HMO - HO HO HO!

There is an old saying, "You get what you pay for."  This is said when someone complains about something they paid little or nothing for; something bought on the cheap, a bargain, a perceived good deal, and then it doesn't work well.

"I bought this two dollar watch off a guy in the street and it stopped keeping time two days later."

"Well, you get what you pay for," is what the fool is told.

Quite often this saying is true.  Not in the case of the Medicare Advantage Plans, at least not the one offered by the A-As-In-Hole Insurance Company. "One of the wonderful things about reaching age 65," a TV ad tells us, "is Medicare." (Not an A-As-In-Hole ad in case you are guessing.) Medicare may or may not be wonderful, but most certainly the Advantage plans aren't. But who knew? Most people I have spoken with about what happened to my mother are amazed when the medicare Advantage is explained to them. I have to admit I didn't know what they were.

I thought they were Medicare Supplement Insurance, you know, policies that cover what Medicare doesn't, like co-pays and deductibles.

By the way, this is another thing where "you get what you pay for" doesn't apply, Medicare Supplement Plans (known as Medigap). You'll see ads from Company Y pushing their supplement plan as being better than Company X, and you are only paying a little more a month. Well, then pick Company X because these supplemental plans are standardized by the government. There is a menu of 10 choices. Each choice offers some additional services, for example Choice C offer Skilled Nursing Co-Pay Coverage, while Choice B doesn't and Choice K only offers 50%; however, Choices B and K don't cover the Part B Annual Deductible while Choice C does.

You need to select the Medigap coverage you think you'll need. Perhaps you never leave the country, so you don't need Choice C because it covers out-of-country emergency care. But whatever Choice you make remember it is exactly the same coverage you will get through Insurance Company X as Company Y, so don't take the one charging a higher premium.

I noticed when we visited one nursing home and I told the Admissions Director my mom had a Medicare Supplement plan called A-As-In-Hole Medicare Super-Duper that she wrinkled her nose.

"That's not a supplement plan," was all she said.

Now remember there were all those crossed off nursing homes that wouldn't accept my mother's insurance. It did seem funny that something from one of the best known insurance companies in the country called Super-Duper Plan would not be universally accepted.

When my mother's coverage was dropped after 43 days instead of the 100 days Medicare normally covers for such therapy I found out why these places wanted nothing to do with it.

I was put in contact with an insurance specialist both by a nursing home and a friend. He explained the different animals. He said my mom would have been fine if she had traditional Medicare, in other words Plan A and B, even without supplemental. What she has is definitely not supplemental.

I had a friend ask me if my mother had the Medicare Plan B premium deducted on her Social Security. Indeed, she did. He said she had Plan B coverage then. Not exactly, what she has is a Medicare Advantage Plan that gives the same coverage as Plan B and she gets the privilege of paying the Plan B premium to the government as well as an additional $145 a month to A-As-In-Hole Insurance Company for it.

So just what is this animal? It is really Super-Duper? Not so much. The A-As-In-Hole Medicare Super-Duper Plan gives you, by law, everything Plan A and B of Medicare does. It still has all the deductibles and Co-Pays, may even have a few additional ones. It doesn't supplement anything. It does include Part D, the prescription drug portion. But you can get Plan D coverage for under $40 a month, so what is the other $105 a month she is paying get her? Remember, she is also paying Medicare her $96.50 a month, but Medicare itself is not providing any of her coverage. No-no-no, A-As-In-Hole is doing it all. No claims ever go to Medicare at all.

It works this way. Medicare collects the regular premium from Mom's Social Security every month. Medicare then pays A-As-In-Hole a portion of that amount. Thus the government makes a little money on the deal. A-As-In-Hole takes that fee and adds their own premium, the $145 a month and agrees to cover what Parts A & B do.

