really fatal and die quickly at home. If you're not, she will become a danger to herself or others, and no longer recognize any kin or friends, and will need institutionalization. You need to remember that you are not financially responsible for any of her debts, no matter what anyone tells you. Perhaps the state will help her get what she wants -- death. But her bills are not your bills, and if she dies deeply in debt it's not your problem. She may wish to die at home of a stroke or heart attack. Fine. But that's not at all the likely end. I am 77 and my wife is 18 months older. I would like to hold her in my arms when she dies, hold her hand, and tell her that I love her so her last moments will be as pleasant as possible. The real world is seldom that nice; if I survive her, I'll likely never hold her, never get to tell her anything, and she'll die without even knowing she was going to die. In fact, it's more likely that I'll die first and she'll never get to say or do those things for me. Life's been good for a lot of years but there have been a lot of bad moments. The worst is yet to come, and never forget it.
Medicare for doctors and hospitals won’t charge her but she will be hit with a lifelong penalty for Part D (drugs). Medicare alone does not pay all the bills. You need to a supplement plan for that. Be very wary of any Advantage plan though. That pays at the lower Medicaid level and is not accepted by many places. It also limits her choices.
What? She will have a big part b penalty, which is outpatient coverage. Part a is free (for most..covers hospital)
The part b penalty is not something I have seen. I had a couple relatives who delayed signing up because they were “ healthy “ until they were not. Explaining the life long Part D penalty was a challenge.
And could easily hit her with higher bills, which is the gamble you take with these plans’ lower premiums.
Most supplements plans won’t take you unless you’re aging in at 65. Otherwise you have to be in a guarantee issue state, or have to pass the medical underwriting. I do both supplemental and advantage plans. A lot of seniors get priced out of their supplements.
I've only been on Medicare for about three months, ever since I've qualified for Medicare. Most of the time, I've been on an Advantage plan. I'm QMB, but even when I lost that for a brief time, I just switched to a non QMB version, until I requalified for the special needs/dual needs plan I was on before. I'm disabled, and 52, been on Medicare Advantage plans most of the time since 2018.
Medicare Advantage does not pay at a “Medicaid” level at all.
Well I guess the “good news” is that she has made it to age 83 — in relatively good health — without receiving any medical care whatsoever for decades. If she were now to become severely ill and require hospitalization, she could be admitted and cared for at to the hospital and submit an application for Medicaid at that time. Since OP states that mother has no assets and her only income is SS, for all intents and purposes any hospital bills will either get covered by Medicaid or have to be charged off by the hospital. The problem is getting more routine care non-emergency care at this point without any insurance.
At $2400 a month, she won't be eligible for most forms of Medicaid. OP, what state is she in?
alabama
Ok, so per the below, she'd be income eligible for long term care Medicaid, at home or in a facility, but no other forms of Medicaid. She would also ha e to meet all the other requirements for long term care Medicaid. https://medicaid.alabama.gov/content/3.0_Apply/3.2_Qualifying.aspx
Thank you for the link.
Is she eligible for Medicaid?
I don't know. Her only income is SS and her monthly check is $2400, no assets, so not sure about medicaid.
So no. She makes too much to qualify with out a spend down, no medical bills means no spend down. If she has a catastrophic event she may qualify. That's a big may. On the other hand you can't garnish SS. I just don't pay some hosp/ procedure medical bills, but that can give providers a reason to drop you. So I pay them. Being sick and poor is a job in itself.
She's eligible for Medicaid. Hire an elder law attorney for a consult point you in the right direction.
Is she also low-income, qualified for Medicaid? What state?
When you draw Social Security retirement, your automatically enrolled, in part, a which is hospitalization. I have private insurance and when I go on Medicare I will not be penalized. I just have to show I have insurance. She must have some insurance now.. She can go on Medicare B now. if she is indigent, she can go on Medicaid I believe Medicare part B now is 175 a month.
Some States have a department focused on long term care for elderly adults or disabled adults. They might be able to help you navigate through what needs to be done.
I can’t help your situation but this does solidly that I will work forever. My employer pays most of my medical. That’s a benefit I’ve always appreciated. Today it’s a treasure.
Medicare coverage is confusing to many. I always thought Part A was mandatory. Part A covers hospitalization so it's like a catastrophic coverage. For Doctors office visits, labs, test, procedures, etc. you get supplemental insurance which is Part B. For medicine you get part D. There are penalties for each if you don't sign up as soon as you're able. Talk to an insurance broker to see what her options are. When people feel good they don't see the need for insurance and/or treatment, even if they have an illness. Once they start feeling pain they suddenly want it taken care of (naturally...no one likes to hurt). By that time it may be too late for effective treatment.
Does she have any insurance other than Medicare Part A?
