I Need Help w/Medicare, Medicare Advantage Plans

I'm losing my Cobra insurance coverage and have to sign up for Medicare. I am utterly confused. If anyone can help me I would appreciate it so much. First, I am not old enough to get a Medicare supplement (Part C)so it has been suggested I get an advantage plan. What is the "advantage" to the advantage plan over regular medicare? What about drug plans? What's covered, what's not? I am in a "fibro fog" and cannot reason all this. Please give me some advice!!!

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A Medicare Advantage plan is a "Medicare" plan offered by a private insurance company. The advantage was that they offer medications, a disadvantage is that they are subsidized by the federal government (about 16%). Thus, the insurance companies are profiting from taxpayer money. Traditional Medicare offered by the government is best, I think, but you have to be 65, and part D (meds) has problems though I have heard it will be reformed.

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Thanks Linda. I am eligible for Medicare because I am on disability and have been for many years. I never needed the Medicare coverage because my husbands insurance through his employment was so good. Now he is no longer employed and my Cobra coverage has exhausted. You have to be 65 to get a supplement or sometimes referred to as gap plans or part C and having one is the way to go for anyone 65 or over. My best friend has the BC/BS 65 Plus C plan and she never has to pay anything out of pocket. I am not accustomed to having to pay large medical bills, my insurance paid most of my medical costs. It is ironic, when the husband was working and I could afford the bills, I didn't have them. Now that he is out of work and we can't afford them, we will have them. Oh well, it is just something that I'll have to handle when the time comes.

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You are able to get a supplement because you are disabled. You don't have to wait until you are 65 due to your disability. Also you don't have to worry about signing up for the supplement during the "open enrollment" time which is 3 months before you became eligible for Medicare and 3 months after because you lost your present insurance.

I just went through this. I'm 50 and I am on disability. January 1, 2010, I start on Medicare as it's 2 years since my disability started. Well I am on my husband's insurance plan so I needed to find out which was the best way to go...........stay where I am............or have Medicare, a supplement to pick up the 20% medicare doesn't cover, and a Medicare Part D plan to pay for the prescriptions.

So I called Social Security first and was told that if I didn't decide to go with Medicare and the Supp and Med D now that I wouldn't face a penalty to sign up for that a later time down the road because my husband's health coverage is a "medicare recognized plan".

So I sat down with my insurance agent who plugged in all the numbers so I could compare all costs staying where I am and all costs if I go on Medicare. Well with my meds I would hit the "donut hole" on Medicare Part D in July! So we found out it would be cheaper for me right now to stay where I am.

So I have Medicare Part A but I didn't take Medicare Part B right now, which is $110 taken out of your disability for that premium; and I didn't take out a supplement.

Now about supplements.............contact a reliable person to plug in your information. There are supplements where there is no deductible so medicare pays 80% and the supplement pays the other 20% and all you pay is the premium for the supplement. Find out from where you doctor at what supplements they take and what they don't. Around here there isn't a medical facility around here that will take Unicare, which was the popular plan last year. So now everyone that had that plan is having to switch to a different one before December 31st.

That's the nice thing in that November 15th to December 31st of each year you can switch to a different supplement and a different Medicare Part D in case your meds changed during the year and your current plan isn't good for you any longer.

So now back to supplements. Meet with a reputable person (here where I'm at we have what they call the Senior Linkage Line and you can call them up and they help you decide which Supplement and which Med D plan is best for you). Or sit down with a reputable trustworthy insurance agent who is a broker of different plans to decide which is best for you.

Advantage plans replace Medicare so you no longer have medicare. These kinds of plans are for people who don't go to the doctor very often. Well in my case I go alot so I needed a bonafide supplement and not an advantage plan. The advantage plans are usuaully pretty darn cheap too. My supplement would have cost me $199 but I was covered 100% with no co-pays so I knew right up front that that was my total medical costs for the year. No surprises with co-pays.

The most important thing with medicare is to always ask your doctor "is Medicare going to cover this test or treatment" before you have it done. Because if they don't you will be responsible for the whole thing! With Medicare for instance you can only have 1 mammogram a year. If you happen to have your annual mammogram just one day before the year was up you will be paying the entire bill!

So I hope I haven't confused you but you are eligible for a supplement and you NEED one if you are on medicare because 20% is alot of money and you need the supplement to pick that up. Can you imagine what 20% of a CT scan is or a PET scan? Unaffordable and probably bankruptcy material, so check all this out.

Warm hugs,

PS - I was an insurance agent that dealt with Medicare Supplements before this disease took over.

