My Mother is on a Medicare Advantage plan with a secondary insurance through her former employer. She is currently in assisted living and there is no provider that will see her there. There is little choice in providers as well. Therefore can she bypass her primary MA plan and see providers on her secondary plan instead? Please advise. Thank you.
(*if you look at her insurance with her employer, its probably a supplemental not full insurance. My DH had to retire at 62 so had full insurance until 65 when Medicare kicked in and the insurance was changed to a supplemental. I find this is pretty true with employer insurance)
I think you need to make an appt with ur local Office of Aging. Take in the benefit booklets of each of the insurers. You may be better off with Traditional Medicare and the employers supplemental than with a MA u can't use.
Also, be aware that some MAs are now PPO not HMOs. This means you can go out of network but you save by staying in Network. Also, once you drop an employers insurance, u may not be able to pick it up again.
You may not be able to use the employers insurer because its probably a supplemental. Meaning, they only pay what Medicare pays for. With traditional Medicare, the doctor bills Medicare. Medicare pays 80% of what is reasonable, the supplemental paying the 20%. Your problem is you have MA which includes a supplemental. If the employers is also a supplemental, a doctor can not bill them directly because they only cover the 20% Medicare doesn't. The MA is your medicare and supplemental rolled into one. I really have no idea how a MA works when there is another supplemental. When Mom went on Medicaid she had a supplemental with her employer. Medicare was billed first, then her supplemental and then Medicaid. Thats why I suggest u talk to someone from O of A.
Currently her past employer supplemental does pick up a lot some of what the MA plan doesn't pay.