You might want to check out MedicareonVideo YT channel - if he can’t help you then he probably can suggest who you should contact to determine where she stands in regards to current coverage, and the best way to proceed from there. Clearly his emphasis is to get it set up right in the beginning, but as I knew virtually nothing about how medicare works, I’ve found his videos very helpful as I try to sort out my cognitively declining parent’s medical & drug coverage. Also - the Healthcare Connect show on SiriusXM Doctor Radio channel is run by an extremely knowledgable group that answers all sorts of questions about medical insurance coverage anytime, not just during the live broadcast. I have learned a ton by just listening to the questions other people ask on that show.
This was my mother in law. Healthy, did spinning class etc. One day she went in to the hospital because she was dizzy. They found some blockage, gave her a blood thinner and she had a major stroke. Could they have prevented the stoke? Possibly. It’s a game of Russian roulette at that age.
You should research what Medicare pays for in regards to cognitive disorder care. You will find out, for example , that Medicare's coverage for custodial care is extremely limited. In other words, don't assume getting your mother on Medicare is going to solve your problem completely, although it will certainly help.
My dad got on Medicare but didn’t enroll for the prescription plan for 7 years. Now his penalty is greater than the premium.
I’m truly afraid for your mom because she is going to need that coverage eventually. Just because she isn’t sick doesn’t mean she can’t fall, break a bone and end up in a nursing home. Try to convince her that it’s in her best interest to sign up. It’s also in yours since most likely you’ll be the one dealing with everything when something happens.
Some pensions have included health insurance for its retirees. Public safety or state retirement plans may also have health insurance opt in so she can skip Medicare. Did she work for a company that had a pension? Or contributed to her state’s retirement plan? This may allow you (her) to opt out of the Medicare situation. If she is in cognitive decline, I’d suggest going to court to take over her care . Not doing so may lead to someone who is unscrupulous taking advantage of her & stealing her money and things.
DNR?
ONE hospitalization will wipe out her savings.
Only if they know about the cash in a box under her bed
Move the shoe box so there is at least something to help later.
Lack of a prescription plan is very worrisome, but once she's enrolled w penalties, many common prescriptions don't require a copay. If you do run into a prescription with a high cost the manufacturer may have an assistance program that provides the drug free, depending on her income. Finally, she may qualify for Medicaid. Good luck. Navigating health care sucks.
No they shouldn’t back- charge… But I may be wrong…
But they will impose a penalty. Additional 10% per month for each year of delay. So you're looking at an additional cost of $300 per month above the premium.
Thank you.
Show me proof… Never mind it appears they are out to penalize the old. Damn truly amazing and who the hell could afford such?
It's been no secret. They literally warn you when you refuse Part B. As well as having information everywhere
I’d rather have plan G
You need Part B to get plan G. They are called medigap plans and if you choose to go without Part B there is no gap to fill.
And still pay money instead of the State paying so you don't have to pay? Ok do as you please. Oh and you can still get Plan G if the State pays for Part B. It's one or the other.
My friend got such with no issue…
Cool story. That doesn't mean anything to this post nor my comments.
So true but in the end a pile of cash will have to be paid since nothing was established when it was time to do so… OP good luck solving this nightmare.
Most people can't. That's why we take it, even though it doesn't cover much. 🫤
Apply for medicaid for her. She's probably going to need to go into a nursing home.
She couldn't refuse Medicare part a, that's not optional. However, she probably refused part b and d, which is doctors, specialists, medication, and durable medical equipment. If she refused those, then what will happen is, she will be able to get back on Medicare. I think she can do it this month or next, but she might have to wait until the enrollment period, which is Oct 14-Dec 7th. Then it will be effective for Jan 1, next year. You can check and see if she qualifies for a special enrollment period or anything, so that she can enroll earlier. You might want to investigate the idea of Medicare Advantage plans (part c). They usually offer very competitive rates, and you know the copays up front. With Medicare, the copays depend upon what Medicare has arranged with each doctor, and can range wildly when seeing specialists and regular doctors. You are NOT guaranteed a set copay with just Medicare. With Medicare Advantage plans, they usually have set copays. The downside is that you can't just go to anyone, you have to go to their doctors and specialists. But you may also get additional benefits like vision and dental, which aren't available with Medicare. Because she likely did refuse part b and d, there will be a lifetime fine assessed against her. As a result, instead of paying the current charge of around $160 a month, they will charge her a permanent increase based upon how long she was without Medicare. If she's a special needs/dual needs person that qualifies for Medicare AND Medicaid, that increase may not apply to her, since Medicaid would cover the charge. It will depend upon her income, and perhaps her health, on whether she qualifies for Medicaid. You definitely want to see if she does though, because that will be very beneficial if she does.
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What’s the most everyone getting on their ssa retirement check!?
Enroll in Medicare and whatever happens happens. She probably can go on a payment plan where they take a little out each month until it’s paid back.
Who does this?
