medicare vs aetna medicare

[YvetteR653236]

My father in law suffered a stroke which has left him with left side weakness, he can not stand, walk or use restroom on his own. He lives in Michigan my husband and I have decided to bring him to live wth us in Florida. We both work full time with three gilrs in college. We will need help with his daily activities, he willl need Pt, Ot & speech therapy. He is 78 , has Aetna Medicare but we were told that possibly changing him over to just Medicare would be better. We are new at all this and quite frankly scared and overwhelmed , can I call Medicare directly to guide us ? Does anyone have any advice on this topic as I am sure there are many families that may have experience and valuable advice?

[GailL1]

You do have a problem - he needs that therapy to bring him back as far as he can physically.  Most likely his MA plan in MI will place him in a rehab facility - usually this is in a SNF and you will have to read his plan to find out the cost to him.  Actually, I am wondering if it wouldn’t be better to let this play out in MI - I hope you have his Health Care POA so that you can talk to his doc about the prognosis and timing of the in-patient care.

Since MA plans are usually local plans - you need to find out what type of plan he has with Aetna - A PPO, a HMO - then you need to find out if he also has Medicaid to see if it is a Dual Eligible plan or some sort of Special Needs plan.

You have to know his status and type of plan before you bring him to FL - states have different rules and plans with Medicare especially if they also have Medicaid as the secondary.

So you will need to make sure he can get basically the same coverage in FL or something that might be better with his current condition and finances 

Yes, he can go back to traditional Medicare but unless he also has Medicaid as his second payer, then there are those out of pocket cost that he will have to cover because I really doubt that he is eligible for a MediGAP plan which picks up various out of pocket in traditional Medicare cost which is the beneficiary’s responsibility.

Remember that traditional Medicare does not have an annual or lifetime limit on the beneficiaries out of pocket cost.

You would come out better talking to both MI and FL Dept of Ins - SHIP dept (State Health Insurance program).  

Aetna may have some MA plans where you live in FL but maybe not.

What you have described sounds simple until you start putting a real face and situation into the plan then it gets complicated.

If he only has a MA plan with no MEDICAID then he won’t qualify for in-home care unless his MA plan has sone coverage.  Medicare only covers medically necessary stuff - not custodial care or daily living care.
Just understand that - but does he have a LTC policy?

1st Find out about his insurance - Does he have Medicaid in addition to Medicare in MI?  Can he qualify for Medicaid in FL - states are different.

What type of plan does he have with Aetna MA plan?    Does Aetna have such a plan in FL.  

Good Luck