UNITED STATES—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, then use “Telehealth” which is popular since COVID-19 has made medical changes, or I can ask about using a “House Call Doctor” for her.
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 that does use telehealth or makes house calls like Dr. Welby did in the old days?
Is this something that Medicare or Medicare Advantage plan will pay for it? Thanks, Trish from Atlanta, GA.
Trish: I have good news for you because the Dr. Welby days are back for those on “Original Medicare” or Medicare Advantage plans. In today’s pandemic times with social distancing telehealth, also known as telemedicine has become popular. These current doctor at-home office visits via the computer are keeping the sick from having emergency room hospital visits when one cannot get to the doctor’s office for a face-to-face meeting.
My advice to you Trish and the Toni Says® readers is to ask your family member’s primary care doctor or specific healthcare provider about which telehealth, house call or visiting physician organization that their office is contracted with, whether your family member has “Original Medicare with or without a Medicare Supplement, a retiree group medical plan or a Medicare Advantage plan.
Not only are doctors making telehealth or house call visits, but dentists, eye doctors and even mobile x-ray/ultra-sound machines with technicians are visiting homes, assisted living facilities, nursing homes, etc.
A telehealth or house call visit can help keep those who are having a minor ailment turn into a major operation, keeping a frail Senior healthy and out of the hospital.
Doctor or medical provider visits by telehealth or house call services whether at home or at a long-term care facility such as assisted living or nursing home are being accepted and paid for by Original Medicare, Original Medicare with a Medicare supplement and Medicare Advantage plans (depending on your house call provider or telemedicine service being in the Medicare Advantage 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 home bound to qualify. The house call doctor can schedule regular appointments, especially if there is a chronic illness or you can schedule appointments as needed.
Trish, you are wise to look at all your mother’s options regarding disenrolling from her Medicare Advantage plan with her serious health situations. Many do not realize that you must qualify medically to apply for a Medicare Supplement which helps pay for what Medicare will not pay for. If she does not qualify, then she will pay the Medicare out of pocket amounts.
Therefore, it is vitally important to look over all of one’s Medicare plan options because no one knows when their health will begin to deteriorate and then they cannot change Medicare plan options. Call Toni Says® Medicare office for personal Medicare planning at 832-519-8664.
In 2021, who would believe that doctor’s offices making telehealth or house call visits would be making such a huge difference because of the necessity of social distancing regarding the pandemic.
Toni King, author of the Medicare Survival Guide® Advanced edition is giving a $5 discount to the Toni Says® readers on the Medicare Survival Guide® Advanced book at www.tonisays.com.
