Part A, Part B and Rx Wellcare? Is that adequate for now? Newbie trying to figure out plan for my mom.

[anonyx]

Today being the deadline, I don't expect to be able to figure out the perfect plan for this year. I know virtually nothing about medicare, but my 83-year-old mother has recently moved in with me and I just want to make sure her coverage is okay for the coming year. We live near Rochester NY.

She has Part A for free. She will be paying $148.50 per month for Part B. And she apparently has some kind of Prescription drug plan with something called Wellcare, but the premium seems to be $0.

She has medical issues but hasn't seen a doctor in decades, and has no prescriptions. She could probably use an eye exam and prescription glasses. She has dentures and incontinence issues. She moved in with me as an emergency measure because she was being evicted in another state. The plan was to find her some assisted living, but that turned out to be complicated and not-likely-affordable, and then the pandemic hit and we've stayed home.

Anyone terribly wrong with sticking with what she has for 2021? Am I missing something major? I appreciate any constructive advice because again, this is all completely new to me. Thanks.

 

[MBSC]

Part A will cover inpatient hospital facility charges after a $1484 deductible so she has adequate coverage there.

Part B only covers 80% of professional services. This includes the doctors who would see her as an inpatient, any outpatient hospital services, outpatient cancer treatment, office visits and lab work. Most people purchase additional insurance to help pay for the remaining 20% but it's not required.

There are two types of additional insurance: 1) Medicare Advantage plans, and 2) Medicare supplements also called Medigap plans.

If she becomes a resident of NY, she can enroll in a Medigap plan anytime without answering medical questions. Medigap plans and rates for NY can be found here: https://www.dfs.ny.gov/consumers/health_insurance/supplement_plans_rates

I suggest looking at the 'High Deductible G' Medigap plan which is called 'G+' on the website with premiums in the $53-64/month range for Rochester. She will be responsible for the 20% not paid by Medicare until that amount totals $2370, then the 'G+' Medigap will start paying the 20%. This provides catastrophic coverage in case of expensive cancer treatment.

The other option is Medicare Advantage. You stated she has a $0 premium drug plan. All drug plans have a premium. There is a program for low income seniors called "Extra Help" that pays the premium. The other possibility is that it is a $0 premium Medicare Advantage plan that includes drug coverage. If it is actually a Medicare Advantage plan, she would not need a supplement (Medigap). She may need to change Advantage plans if she has moved out of the plan's service area. Let me know if I can be of additional assistance.

 

[anonyx]

MBSC, Thank you so much for taking the time to respond to my question!! This is extremely helpful! I will check out plan G+.