Medicare, Medigap, Advantage decisions

There has been some interesting discussion on kidzdoc's thread about how to make decisions about which medical plans to enroll in when you turn 65 in the USA. For those who may be interested, I'm starting a thread here. I'm trying to do my research now so I will hopefully be able to make a good decision later this year.

I'm posting two resources that I'm looking at, as well as a YouTube video shared by qebo here.

Resources

• https://www.medicare.gov/


• The non profit Triage Health has resources on medicare, and is offering a free webinar in April for people signing up for Medicare for the first time.


• John Oliver on YouTube


• Find your state SHIP office (state health insurance assistance program). (Click on find local medicare help button at the top of the page.) This gets you to someone who is not employed by an insurance company to explain plans and coverage to you.


Edited to add link to state Ship (state health insurance assistance program)

My advice is that if you are on Medicare and worry about medical costs, take a supplementary plan if affordable, rather than an Advantage plan.

Thanks, Ardene and Kate! I look forward to learning from and contributing to this thread. As I mentioned I'll turn 65 in large March, and I currently have an Independence Blue Cross (IBX) HMO plan through the ACA, which has served me well, including coverage for my recent cataract surgeries.

>3 kidzdoc: yes, I haven’t read advice was if it works don’t change it.

For anyone with a Facebook account, two groups that often discuss Medicare:
Retiring on a Budget : https://www.facebook.com/groups/1414320586448534
Retiring on a Shoestring Budget : https://www.facebook.com/groups/1923758388422322 (created because of frequent complaints in the other group that many members had too much money to call it "budget")

Interesting thread. We put my mother, who was dealing with dementia, on an Advantage plan and regretted it. We had restrictions on how to get care was covered that were easy to overlook, so we had to constantly deal with that and think about how to manage. If there wasn’t a proper and documented referral for each diagnostic treatment, like an MRI ordered by the ER, then it might not be covered. We had to call nurses have them explain retroactively.

>4 kjuliff: Oh, crap. I just checked, and IBX, the largest insurer in SE Pennsylvania, is no longer offering Medicare supplemental insurance plans as of January 1st. So, I'll have to get an IBX supplemental insurance plan, or search for another insurance company that does offer a plan in this area. This may only apply to myself and possibly @qebo, but I wouldn't be surprised if other insurers are doing the same thing, given that IBX has over 7 million members.

>5 qebo:, >6 dchaikin: Thanks, Katherine and Dan. Given that your mother was in the Philadelphia area, IIRC, this would directly apply to me. (Crap.)

>7 kidzdoc: FWIW, I had health insurance through Highmark when I got it through the ACA, then when I turned 65 I switched to Highmark Medicare Advantage plan, then when that plan was discontinued I switched to traditional Medicare with Highmark G supplement. Smooth transitions all, once I'd made decisions. I get Humana D because Highmark D is a lot more expensive and I don't need it.

As I understand it, you can switch from one D plan to another no questions asked during open enrollment each year, so the advice is to get the least expensive plan that will cover the prescription drugs you use.

>6 dchaikin: I attended an information session at a continuing care retirement community several months ago and in the context of how to be prepared someone asked about Medicare. The CEO was running the session and said they have more trouble getting approval and reimbursement from Medicare Advantage plans.

I have had traditional medicare for 10 years, and love it. I can choose my doctors, and there is never any preapproval/referral required for visits to specialists or procedures like CT scans and MRIs. Before choosing a plan, I had advisors I trust tell me that the Medicare Advantage plans are okay--unless and until you actually get sick. Then it's delay, denial, and appeals. However, when you are younger, and relatively healthy, the (sometimes) lower premiums and "extras" like eye exams and dental exams appeal to many.
Once I went on traditional medicare, I researched the Medicare web site for the gap plans that were available to me, then chose based on coverage, premiums etc. Because I am surprise adverse, and wanted the most coverage I could get (rather than being surprised by a large copay or non-covered item). The premium might have been slightly higher, but after 10 years I have basically never had to pay for anything other than the annual medical deductible.
If you get traditional medicare, you will also have to get a Part D drug plan. In the past drug coverage has been very confusing, with a long "donut hole" after a short period of coverage before catastrophic coverage kicks in. But starting last year, a bill passed by Biden has made it so that once your out of pocket costs reach about $2000 for the year, you don't have to pay for your drugs for the rest of the year. This has made a big difference for my husband and me as we both have some very expensive drugs.
All I can say is that I don't think the intricacies of coverage for seniors could have been made more complicated if they tried !

