I know there have been lots of discussions on this board about Medicare & Medigap policies. Please forgive me for being late to the party.
For the past 2 1/2 years I 've been working 50-60 hours a week so I haven't had a chance to read all of the posts. I'm overwhelmed with this decision process. I have the family currently on my insurance policy which costs me $11,000/yr despite the fact that my insurance is free! With one child off the payroll & my husband eligible for Medicare early next year I need to review our situation.
We live in Georgia and I have called several insurance companies about a medigap policy for hubby. I have not found any that will cover him. I have been told by a few agents to go with an advantage plan.
Here is our situation- my husband is in excellent health except for his AD. He is in a clinical trial through the end of 2009 and because of the intense testing I do not plan to have him return to his internist (especially since this bozo referred him to get a colostomy after I told him I did not want my husband to be exposed to anesthesia). Our neurologist does not charge us & we get our meds for free (samples). I know everything is subject to change with this disease and am looking for feed back from my fellow caregivers. I can afford to pay for higher out of pocket expenses if I need to.
Have you tried AARP for medigap? My husband was by no means in great shape when he went on, though he didn't have Alzheimers. One of the things to consider, of course, is that medigap - and medicare classic - do not pay for meds, and do not pay, except in a limited way, for nursing home or home care. SO taking someone on with AZ who is healthy isn't particularly expensive for them, at least that's what I would guess.. someone tell me I'm wrong!
Trish----Based on your title, I'm assuming your husband is under 65 and will become eligible for medicare due to his social security disability? About the time my husband became eligible for medicare----last summer at age 55---I had just hired a long term care consultant to help me find a parttime caregiver/driver, since I still work, have a teenager and was emotionally exhausted after dealing with the car key issue. Turns out he/the consultant, had some insurance leads and so I decided to be lazy and let him take care of it. One thing he told me is depending on what state you are in (we're in Texas), you may be limited on the type of medigap policy available if your husband is under 65. Sounds like you may have run into that. All I can tell you is that my husband is covered under American Continental Insurance Company out of Brentwood TN and their phone # is 615/377-1300. His card says its a Plan A medicare supplement. I didn't comparison shop, because my husband has great (private) disability benefits, and I just have the monthly premiums deducted out of his account where his benefits get deposited. Like your husband, mine is healthy except for the AD, so I really cannot even tell you if this insurance has been that beneficial or necessary. However, if I remember the medicare brochure, you may have to buy medigap insurance within a certain time period of becoming eligible for medicare to be assured of getting covered. (I'm sure there are others on this board much more experienced than I in this matter!) Also, FYI, I found the online Medicare Part D comparison one of the few governmental online programs that makes sense. I typed in the actual pharmacy we go to, the actual meds he takes, and it gave us a list of plan options and the cost. I didn't pick the cheapest, because it seemed to be an only Texas plan, and I wanted the option to move if necessary, but I picked the next one. I hope this helps, but I will be the first to admit I was too tired to put much effort into this. Also, after I did all this my regular insurance agent (car, house, etc.) told me that he probably had some leads that could have helped, so you also might try that. GOOD LUCK! TexasMom
Sorry I can't help. DH was able to get disability early retirement benefits through PERS. So when he qualified for medicare, he was able to get a supplemental plan thru PERS. I did talk to the Insurance agency that handled his employer's health plan but they could not offer what PERS could.
I have Blue Care Network of Michigan for both myself and DW. It is a Medicare advantage program and includes Medicare part D perscription coverage. It is my understanding that an Advantage program, like basic Medicare, must cover you regardless of health status. Medicare has a very good interactive web site (www.medicare.gov) that will detail all the plans in your area. DickS
I can't talk about early entry into the Medicare program, but if you are 65 they can't refuse you for medigap insurance or an Advantage plan because of previous conditions. There is some kind of federal rule about that. And if he has been on your insurance policy, no insurance company can refuse them for previous conditions because they are coming out of one insurance program into another one with no gap in coverage.
My husband has classic Medicare with a classic medigap policy. That is how I set him up when we retired. He was over 65 at that point. I was having problems with California Blue Cross getting both of us transfered to Pennsylvania and finally called the PA company in tears. Upon finding out that he needed a medigap policy she simply told me he was automatically qualified and they would deal with California and set him up. I ended up with a different company and a policy I paid for in full because I was under 65 at that time.
I ended up with an Advantage plan (PPO not HMO) with the second company. Both companies are great. Both companies have paid bills with no problems. I am paying less than half for me than I am for my husband, but I've chosen not to move him and just add on a Plan D insurance plan for him to cover prescriptions. I haven't moved him because they are paying way more for his various doctors than I'm paying in premium. I'm not rocking the boat.
I ended up with the first Advantage plan available in my area. At this point the first company also offers Advantage plans. Almost all of the doctors in this area are on both my husband's insurance and mine. The one time I went out of plan for me (my therapist) the company negotiated a substantially lower charge even though they didn't cover that particular therapy practice.
There are people here who don't approve of Advantage plans, but my personal experience has been excellent. I was also told that although I do have a small $15 co-pay up front, there is no difference at the back end if I get seriously ill. At that point they just pay everything.
If the doctors you expect to go to are on the Advantage plan, go for it.
