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November 11th, 2022

Medicare, It's Not That Complicated

  1. Medicare, It's Not That Complicated Phyllis Ayman, MS/SLP, CDP, CADDCT, CDCM, CMDCP 49:16

The Medicare Enrollment period began October15 and continues until December 7th.
For many of us the choices seem complicated, especially as we are bombarded with information, robocalls, and television commercials featuring high profile figures, actors, etc.
The situation is ripe for people with less than honest intentions. Scammers seek to take advantage of the confusion and successfully dupe older adults out of millions of dollars each year.
Where do you turn to get reliable information?
Ari Parker has an extremely simple way of explaining it all.
He breaks down the supplemental Medigap and Medicare Advantage plans in such simple terms, you’ll wonder why it needs to be so complicated.
Almost half of the 65 million people who have Medicare coverage also carry private insurance through Medicare Advantage Plans as an alternative to depending on government insurance alone. These plans are supposed to cover at least what Medicare covers which is up to 100 days of skilled nursing home care each year. However, these private plans can make their own decisions on how much nursing home care they are willing to cover..
But is that really clear when you’ purchase a Medicare Advantage Plan?
And while it all seems rosy when you purchase a plan, there are difficulties people encounter once they have to use the plan benefits.
Here’s an example that may give you pause for thought when looking into a Medicare Advantage Plan.
The plans have a practice of ending coverage for nursing home and rehabilitation services before the person is ready to return home.

When people are covered by traditional Medicare, the facility determines when the patient is ready to return home. With Medicare Advantage plans, the plan decides.

Therefore, when ending coverage for someone earlier than they are ready, the person and their family can be faced with serious decisions as to whether to take the chance to appeal the decision or remain in the setting possibly amassing thousands of dollars in medical bills. Whose interest does this serve? Certainly not the patient.

This situation can be very stressful for a family already stressed with their loved one’s condition.

The federal government pays Medicare Advantage a set amount on a monthly basis for each person enrolled in the plan, regardless of how much care the person needs or receives. One could not help but think that this model provides an incentive for insurance companies to deny access to services and payment in order to increase their profits. That most probably isn’t new news to anyone.

Listen in to hear Ari discuss this situation and others so that you are making an informed decision about medical care for you or your loved one.

Phyllis Ayman Ambassador for Conscious Aging Life Management and #1 WSJ and USA Today Best Selling Author, Podcaster

Phyllis Ayman is the Ambassador for Conscious Aging Life Management, and founder of Mindful Longevity Solutions. She coaches individuals to develop their Personalized Longevity or Wellness Care Plans so they can live as healthfully, happily ,and fulfilled as they possibly can. As an aging life careplanning coach and mediator, she guides families to make decisions and mediate challenging conversations around aging care issues. She conceived and owns the trademark IMpathy®, essentially the inner game of empathy, which the hallmark of her proprietary programs.

Ayman is a #1 WSJ and USA Today Best Selling author, featured speaker, panel moderator, trainer, advocate gerontological speech/language pathologist and dementia care specialist. She spent over 40,000 hours working with thousands of individuals and families in long term care. Her writings have been featured in Next Avenue, McKnight’s Long Term Care News and McKnight’s Senior Living, and the National Council of Certified Dementia Practitioner Newsletters.

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