ETA I think the most important take away is that with traditional medicare, there are no pre approvals required, and I think that is hugely important. Your medical care is strictly up to your doctor . HOWEVER, I have read that Trump has a trial plan to take place in several states to require preapproval (by AI) for several procedures they feel may be being abused.

>8 qebo: At a quick glance it does appear that Highmark does offer Medicare supplemental plans for my zip code, and that my PCP's group does accept this insurance. I'll need to look at this in much more detail, especially to see if the other specialists I see also accept one of these plans.

>10 arubabookwoman: Thanks for that very helpful advice, Deborah. I think my mindset will be the same as yours, as I'll also want to avoid surprises or having to jump through hoops to get prior authorizations for referrals and procedures.

>10 arubabookwoman: pre-approval - that’s the word i was looking for. It was a huge hassle with my mother. There were lots of fights with hospitals and assisted living staff - “no. You can’t just do that. We have to get pre-approval first.” And they wouldn’t always get the message. And, of course, there were delays as we figured out how to get pre-approval.

>10 arubabookwoman: I don't think the intricacies of coverage for seniors could have been made more complicated if they tried!
Really. I'm self-employed so I'd been getting insurance through the ACA since it started, and nearly every year I had to sort through all the choices. I'd assumed Medicare was just a single automatic thing, but it turns out to be much more complicated.

>11 kidzdoc: My understanding (and do double check this because I'm operating from memory) is that while Medicare Advantage has a network so your doctor or hospital has to be in it, any Medigap plan applies wherever Medicare is accepted, regardless of the insurance company.

>7 kidzdoc: some providersdon’t seem to like those plans. My plan is with United healthcare and I was first on the most expensive supplementplan F because I was worried about the condition of my eyesight, and I wanted to be cautious. I’m glad I was. But now they no longer offer plan F . I think they only offer plan G for new people..

I managed to get grandfathered in. I’ve had several procedures in operations, two of them quite extensive and not had to pay a thing..

>10 arubabookwoman: I completely agree. When I go to a new doctor and I mentioned United, some of them say I’m not covered, but when I say traditional Medicare with supplement, they say oh that’s fine.

>13 dchaikin: Ugh.

>14 qebo: Thanks, Katherine. I did look at my PCP's website to be sure that the group takes IBX Medicare Advantage, which it does, and it also takes Highmark, although I'm not yet sure if that applies to the Medigap plans or not. I may need or want to request a pamphlet from Highmark, and look at the Pennsylvania specific link that you posted on my thread. As far as I know you and I are the only active Pennsylvanians in Club Read.

>15 kjuliff: Yeah, for F you had to turn 65 before 1 January 2020. The only difference between F and G is that F covers the part B deductible (currently $283) and G does not.

>18 qebo: so there’s not much difference. But I’m still keeping it..

>10 arubabookwoman: Thanks again for your great advice, Deborah. I've now spant a few hours last night and early this morning, and although I need to do more reading and research I'll almost certainly choose Original Medicare, get prescription drug coverage under Part D, and purchase a high deductible Part G supplemental insurance plan, possibly from Highmark, provided that my specialists do take that plan (my PCP does)..This thread has already been incredibly helpful in advising me on the best options for me.

>14 qebo: I wish I had known much more about Medicare a couple of years ago, when I had to sign up my mother for health insurance after my father died. I foolishly chose a Humana Medicare Advantage plan based on television ads, but thanks to the advice I've received here I won't make the same hostage for myself.

any Medigap plan applies wherever Medicare is accepted, regardless of the insurance company.

Thanks; I'l look into this.

>15 kjuliff: Part G supplemental insurance plans seem to be the best fit for me. I don't think United supplemental plans are valid in this area, but ones from Highmark (a BCBS plan based in Pittsburgh) are. I would have chosen Independence Blue Cross, the BCBS insurer for the Philadelphia area, but they dropped their supplemental insurance plans as of this month.

>20 kidzdoc: I'd had Highmark insurance through the ACA for years, so when I approached 65 and was bombarded by mail ads, I went to an information session at the local Highmark office, and based on advice from the pleasant helpful representative, I signed up for a Medicare Advantage plan. It wasn't until last year, when I got a notification in the mail that the plan would be discontinued, that I seriously researched options. And that wasn't because I was wiser, it was because after 5 years of family emergency followed by long slow decline both parents had died, so I began to focus on my own retirement.