Medicare has a good web site on Medigap policies ... eligibility requirements, the different types of plans that are available, and a tool for helping you pick the plan that's best for you.
http://www.medicare.gov/medigap/Default.asp
The basic types of plans (A through K) cover exactly the same thing, no matter which insurance company offers them. Note, however, when you're working with this web-site tool, that some companies now offer low-premium versions. While the premiums are much lower, you do have to pay more for the doctor/hospital services. So be sure you know what you're buying.
I would suspect that if your husband qualifies for Medicare, and especially if he has had continuous coverage under your current policy that offers comparable coverage, he cannot be denied by any insurance company that offers medigap, as long as he applies within certain time restrictions (e.g., within a certain period of time after applying for Medicare Parts A and B.) AD patients are no different from anyone else when it comes to medicare/medigap.
I did have one company initially tell me that my husband wasn't eligible, until I pointed out he had been covered by a regular policy through my company. That settled that.
We went with USAA. They tend to be one of the very best insurance companies, and I was pleased to find out (using the website tool) that theirs was also one of the most competitively priced.
If they look good to you, give them a call and discuss the situation.
Thanks everyone for your answers. I have already talked to United Health care & AARP and they said my husband is not eligible because he is in his mid fifties. Medicare today suggested that I call SHIP for Georgia which I did. They will have a counselor call me next week about my options. He is still covered under my plan until Medcare starts.
Thanks Sunshyne- I will bring up the fact that he is currently covered when shopping policies. - Is this similar to a HIPPA law? I will also call and check with ACIC per Texasmom's recommendation as well.
Good to hear some of you are happy with the Medicare Advantage plans with I will use if all else falls.
You guys have been a God send. Have a terrific Thanksgiving!
Trish, please rephrase your question to the Insurance companies when asking about a Medigap supplement for your husband under age 65. Even though he is only 55, in most all States companies that offer Medigap plans are required to offer a medigap plan to a under 65 disabled person. They are not required to offer you your choice of the 12 plans, usually they will only offer plan A, and in some cases maybe a higher plan, but most all will offer the Plan A which is the basic plan. Your husbands open enrollment will begin the first day he signs up for Medicare part B.
I don't know if you mentioned to the companies that he would have an open enrollment or not, maybe you would get a different answer if you phrase the question in that manner?????
Even after taking the basic plan under his disability open enrollment, he will then have another open enrollment when he turns 65. and at that time he will be allowed the plan of his choice.
They cannot turn him down because of the Alzheimer disease while he is in either of his open enrollment periods.
Sometimes it is the way you ask the question that gives you a correct or incorrect answer. Sometimes even the people you are asking are unfamiliar with the under 65 open enrollment.
Thanks for answering my question- I'll try to rephrase the question per your suggestion. I did talk to some one from our state healthcare assistance program and he said only one company offered insurance for people under 65 in the state of Georgia. Since they are so busy he asked me to call back in January and they would help me with my options. I did notice that plan "A" is pretty basic and did not cover skilled nursing or hospice. I'm assuming this will not matter since I have long term care insurance on my husband.
Tish, Hospice is paid for by Medicare part A, it makes no difference whatsoever if you even have a supplemental plan in order to have Hospice. Skilled Nursing is covered under Part A Medicare up to 20 days, and then the next 80 days you would have a co-pay which of course plan A supplemental would not cover. But you must remember, even with Mediare Part A covering the Skilled Nursing Home, it has to be that the person requires skilled care, most Alzheimer patients do not require skilled care unless another ailment comes along that requires that need. The vast marjority of people in a Nursing Home do not rquire the skilled care for a complete 100 days.
Trish, Georgia is one of the States that are not required to offer a Medigap policy, that said, it does not mean that they WILL NOT, some companies may still offer this to you. Georgia is one of the few who do not require it. Federal Law does require that he be allowed a Medigap once he turns 65.
Florida is not required to offer medicap to under age 65. I am unable to get a Medigap policy due to the Alzheimers. I have a good Medicare Advantage, but with my DH in an ALF he is dependent on the physicians that visit. The best one and most highly recommended will not take Medicare Advantage (also Mayo Clinic here has stopped taking any Medicare Advantage patients). I am changing to Medicare and purchasing a prescription drug plan. I pray we do not have any hospital visits for "medication adjustment".
Alice, You are doing well to take the original Medicare plan. That is what I have always recommended to people.
The problem you have encountered is one that is always lurking with the Advantage plans. Never know when your provider or physician will up and opt out of those plans.
..and the Advantage plans apparently cost the gov't more - it subsidizes the insurance companies to offer them, that's why they're cheaper. Hence they're in the crosshairs as the new admin. looks for places to cut spending.
bluedaze - I am in Jacksonville. The www.medicare.gov website worked really well for me when comparing med. appd. drug plans. I was able to get all the info I needed to make an informed choice. I had no luck at all with SHIP for some questions when I was originally looking for a med. supplement (medigap). They are so busy that I could only leave messages and I have not received a call back as promised. Fortunately, my I found my info elsewhere. I was told by an agent from United American that their company did offer medigap for under age 65, but they would not offer it to someone with Alz. This compay was shown on the med.gov website as the only one that would offer it to under 65 in my area. He did give me a name of another company to try but said that the premium would be about $300/month. Since my DH is very healthy I decided not to even call. Budget is tight, but you know how insurance is - you hate it due to the cost and hassle, but sure are glad you have it if you need it.