Toni: My 86-year-old mother with Alzheimer’s needs 24-hour care and lives in a personal care home. She is enrolled in a Medicare Advantage HMO and taking her to the doctor is quite an ordeal. Friends have suggested that I disenroll my mother from this HMO and return her to Medicare and use “telehealth” which has become popular since the pandemic.
Financially, it is costing over $4,000 for her personal care home, and she does not qualify for a Medicare Supplement due to her Alzheimer’s because I have tried!
How do I find a doctor who does use telehealth or makes house calls like in the old days? Is this something that Medicare or a Medicare Advantage plan will pay for? Thanks. — Victoria, Lake Charles, LA
Hi Victoria: I have good news for you because the “Dr. Welby” days are back to stay since the pandemic for those on Original Medicare or Medicare Advantage plans. Social distancing has caused telehealth, also known as telemedicine, to remain popular in 2023.
At-home doctor visits via the computer or other device are reducing the number of ER visits for patients who cannot get to the doctor’s office for a face-to-face meeting. A telehealth or house call can help prevent a minor ailment from turning into a major health care issue while keeping a frail senior out of the hospital and healthy.
Medical doctors are not the only ones making telehealth or house call visits. So are dentists and eye doctors; even technicians with mobile x-ray, ultrasound and other medical diagnostic machines will come to homes, assisted living facilities, personal care homes, and nursing homes.
My advice to you, Victoria, and to Toni Says readers, is to ask your family member’s primary care doctor or specific health care provider which telehealth provider their office is contracted with, regardless of whether he or she has Original Medicare with or without a Medicare Supplement, a Medicare Advantage plan, or a retiree group medical plan. Original Medicare and Original Medicare with a supplement will pay for house calls or telemedicine services. Medicare Advantage plans will also pay for these services, provided the service is in the plan’s network.
House call doctors are generally board certified and the providers consist of doctors, physician assistants and nurse practitioners. The patient does not have to be homebound to qualify. The house call doctor can schedule regular appointments, especially if the patient has a chronic illness, or you can schedule appointments as needed.
Victoria, you are wise to look at all your mother’s options regarding disenrolling from her Medicare Advantage plan with her serious health situation. Many do not realize that they must qualify medically to be approved for a Medicare Supplement, which helps pay for what Medicare will not pay. If one is not approved medically, then they will pay out of their pocket.
It is vitally important to consider all Medicare plan options because no one knows when their health will begin to deteriorate, and then they discover they can no longer change their Medicare plan. Chapter 2 of Toni’s Medicare Survival Guide Advanced edition explains Medicare Parts A and B which can help avoid problems like Victoria is experiencing with her mother.