Rehab stay casts doubts on couple's Medicare Advantage coverage

Rita and Ted Winters
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Picking health insurance can be a dizzying task and the environment is ever-changing in wake of the Affordable Care Act.

A Hamilton County couple is revealing regrets about their Medicare Advantage coverage and worry how much a plan they hoped would save them money will really cost.

A second bout with pneumonia led to a second stay in rehab for 79-year-old Ted Winters. He was diagnosed with Alzheimer's six years ago and is aware conversations can be confusing.

"It is frustrating, but...and I feel, 'Is it me or is it them,' not communicating right, you know?" Winters said.

And yet he doesn't recognize his relationship with his wife.

"Rita...this daughter," he said.

It's an emotionally draining journey.

"There is times that I see Ted, but they get more rare and rare as time goes on, fewer and fewer, but you learn that one moment of a simple memory can mean so much, it can make your day," Rita Winters said.

Add to that worries about how she will pay the health care bills.

"Whether it will be maybe even sell my house or what it is going to take to get him the care. At this point, I'm just very unsure of what I am going to have to do," Rita said.

Rita is 60 years old and her employer is now dropping insurance coverage for spouses. It meant she went shopping and changed Ted from basic Medicare as a supplemental insurance to a new Medicare Advantage program.

She made a selection she expected would drop his out-of-pocket medication expenses from $150 to $11 a month, never considering what the insurance change would mean if there was another rehab stay.

"In the instance of Mr. Winters, his co-pay is $50 a day for the first 20 days and then it bumps to $150 a day for days 21 through 100 and that is quite a difference from what they were expecting and what they were used to before they made the switch," said Registered Nurse Angela Norris.

"Everything was covered the first time under my insurance and the Medicare," Rita said. "The ironic thing is that he has been taken off his Alzheimer's medications because they were no longer doing anything for him."

Open enrollment for Medicare is now underway and Rita feels unqualified to make the right decision.

"It's just been very confusing, because there are so many plans out there right now and the information you get in the mail and the TV commercials, you know, they all sound good," Rita said.

Norris says patients need to do research, shop around and ask questions.

"My recommendation to patients and families, when you are thinking about signing up for them, make sure that you make a list and you can compare the pros between pros and cons between original Medicare and the Medicare Advantage at all levels of care," she said.

Now, Rita is looking at Medicaid, a route she never expected she'd take.

"But I am going to do whatever it takes to get him the care he needs," she said.

If you are in a similar situation and would like help navigating your Medicare and Medicare Advantage options, we encourage you to come meet with Norris, a local expert on this topic, at our health fair tomorrow. It's free and she will be there to help you map out your options from 9 a.m. until noon at the Community Healthplex Sports Club on Guion Road.