Social Security, Medicare Loopholes?

• By AJS
• Posted March 25, 2009 at 7:46 pm
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I'm on both Disability and Medicare and, so far, Medicare and my secondary insurance have covered everything once I've reached my very reasonable annual out-of-pocket deductible. Although I must admit I've not had a stem cell transplant nor have I participated in a clinical trial. (Aren't clinical trials free?)
I'm also responsible for my 91 year old mother and her 87 year old sister and Medicare has covered them quite nicely as well.
Of course, if Medicare is reformatted in the future to make it less of a burden on taxpayers, all bets are off on what they'll cover and for whom. But I don't think you need to worry about that yet.
Anita

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• By lynnwv
• Posted March 26, 2009 at 8:05 am
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I just got my SSD approval and won't be eligible for medicare for 2 years (so I have to cope with my $5000 a year co-pay on insurance until then). But my ex-husband has been on medicare (with a supplimental policy) for years. He has had very little trouble with the medical community accepting his medicare. He has a strange, cronic condition (not cancer) and has seen lots of different doctors in many facilities up the East Coast. He's only been turned down one time (that I can recall) because it was medicare and that was an obscure alternative medical treatment.

I hope the information helps some.

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• By blanche149
• Posted March 26, 2009 at 12:00 pm
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When I was dx'd with mets to the bone in Sept 2007, I was on a regular Blue Cross/Blue Shield plan through our business - (pretty expensive coverage due to my age of 64, and had a $2,500 co-pay before 100% coverage.)
In Sept. 2008, I went on Medicare with a Blue Cross/Blue Shield supplement that included drugs and had a pretty reasonable price. I have been very impressed with the coverage, and have had very little out-of-pocket expenses so far. However, this will be my first full year, and there is a coverage gap in the drug coverage to the tune of a couple thousand dollars. This gap kicks in after your drug costs reach a little over $2,500. Then you pay the full amount of drug costs until you reach a total of about $4,500. After that, your drug costs are covered again (except of course for your small co-pay.)
Keep in mind that this gap in coverage is only for prescription drugs that you administer yourself, such as pills. The drugs that you receive in hospital in the form of chemo treatment are covered under the hospital portion of Medicare.
I understand that some doctors don't take Medicare patients, but I haven't run into any yet. The only thing I might caution you about is, if you decide to take Medicare with a supplemental insurance plan, don't sign up for an "Advantage" plan. This is a plan that pays first, and then bills Medicare. Although the rates are usually cheaper, Congress has been considering getting rid of the plan.
My husband has a supplemental "Advantage" plan, and he just switched out of it. He is having back trouble and may need an operation. When he called the Mayo Clinic in Arizona to check on coverage, he was told that - as of 1/1/09 - Mayo was no longer accepting Medicare patients that had an "Advantage" plan supplement.
If I were you, I would research the insurance issue very carefully before changing. It helps to have a truly knowledgeable health insurance agent to help you navigate through this. It sounds like you have a very good plan right now, and unfortunately, I am quite concerned with what this present Congress might do to the current Medicare coverage!

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• By Shanti
• Posted March 26, 2009 at 2:16 pm
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Hi Sally,

I am grappling with the same decisions. When I realized I was probably going to be on chemo for life, I applied for disability and got approved immediately as they went back to the date when I actually stopped working due to the cancer treatments. They told me at the time, I think May 08, that I would be eligible in Oct 09 for Medicare. I have been trying to research what is the best course to take regarding Medicare.

The most helpful resource I found was a person that worked for a non-profit that advocates for people having problems with insurance issues here in California and that helped people understand medicare. Since I am under 65, which I think you are too, there are different supplemental policies available to you. I would suggest trying to connect with someone in your area that can help you navigate the system. I am not sure an insurance agent would be the best person. I would look for someone with knowledge and nothing to sell you.

The insurance advocate I spoke to told me that as soon as I went on Medicare then my Blue Cross policy would drop me immediately. I then checked with Soc.Sec. and they said that when I was eligible I would be enrolled automatically. I could then turn it down, but I am afraid that would give the insurance company a legal right to drop me. So I am probably going to give up my blue cross and jump into the world of medicare when the time comes. I hope to have the best supplemental policy chosen by then.

I too go to MD Anderson and just returned from my latest trip. I asked my oncologist if I could still see him if I was on medicare and he replied, of course. But he is European and I think, of course, is a statement of their philosophy of life, but I digress. I also asked him if Medicare would ever pay for clinical trials and he said yes. Maybe a conversation with the person in the MD Anderson business office would help you make the decision. I plan on doing that myself. Calling them and asking what medicare has paid for in the past and what it won't pay for. I am applying for the clinical trial that you just completed and I wondered about the follow up tests from the trial and whether medicare would pay for them. I think the business office for the Stem Cell division would know what Medicare has done in the past.

As Anita said, the prescription donut hole appears to be the biggest out of pocket cost with Medicare if you have a supplemental insurance policy. Personally, I hope that if they try to "fix" medicare that they will allow the government to negotiate drug prices which is what the last administration wouldn't allow, thus leading to the mind-boggling complex prescription drug plans we have now.

Have you ever been to the bcmets.org discussion board? You could post the question there and they also have an archival system where you can put in key words and search prior posts for information on a subject. I have found that site to be very useful when seeking information from other bc mets people. You might find someone from your area who can help you with more specifics. This is a continual topic of conversation as you can imagine.

Terry

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• By frannyv
• Posted April 1, 2009 at 11:19 am
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For me, medicare has been great. I also have a supplemental insurance. You cant go on Medicare unless you have been on SS Disability for 2 years. Then once you start Medicare Part A & B, select a Medicare Part D prescription drug plan and a supplemental plan from an independent insurance company. (I have posted this information on another discussion and answered your questions there) Right now, Medicare is working well, but the changes that Obama wants could potentially put us at risk. It will take years for that to happen, so we have to work in the present and hope his ideas get voted down. Universal health care hurts the elderly and the disabled the worst.

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