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Soozi----OK--here is what I found out by personal experience---I have been on SS disability (with Medicare Part A)for over 10 years, but still had insurance through my previous employer and when I turned 65, I had to apply for Medicare Part B and a supplement. I chose AARP Health Care Options (Plan F) with the Enhanced Prescription Plan as being the most cost effective for the precriptions I use as well as the medical services I need. NOW, Soozie, the best advice I can give you is to do a comparison of several different plans online (Medicare Part D, AARP Health Care Options, Humana, etc. ) to see which plan fits your individual needs. Check all of your meds to see what tier they come under. This is VERY important because when you have your prescriptions filled, you are charged according to the tier level; also, when you hit the donut hole (the gap where medicare stops paying believe it is now 2830 for 2010), generic drugs are still paid for by Medicare that are in TIER 1! The best way to choose your plan is to compare each plan by who covers the majority of your medications in their prescription coverage--every plan has the gap--but if you are like me, prescription meds can take you to the cleaners in a heartbeat! Next look for a plan (supplement) that provides no deductibles or copays (AARP Plan F for example). I have had 3 major surgeries since December, scads of Dr. appointments, lab tests, etc, and have not paid one penny for any of it!!!!!!!!!!!!!! Soozi----if you need more info or have any questions, let me know and I will send you my phone number via regular email. Just for FYI--another good source of info is your pharmacist----they have good resources on the good plans.........Cheers-Lin

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I have checked and double checked about medicare supplements for people under 65. There are no companies in the state of Tennessee that offer a supplement to someone my age (56). If I lived 10 miles down the road in the state of alabama, I would not be having a problem as they do offer supplements to people on disability under 65. It is a dilima. I have checked all advantage plans and feel that Blue Cross would be the best one for me, but then again I am left with the 20% for certain items, like my oxygen. When my husbannd was working, this woukd not have been a concern. . .but now we just don't have the income to pay astronomical medical bills and I don't want to deplete our savings. Oh well, I know there is an answer out there somewhere and I am not going to stress over it. The Lord is on my side and He will provide. Thanks for your reply Lin. It is always a pleasure to get your input.

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Hi Soozi,

I am in the (almost) exact same place as you. I live in Georgia and my COBRA ends in January... right at the same time my Medicare begins.

Part A and B are automatic. Part D is no problem but you have to sign up.

And then, there's Part C, or the gap insurance (referred to as Medigap) for the 20% that Medicare won't pay for. Medigap coverage is offered by private insurers, not Medicare.

The Federal government does not require private insurers to offer Medigap policies to individuals, under age 65, who qualify for Medicare due to disability. It is up to the states to set such a requirement. At present, 27 states have enacted legislation that requires any private insurer who wants to offer Medigap (to anyone) in the state that it must also include individuals under 65 years of age. The rest of the states have no such requirement.

Your Options:
1) Make sure you thoroughly research that there are no insurers that will offer traditional Medigap coverage to individuals under 65, in the state of TN. (After many phone calls, I found 1 insurer who write me for Medigap -- United American -- and I am now in the application/approval process with them.)

2) If there are absolutely no private insurers that offer Medigap for individuals under 65 in TN, then research if a Medicare Advantage plan could help you.

The federal government is starting to drastically cut funding for Medicare Advantage, but such plans are still widely available and should be okay for at least the next few years. In this type, you would forgo traditional Medicare in lieu of the insurers own network and claims handling.

Some Medicare Advantage programs don't charge anything for their program and basically just offer coverage similar to Medicare, albeit with a few extra bells and whistles. However, other Medicare Advantage programs offer coverage that can close at least some of the 20% gap though you will pay for that. Don't forget though that Medigap would cost extra as well.

Hope this helps you. A really good Medicare insurance broker could go a long way to really helping you.

Also, don't forget that Medicare Part (i.e., prescription coverage) has that dreaded doughnut. If your drugs are terribly expensive, then please contact the manufacturer's about what you can need to receive financial assistance.

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If you are on Medicare because of a disability then you qualified for a medicare supplement. Back in 2000 I qualified for Medicare because of a diability and I got a Medicare supplement from CareFirst BC/BS. Like your friend I never paid any bills it always was taken care of. Since that time I have the same insurance but a different plan. I have Plan F.

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I forgot something Brain Fog or a senior moment
I would look very closely in a medicare advantage plan. As some doctors do not accept this.

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Hi Soozi-aka Miss Sunshine-I have read your latest post and you sure are in a bind with your Medicare/supplement problem. At this stage of the game, and with all you have at stake, I would urge you to contact a local insurance representative that YOU TRUST and ask them to advise you what is the best course of action for you to take to keep your medical costs within reason. Being under 65 but on disability may have some qualifiers that can help you (and don't overlook Medicaid unless your total income will absolutely preclude you from qualifiying for assistance if needed). Some drug companies will also provide you with assistance under certain circumstances with a break in cost (not quite sure how that works but your pharmacist can help you there)--it is a special program and you may qualify. As for the oxygen, look into seeing if your home health company bills with your oxygen as a deductible/copay item or if it is covered 100% by your insurance. Keep me posted friend-will be anxious to hear how you fare. Lin

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Thanks Lin, Evan, Koolmama and all who have replied. I met with an insurance rep. today to see what can be done. I am caught between the proverbial rock and a hard place. Medicare supplements or Medigap policies are not available to people under the age of 65 in the state of Tennessee (I plan on addressing this with my senators and congressmen). If I lived 10 miles down the road in Alabama, I wouldn't have a problem. They offer supplements under 65. The ins. rep. went over the Blue Advantage Gold and Platinum Plans available to me. It is OK but it costs $161.00 per month along with the $110.+ change for Medicare, that will mean my total cost per month for insurance would be $271.00, ouch, that doesn't fit into my "husband out of work" reduced budget. According to the rep. each state has different guidelines for Medicare supplements and Advantage Plans. I will do alot more research and an awful lot of praying that I can get something I with good coverage tha I can afford. Income levels are too high for Medicaid. I have faith that it will all work out. It's just frustrating to lose the excellent coverage I have now. Hoping for pain free days and nights for all.