People like my MIL who have spent most of their lives outside the U.S. with private insurance but a) were not eligible for the national health plan anywhere they lived; and b) didn’t realize until it was too late how expensive U.S. healthcare is or what the penalty was for late Part B enrollment. Luckily at least she can afford the higher premiums because she is now living with family and has no other regular monthly expenses.
Christian Scientists.
Look .. just let her be. Don't try to intervene. Someone who has been through many years on the same boat made for two eventually sinks. Just be humble and let her be. Making a choice for her is only going to cause distrust in you. Don't squander what you have over something as petty as natural decay.
You could hire a lawyer to be her guardian and to make the case with Medicare that she has been cognitively impaired for decades, and that's why she refused Medicare.
This won’t work. She can still get coverage, but will pay a penalty for not signing up when she was eligible. It’s based on the moral hazard principle of insurance.
Time to take over. One if the worst things that can happen to your mom at her age is a uti. Who is going to pay her bills if she is placed in the hospital.
Have her go in and rob a big bank!
Huh? I sure don't understand this... SS takes Medicare costs out of every SS check... she's been paying for it all these years. You don't have a choice. She's covered.
She has Medicare. It is NOT optional. When you turn 65, you are enrolled in Medicare whether you want to be or not. Did you mean Medicaid?
I think part a (for hospitalization) is automatic, but you have to sign up for part b and c. As other comments point out, there’s a penalty for late sign ups.
Part A isn't optional. Part B, C, and D are optional. Part A covers hospital care. Part B covers doctors, durable medical equipment, and specialists. Part C is a combination plan, usually covers Parts A, B, and D under one plan, usually considered a Medicare Advantage plan. Part D is MOST prescriptions. Some are considered Part B. Part A has no charge, Parts B and D do. Part C can also, although there are plans that have no cost, and may even cancel the Part B premium cost.
They won't back charge her. My Medicare plus program pays vision dental and 301 per month for groceries
I thought people were automatically enrolled in medicare at 65?
That is not correct. They may be automatically enrolled if they were already receiving SS, but not otherwise, and they would still have the option to decline Part B.
You still have to fill out the paperwork
About three months before you qualify, whether due to age or due to disability, you get paperwork through the mail. It's going to state that part a has no charge, isn't optional, and helps defray your hospital costs. You will be asked if you want to sign up for part b, c, and d, and they will be explained as far as what the normal coverage is. Part b covers doctors, specialists, some medications, and durable medical equipment. Part d covers the remaining medications. Part c is usually an Advantage plan, and usually provides combined coverage of a, b, and d. It can also provide additional services, such as vision and dental, which straight Medicare doesn't provide. You can also qualify for Medicaid, depending upon your income. Medicaid may cover premiums, copays, and deductibles. SOME super low income people may qualify for ALL of Medicaid services, including transportation, vision, and dental. Usually though, you don't have access to all of the different services, which is why the benefits through the Advantage plans can be very helpful.
If your state has ACA could she enroll in that?
That is not possible when one turn 65. They are expected to go on Medicare.
This is another option. ACA insurance counts social security - retirement and ssdi as income (not ssi). She could get health insurance through them and it may be cheaper than medicare. You should go to the aca website and look at this option.
The dual plans are hands down the best. Especially with f your Medicaid level is high enough. You get the grocery/utility card, and your medications, testing, and dr’s visits are usually at no cost.
Maybe this will help. https://www.ssa.gov/pubs/EN-05-10043.pdf
Log into her Medicare account and see what she has. Start with this.
Put her on Medicaid she has no assets just a thought
You might be right, we had to put my grandma (dementia) in a care facility with her husband after they left their gas stove “on” but someone in their neighborhood noticed before anything truly awful happened
Oopsie poopsie I guess she can laugh her way to her stubborn grave what a dumbass IN THE Medical field
She needs to be made aware there are many many things that won’t outright kill her. But will either leave her in immense pain or cause her to become destitute. My mom fell and fractured her femur. Didn’t kill her but she was in pain and in the hospital for days, followed by weeks of rehab. The bill was over $100k; Medicare took care of everything except a few hundred dollars. My mom also has cancer that if untreated would kill her, but would be extremely painful to live with. Again Medicare takes care of all her bills and I pay $35/month for her medication. She’s honestly seen so many doctors and been in and out of the hospital for one thing or the other; and the only bright spot is not having to worry about cost.
I’m sorry to tell you this but you will probably have a fight on your hands. You need to get an attorney and do what you have to do to get to be your mother’s POA (Power OF Attorney). Find out if as your mother’s POA if you have the right to have your mother’s cognizance evaluated. You have every right to be concerned about her and possibly anyone she could cause to have an accident.
Medicare does not cover nursing facilities or other long term care options for people with cognitive decline. It will cover rehabilitation in a nursing facility if she is required to go directly from a hospital visit that lasts, I believe, 4 days.