>21 qebo: I just checked, and apparently my closest Highmark location is just over 50 miles away, in Easton! I can certainly drive there, especially now that my mother is still being cared for in a local skilled nursing facility, but I'll see if I can receive information about their Medicare supplemental plans by electronic or snail mail instead.

I have been casually looking through my mother's copy of "Medicare & You 2026," the 'official U.S. government Medicare handbook' that came in the mail before last year's Open Enrollment Period. It contains detailed information about Medicare although not as much about Medigap and its plans, so I did request a print copy of the booklet "Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare" from http://Medicare.gov/Publications.

I also noticed that my financial advisor sent me an email last week inviting me to take advantage of Fidelity's services for retirees, although I'm already feeling much more certain in the direction I intend to go.

>20 kidzdoc: it’s pretty bad that they can just drop a plan or part of a plan like that. When will the U.S. federal government of either party realize that it just doesn’t work having private insurance companies like this. It’s costly and messy.

In Australia, we have coverage for everybody, under funded by a a Medicare tax. Everyone in Australia, legally is entitled to Medicare. Conservative governments have tried to whittle it away by having supplementary insurance and tax breaks for people who take out private. But it’s still there and if I were in Australia, I’d be taking it. Well, this is a silly thing to say because every resident of Australian is entitled to it, so it’s not a matter of taking it or not. But you can take out more private insurance, although most of my friends don’t on principal..

>23 kjuliff: It still isn't completely clear to me but it appears that IBX was losing a significant money on its Medicare supplement plans, and that it no longer offered these plans for new enrollees beginning this month, although people who were previously enrolled were allowed to stay on one of those plans. Fortunately I do have options, such as the Pittsburgh based BCBS plan that I had previously mentioned.

>24 kidzdoc: the same thing happened to me when I was on plan F for United healthcare several years ago and they stopped offering it and they gave you an option somewhere to have grandfathered it in and I took that option and I have it have it still.

I was a bit weary that they’d take it away from me because I’ve had it for years, but it’s still there and it worked.

One of my former partners who has been retired for several years recommended United Medicare Advisors to me, which is a service that helps people who are ready to enroll in Medicare. After speaking with a very helpful and knowledgeable advisor and learning about my medical conditions and travel itineraries she agreed that a Part G Medigap plan would be best for me, and after we discussed different carriers I chose the Aflac plan, which has an A+ rating, similar to United Medicare Advisors. She sent me information by email, and after our conversation I enrolled in Parts A and B of Traditional Medicaid. So I've now completed the process I needed to enroll in Medicare in roughly an hour, and I have an advisor who can guide me with any problems or questions that may arise.

>26 kidzdoc: Good news. I have a similar set up, but I have plan F which I got some years ago and it’s grandfathered in. Plan G is good too.. Now you can rest easy on medical insurance I think..

>26 kidzdoc: I enrolled in Parts A and B
I'm still learning, but don't you also need Part D for prescriptions?

This thread is really helpful in understanding how things work. My husband becomes eligible this year, and I'll be eligible next year.

>27 kjuliff: Several of my friends who are retired and not on LibraryThing strongly recommended that I get Traditional Medicare with a Part G Medigap plan, and not a Medicare Advantage plan. The United Medicare advisor was very informative without trying to force me into a particular plan, and given Aflac's reputation and A+ rating I'm completely comfortable with this choice, and this advisor.

>28 lauralkeet: Absolutely, Laura. I'm not completely sure but I think I need to do that as part of this enrollment, presumably in the coming days and weeks. I'll look into this now.

I checked one of the emails I received from my United Medicare advisor, and she said that she will contact me to explore Medicare Part D options once I am enrolled in Medicare later this month.

>28 lauralkeet:, >29 kidzdoc: Having recently been through this... D is not exactly mandatory but there's a penalty if you don't sign up now but do sign up later, and it can be changed each year, so the recommendation is that you look for a plan that covers your prescriptions and choose independently of your MediGap plan. I don't have any prescriptions, so I chose the least expensive plan which was Humana for $6 per month. An annoying little bit to attend to, can't pay the full year in advance but can set up for autopay each month. I have plan G through Highmark and its D would've been clerically simpler but was far more expensive than Humana.

>32 qebo: That's my understanding as well, Katherine.

>30 kidzdoc:, >31 kidzdoc: I'm glad you'll be well taken care of Darryl!

>32 qebo: super helpful Katherine, thank you.

That was fast. I just received an email message from Medicare, which informed me that my application has been approved, that I should receive my Medicare card in about 2 weeks, and that I can now apply for Part D coverage. Medicare will kick in on March 1st. Given the conversation I had with the advisor from United Medicare I'll reach out to her in regards to looking for Part D plans.