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Hi Soozi
I know its been awhile since you posted. Not sure you will see this now. But I just read this the first time today, April 13, 2010. I am like you in Tennessee living and have been on SS Disabity for 21 years , on Medicare for 18 years and I too am soon going to exhaust my Cobra via a divorce process in the coming 19 months. I will be 61years old at that time and had always been planning to get a Medigap policy when I was 65 since I was married , 36 years. But life happend, I got suddenly divorced and learned TN was one of the many states left that still did not offer MEDIGAP supplements under 65. So I too have been trusting and praying to God for guidance and an answer. II was led to contact the TN state insurance commissioner office with this issue and received an email response from the Manager of Consumer Insurance Services there. He passed along the name of United American Insurance Company, 3700 Stonebridge Drive, McKinney, TX 75070, 972-529-5085 and told me they were the only agency that MEDIGAP supplement policies to people in TN under 65. I plan to contact them later today to see percisely what MEDIGAP supplement is actually available for me to purchase .

I also learned that this Spring 2010 a bill is to be introduced before the TN state house for a senate vote to add Tennessee as one of the states that WILL make available MEDIGAP insurance policies to people under age 65 that are on MEDICARE already as me and you. This article encouraged TN MEDICARE disabled clients under 65 to aggressively contact the needed TN legislators and to make sure they are aware of this bill that its indeed introduced, supported, addressed and voted upon to pass.

When all is said and done I am not sure what to do either , as I have had both A and B Medicare in use since 1994 as my secondary insurance when my spouse was still employed. Then 4 years ago he retired, and Medicare suddenly reversed for me, becoming Primary and his retirement insurance became my SECONDARY. BUT then he walked out and divorced me and the latter retirement insurance then became defined per COBRA law for just another extended 36months than ceased versus as planned if I stayed married. His retirement insurance istays SECONDARY, and has been amazing for me, the better plan for my multiple Pharmacy meds and an amazing supplment overall I can never match that I am about to now loose soon. So when COBRA exhausts I am forced to get a MEDICARE PART D plan for Pharmacy and the rest I pray there will be some kind of Medicap policy available via that one company or that new bill has somehow passed allowing uz TN under 65 to get MEDIGAP.

And if anyone else has anything to offer for TN residents as what would be a better MEDIGAP plan or knows anything differnt I would appreciate it. .I was told AARP's MEDIGAP is one of the best with their enhanced Pharmacy but I know things change all the time. Thanks and God Bless.

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Thank you for the information, Nanu. I am going to look into the United American Company. I am desperate for additional, affordable insurance. You only live about 50 miles from me. Maybe we can get some sort of support group started. Can anyone out there in sclero land give me any info on the cost of cytoxan treatments. Medicare will only cover 80%. I want a general idea of what I'm going to be paying out of pocket per treatment. My pulmonologist said I NEED to start these treatments if I want to continue to have any lung function. PFT shows losing about 20% every 9 months.

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Peggy, thanks for all that information. I am applying for disability now...mainly for macular degeneration but I also have scleroderma. I used to think you were covered under Medicare immediately after being approved for permanent disability but now people are telling me there is a waiting period. Do you know?

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I too am on Medicare A-B with no drug plan, Medicare is automatically enrolling me in the AARP plan for drugs but it is TOO expensive for me to make a premium. I will be opting out of this as they will start taking a premium out of the $481.00 I get a month on disability! I called Medicare and spoke to them about my options. I would suggest you call Medicare at 1-800-633-4227 and talk with someone about your options for help with drug coverage. They need to KNOW if you need help paying for drugs first so call the 1-800 number and choose to speak with an agent.

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Truthseeker, If your income and assets are under a certain amount, then you can apply to have your premiums paid for both medicare and the drug plan. I am sure Peggy can probably tell you what website to go to to get information. You can also apply for medicaid if you meet the income requirements.

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I spoke with Medicare about getting help with my med costs, they have 3 plans and one, AARP , Medicare will pay the premium but I would need to pay 50% of each med costs and does not cover ALL the meds I am on. The other two I would need to pay a premium out of my own pocket plus a co pay. All 3 do not cover all the meds I take. So it depends on each of our needs. I have time to think about it as my choice will start June 1st. I can choose to opt out or pick another at that time.

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I have been on disablility since 2003 and medicare since 2005. I live in Washington state and am under 65. Each state has different income levels, but if your income is under 1300 a month you could qualify to have your part B premium paid by the state you live in (apply at the same office you would for food stamps). You can also receive help for your part D prescription coverage. I don't pay any premiums or copays and I receive about $850 a month. I do have a medicare advantage plan; it is with the same HMO I had before medicare. I kept it because I really like my network of doctors.

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