So why would anyone go for this, you ask? Because when you are our age and you see the ad telling you how great the Super-Duper Plan is because it not only covers your Medicare care, but your drug prescriptions and your eye exams and glasses and your hearing aids and hearing exams and for an additional $10 a month your dental, it sounds like a good deal to a lot of us Seasoned Citizens. But since you can get a separate policy for Plan D at less than $40, that $105 additional a month should easily cover those other costs for most of us with money left over in our bank accounts.

And The A-As-In-Hole Insurance company and its cohorts who offer these Medicare Advantage Plans are allowed to make their own rules in some areas.

Thus instead of the 100 days of rehabilitation my mom would have received under traditional Medicare, she was cut off at 43 days by her supposedly Super-Duper Insurance Coverage.

Now a further note concerning my dad, who has this same type policy. It is even more odorous since he already gets his prescriptions and hearing aid needs through the VA as a combat veteran of WWII. What in the world is he getting for that $145 a month?

Part Three: Lost in the Land of the Last

I had exhausted the lineup of homes my mother and her friends had suggested. It was time to step away from the few to the many. But how?

I began by that new old fallback, Google. I thus stumbled upon a website that listed every Nursing Home known to man and then some. It gave general information, such as name and address and phone number, a few tidbits such as number of beds and affiliation and lastly the Medicare Rating.

Medicare has a Five Star Rating System for all Nursing Homes that accept Medicare. 5-Stars are the most a home can receive and I am told by professionals in the Medical Field this is very difficult to get. The lowest is 1-Star. There is no such animal as a Zero-Star nursing home. Everybody gets something, even if only a Certificate of Participation.

For Instance, Sunset City only had 1-Star; translation -- Well Below Average, while my mom's vaunted Mushmouth Manor managed 2-Stars, or below Average. Her latest ideal of PassingGo Home wasn't bad at all with an above average rating of 4-Stars.

But these were out of the running for a permanent solution at this point. I needed fresh storage space in the warehouse district of the elderly.

Since Medicare ranked every Nursing Home they came in cahoots with I had some pruning to do. The list did allow you to select by state, so I started with that, but it didn't go so far as allowing the selection of  county. (Later, after more hard-knock education in this field I did find the actual Medicare ranking site and it did allow selection by county, even by individual home. Here is the website to save you the trouble of Google fishing for it if you are ever interested or need it:)

http://www.medicare.gov/nhcompare/include/datasection/questions/proximitysearch.asp?bhcp=1

I then spent an eye-glazing, mind-numbing time scrolling through all the Pennsylvania Nursing Homes and copying all located in my parents' general area to an Excel worksheet. From that list, which in itself was fairly long, I selected those homes rated above average. There were very few near my parents stomping grounds. I then contacted around six homes by email or phone.

Email seemed the better way I found. You could say more and might get a quicker response back. Telephoning connected you to an automated voice allowing you to choose from a menu of buttons just to get to someone's voice mail where you could leave a message, which may or may not ever result in a return call.

From those I emailed, I received an email response, mostly acknowledging they had my email and would contact me in the near future. These places obviously calculate the near future in a different galaxy than mine for I still await that follow-up contact from them.

From the phone calls I received brochures from one, a "Don't call us, we'll call you if we ever decide to care," and a polite but firm turndown from another.

One home did call and invite me to take the tour. My wife and I went on the appointed day and promptly got lost. Once again a road with a hidden part, much like Mushmouth Manor. When we did arrive it was to the wrong building. We finally got to where we were supposed to be and the Admissions Director was very kind and gracious, although we quickly learned there was no hope of placing my parents there. They not only didn't accept her particular form of medical insurance, but they did not accept Medicaid.

Despite this she was extremely helpful and still gave us the tour. This was another lesson learned. Medicaid was not universal in the Land of the Last. I needed more than Medicare ratings, I needed to know who accepted what.

I received about this time a packet from the Department of Aging. Within was a list of the county homes and most importantly whether they accepted Medicaid as well as Medicare. I now changed my approach from less shotgun to more rifle.

TO BE CONTINUED