ETA: I think one other thing I need to do is contact my current insurer, to let them know that I won't need coverage through them after this month, so that I don't pay for both plans. From what I understand from the advisor that is an unlikely possibility, but calling eliminates any problems.

>35 kidzdoc: i’d be interested in knowing about the Paart D plans. I am only using the one that comes with my Supplementary Insurance company. It’s basically just vanilla Medicare, which is oK, as there’s a cap on the amount of what you can pay for prescribed medications, now which is currently $2000 per year. sorry for the irregular capitalization; AI hasn’t yet got to the stage of knowing how to capitalize.

>36 kjuliff: I'll let you know what I find out after I talk with my United Medicare advisor tomorrow morning. I've been visiting my mother in the memory care center since noon.

>36 kjuliff: This morning I received an email from Chapter, a company that provides free advice on choosing Medicare Part D plans, to schedule an appointment, and I'll have a phone conversation with an advisor on Tuesday afternoon. The website is https://askchapter.org/, and the phone number is 855.900.CHAP.

I nearly forgot to mention that I had a virtual appointment with my therapist on Friday, and at the end of the session I told her that the next time I saw her and my psychiatrist I would be on Traditional Medicare with a Part G Medigap plan through Aflac. It was my understanding that most behavioral health specialists didn't take Medicare, but she said that they accept every Medigap plan except United Healthcare, and, of course, they don't accept any Medicare Advantage plans.

Re Part D, I started with Express Scripts which was taken over by Cigna which I had for years. I take several very expensive drugs, and my copays etc were in the thousands each year approaching the "catastrophic." So I was much relieved for the $2000 out of pocket cap that went into effect last year, which I hit in May. After that I paid nothing for drugs. Then this year Cigna withdrew from offering Part D plans in Forida. My therapist recommended I check out Well Care, which she had. I did, and now I have a Well Care plan with zero premium cost, very similar coverage to Cigna, and I will again start having to pay nothing in May.
For my gap insurance I signed up with Blue Cross in Seattle with an "F" plan. If Medicare covers it, they pay the difference between the allowed amount and what Medicare pays. They also pay my annual Medicare deductible. The premiums are on the high side, but quite worth it I think. I never have had to pay anything (other than premiums). This plan followed me to Florida. Kate says they have discontinued the F plan, so I guess I'm also grandfathered in. I prefer to be able to plan for paying possibly higher premiums than being hit with surprises for noncoverage.

>40 arubabookwoman: This is helpful. I looked at the Medicare Part D website listed in the Medicare manual (Medicare.gov/plan-compare), entered my zip code and the medications and doses I'm taking, and the site generated 12 plans in my area listed by cost. From what I can tell the SilverScript Choice Prescription Drug Plan by Aetna is the best fit for me, as it covers all of my medications and my maximum out of pocket cost will be $2100 (that seems to be the same for the other Part D plans, though). I have a phone appointment with a Part D specialist this afternoon, but based on what I've learned so far I would feel comfortable with the Aetna plan unless the advisor suggests another one.

I just finished a brief phone meeting with a Medicare advisor, who helped me choose a Part D plan. I had already typed in a list of my current medications when I registered for the service, so the advisor simply read them back to me and confirmed my area code. She confirmed that the Aetna SilverScript Choice Prescription Drug Plan would be the best one for me, so I signed up for that plan.

So, other than informing my current insurance carrier that I won't need coverage after this month I am done.

>8 qebo: Katherine, I forgot to mention that the Medicare advisor I spoke to yesterday confirmed what you said; you can switch from one Part D plan to another during the Open Enrollment Period without any penalties, and she encouraged me to review those plans on an annual basis.

>43 kidzdoc: Ah, thanks. I'm sure the day will come when I can no longer get away with $6 per month.

There is at least one other thing I need to do: I should enroll in a dental plan, as that isn't covered by Original Medicare (Parts A and B) or my Medigap Part G plan. I'll do that in the next day or two.

I'm not inclined to get a vision plan, as I have two "new eyes" and shouldn't need anything more than annual checkups with my optometrist or biannual checkups with my ophthalmologist, and although it's probably a good idea to get a hearing test I seriously doubt that I have any hearing deficits, as I'm very sensitive to loud sounds. I'll look at the cost of vision and hearing plans, though.

>45 kidzdoc: Completely unrelated to Medicare:
Last year our dentist decided to be "out of network" for all dental insurance plans. We'd heard anecdotally that this wasn't uncommon, and we love our dentist so we didn't want to switch. They still submitted bills to our insurance but they were handled differently e.g., instead of preventive visits covered at 100%, they were covered at 100% of the "reasonable and customary" rate and we paid the balance. Other procedures like crowns were also at R&C rate instead of a network-negotiated rate.

Along the way I learned our dentist offers their own wellness plan, where you pay a flat fee that covers two exams, x-rays, and a credit towards things like crowns. The cost is less than our insurance premium+out-of--pocket so we switched.

>46 lauralkeet: Thanks, Laura. I need to find a new dentist up here (Philadelphia), as I am very dissatisfied with the one my parents were and now I was seeing, so I'll have to ask my local friends and neighbors if there a group they would highly recommend, and see if they take one of the more comprehensive Medicare dental plans.

This morning my Facebook thread sent me a link to an article from CBS News about a story that was originally posted by KFF News, which noted that the monthly premiums for some Medigap plans have increased significantly over the past year.

Medigap premiums leap, and consumers have few alternatives

My Original Medicare and Part G Medigap plan from Aflac went into effect on March 1st, as I turned 65 on March 24th. Since then I've had six medical appointments, including an outpatient surgery last Monday to have a cardiac loop recorder placed under the skin of my chest overlying my heart, as I have atrial fibrillation and have had several brief episodes of dizziness and syncope (fainting) which are probably due to vasovagal responses but could be due to heart rhythm abnormalities. I haven't had to pay a penny out of pocket so far, and I won't have to pay anything for the MRI off my prostate that my urologist ordered for me. I don't know if my Original Medicare plan would have covered all of these services, as I always present my Medicare and Medigap cards whenever I have any appointments.

>48 kidzdoc: Yikes, my gym membership went up double digits this year. I can always change gyms, but medical plans are more complicated.

>49 markon: Right, Ardene. The one good thing is that you aren't locked into the same Medigap plan you had the previous year, and can shop around for comparable plans in your area that may be more cost effective during the annual enrollment period. I found a website containing this information as I was deciding to enroll with a particular plan, just before I spoke with a representative from a free (as far as I know) Medicare service that assisted first time enrollees to choose a Medigap plan, and the plan that was recommended to me was one of the two or three that seemed to be best suited for me, i.e. a high deductible plan with greater coverage and flexibility. I'm keeping my eyes out for any charges from last week's implanted loop recorder surgery and the MRI I'll have in June, but so far I haven't received any bills for those procedures, my medical appointments, or the supplies for my CPAP machine, which I use because I have both sleep apnea and atrial fibrillation. However this is the first year I'm on Medicare and my knowledge and experience are limited, needless to say, so I'll be curious to find out if anyone here or my former colleagues has had any different experiences with their Medicare or Medigap plans.

>50 kidzdoc: My AARP United Supplentary Plan F went up significantly. But then it goes up every year. As Plan F is no longer generally available (I’m grandfathered in) I am not going to change. I’ve had numerous hospital visits and prrecedures since retiring and never had to pay a cent.

>51 kjuliff: I would expect that the monthly premiums of Medigap plans would increase from year to year, but that KFF News article suggested that the rate of increase for these plans was significantly higher than in years past, to the point where some people may not be able to afford to stay on them, particularly in this Trump infested economy.

>52 kidzdoc: I fully agree.i was vague in my wording. All health care insurance plans have become far more expensive due to the Trump administration policies.

Update: I've been on my Original Medicare Part A and Part B, a Part G Medigap plan from Aflac, and a Medicare Part D prescription drug plan from Aetna, and I'm astonished by how low my out of pocket costs have been. In that time I had a minor surgery to have an implantable cardiac loop recorder placed under the skin of the left side of my chest overlying my heart; the overall bill was $11,000, but I paid less than $150 out of pocket. I'm not sure what the charge was for the MRI of my prostate at the beginning of the month, probably over $1,000 without insurance, but I didn't have to pay a cent for it.

I'll undergo a prostate biopsy on June 30th, to investigate a suspicious lesion that was seen on the MRI. The hospital where I'm having it done sent me a bill earlier this morning that I needed to pay in advance for this surgery; the total was a little more than $18,000, but the amount I had to pay was $0.00; I'll probably get separate bills from the anesthesiologist and the pathologist, though. I had a bill from my psychiatrist last month that was less than $50, but I've had at least 8-10 other appointments with my physicians and other health care providers every month, along with at least two sets of outpatient labs, and paid nothing. I'm sure that my out of pocket costs with my former Blue Cross/Blue Shield HMO plan for all of these charges would have been well over $10,000.

I'm still in Stage 1 of my prescription drug plan, which means that I have to pay for all of my medications—although their price is now significantly less than before I became eligible for Medicare—but once I hit $615 Aetna will split the cost of the meds with me, and after the total hits $2100 Aetna will pay everything, although as it stands it's unlikely that I'll make that threshold.

This so far seems too good to be true, and I only hope that the Trump administration, Aflac and Aetna don't do anything to significantly alter either my Original Medicare, my Medigap or my prescription drug plans, other than expected and reasonable annual increases to them.

Thanks for sharing your experience, Darryl. My husband started Medicare on May 1, and has Parts A, B, D (Wellcare), and G (Humana). His experience hasn't been as "eventful" as yours, but we're seeing reductions in out-of-pocket expenses too. On his first day of coverage, Chris was rear-ended and our pickup truck was totaled. We went to urgent care to have him checked out which wasn't nearly as stressful as the crash because we just put all of our Medicare cards on the counter and said, "one of these should work." Turns out this was a Part B visit which has a low annual deductible (less than $300, where BCBS was more like $3000 for the two of us). We were billed just over $100 (and there were no signs of injury thank goodness).

Medications were easy to transfer to our local pharmacy (vs. previous coverage through CVS Caremark), and because the ones he needs are all generic, we get them at no out of pocket cost. Sweet.

I become eligible in February and will most likely choose the same plans.

>55 lauralkeet: You're welcome, Laura. I'm sorry that your pickup truck was totaled and that he was injured in the collison, although not badly so; IIRC you mentioned that the insurance company paid for the cost of a new truck.

I followed Deborah's/arubabookwoman's suggestion in choosing Original Medicare and Medigap plans that cost the most or nearly so, but covered more services in return. I wasn't expecting to have so many costly surgeries and procedures, so I'm glad that I followed her lead.

Two or three of my prescription medications don't have generic equivalents, and I pay essentially the same amount I did before I switched to Medicare Part D; the others all cost under $5 each. I still use the same CVS pharmacy that I went to before I moved back here.

I'm glad that Chris' experience with Original Medicare and Medigap has been a good one, and I trust that yours will be as well. I made the mistake of signing my mother up with a Humana Medicare Advantage plan after my father died and her previous insurance was no longer valid, and I was lured into those ubiquitous television commercials into believing that it would be a good plan for her. I'm paying more for her services than I am for mine, now that she is residing in a memory care center.

Darryl, thanks to this thread I didn't even consider Medicare Advantage plans, and so far, no regrets! Will you have an opportunity to change your mother's plan?

>57 lauralkeet: From what I understand it will be difficult. I was previously a member of a dementia support group, and one of the other members, who was very knowledgeable about the different plans, strongly advised all of us to never choose a Medicare Advantage plan for ourselves or a loved one, as you would be locked into that plan and may not be able to switch to Original Medicare +/- Medigap. From what little I understand it is possible, but only during the fall open enrollment period, and there's no guarantee that Original Medicare and a Medigap plan will accept you.

I plan to try to do that later this year, as I shelled out thousands of dollars for my mother's care in a skilled nursing facility after she was hospitalized late last year as a result of having a stroke, and I'm paying at least $100 per month for physical and occupational therapy and other services now that she's residing in a memory care center. Unfortunately she continues to decline as her dementia worsens, so the cost of her care will only increase. I'm paying nearly $10,000 a month just for her to live there, but no insurance plan would cover that cost. Fortunately I can afford to pay for her care, so even if I can't make that switch it won't be the end of the world.

>58 kidzdoc: Oh I see, Darryl. That's a tough situation. I'm sorry your mom has continued to decline, too. At some point during my parents' "journey", a caregiver described it as stair steps, periods of stability and then a sudden change. It's stressful -- my thoughts are with you, friend.

>59 lauralkeet: Thanks, Laura. The comment by the caregiver you mentioned is spot on, as my mother has had stretches of stable health, each lasting for a year or more, interspersed with medical crises. She rebounded after each prior episode but she never returned to her previous baseline, and I fear that the next crisis could either be her last one or leave her so debilitated that she no longer recognizes or responds to me. It's been difficult and very depressing to witness her decline, but I'm grateful that she remains in good spirits.

Hmm. I should probably rejoin that weekly dementia support group, now that my mother's condition has significantly worsened since the last time I was a member.