Jane, I need your advice on which supplement plan would be best for my husband who is under 65. He will be eligible in July for Part B & I am totalling on my own trying to figure out which plan would be best. My e-mail address is in my profile, I would love here any suggestions you might have.
ACTUALLY, I WOULD LOVE ANYONE'S SUGGESTIONS, I AM GETTING SO OVERWHELMED BY THIS DECISION. THANK YOU TO ANYONE IN ADVANCE FOR ANY ADVICE.
Kaydee - Both my husband and myself have suppliment insurance for Medicare. He has Mutual of Omaha and I have AARP. I have no complaints with either but the AARP is less money and I wish I had both of them with AARP. I could change his but in midstream so to speak I decided just to keep things the way they have been. We both have Humana for Part D. I have no complaint with that either although I have thought about just changing to AARP because I think it is a little cheaper. I, like you was so confused trying to decide I didn't know what to do. You have the right idea though and I imagine you will get enough feedback on this site to help you.
12 yrs ago when I blew 4 discs in my back I was waaaayyyyy under 65 and they still gave Medicare along with SSDI, I still have it and my Mom and I both have the AARP. We are very happy with it.
I have had AARP for many years for both of us and have never had the slightest problem. I just feel that bad publicity could hurt them SO much, and they're "too big to fail.." (!!) that it makes sense to use them.
We have AARP and you can always get to a real person who will be patient with you. It's also very nice being able to walk out of a doctor's office with just a wave and not having to stop to pay a bill.
Thank you to everyone who replied to my post. Sounds like everyone has had good experience with AARP. Are there different plans of AARP? If so, which one do you have. Also, does this take care of RX's? From what I understand Imohr has 2 different plans. Thank you all so very much for caring about me enough to give me suggestions. :) Kadee
Kadee, we have both the AARP Health Care Options and the Medicare RX plan. Different states have different plan, so you need to go on AARP website and plug in your state and it will bring up all the plans and premiums for them. I don't think you can beat AARP.
The question is about before 65, though, and I don't know what happens with aarp then. We have both the AARP medigap which takes care of charges above what medicare will pay for (and there are about four varieties of that, you can find them on the website), and the Medicare Part D which pays for much of your medication for the first 3000-ish etc. None of it's cheap. All of it is tax-deductible.
I have yet to find any supplemental coverage for anyone under 65 on Medicare, and I went on in 1986--2 years after Soc. Sec. Disability was effective. Now, with DH on Medicare plus Medicaid Waiver, and income low as it is with my little job gone, I doubt I could pay the premium, if I could find a plan and I'm only 60 now. I keep checking every couple years,. and watch the ads in the AARP magazines and Bulletins.
I now have a Medicare Advantage Plan--Secure Horizons-- through United Health Care and Part D through the same, which is also the Company providing the AARP Medicare Rx `Plan.
DH has a Blue Cross/Blue Shield medigap and Rx plan, and he is under 65. Of course he has a high rate because of his age. He insisted on going with them so I didn't look any further. Figured it would make him happy and I can change it later if I want to. PatB
My husband has classic Medicare with a Medicare supplement from our local Blue Cross company. They are a good company and the only time they refused to pay for something, it was because the neurologist ordered blood tests that our family doctor had also ordered the month before. I took care of that by insisting that all blood tests be ordered by the family doctor. They are a great company. They are paying out way more than I'm paying in.
I have an Advantage plan (includes Part D) from the local Blue Shield company. How we ended up with different companies is a long story, and definitely OT. My plan is significantly cheaper than his is, and I think the Blue Shield company is actually better than the Blue Cross one, but by the time I found the Advantage plan for me, he was so sick I didn't want to rock the boat. I do pay a $15 copay for doctor's visits. He doesn't. I've been told that in a serious illness there wouldn't be much difference.
On the other hand, my experience with Blue Cross of California was pretty horrible. I keep getting shocked looks when I tell doctors that I wasn't allowed to have this or that thing done in California because my insurance would not pay for it. That included podiatry, pain medication when over the counter would not work at prescription levels, colonoscopy when blood was found in my stools and knee and cancer surgery. So it is possible to have great Blue Cross/Blue Shield companies in one state and truly horrible ones in others. I have experienced both.
Frankly, if you have any experience with any of the companies in your area, call them and ask about over 65 plans. Look at both Advantage and supplement plans. What you are looking for in a company is that they are easy to deal with. The actual plans seem to be basically the same no matter who is providing them.
Kadee, You say your husband is under 65, does this mean that he will soon be turning 65?? within the 6 month open enrollment, or do you mean that he has Medicare due to disability????? Answer me this and then we can proceed with your question.
Jane, Thank you to Jane & Everyone who has replied to my post. My husband is 58 years old & on disability due to his illness. We had medical coverage through his retirement package (GM/Delphi) however, that coverage was taken away on April 1st. He was eligible for Medicare Part B last year, however, since he had company insurance I declined. Since his medical insurance was taken away, I was able to get him enrolled in Part B which will start July 1st...he already was eligible for Part A. I kept his company insurance on a self pay basis which is over $600 a month, I was afraid to not have insurance on him until July. Again, thank you.
Kadee, Ok, this tells me that he will have an open enrollment within 6 months of getting part B Medicare due to disability and the loss of your Company Insurance. He will also be eligible for another open enrollment within 6 months of turning 65 at which time you will be able to switch plans and get the plan of your choice under the Medicare supplemental insurance which is called the Medigap protection.
Kadee, not all States offer the Medigap plan to a person under 65 on disability, but if your State is one of those that do, it will also be much more expensive than the plan will be once he is eligible for the age 65 open enrollment, (JUST ALWAYS REMEMBER HE WILL HAVE ANOTHER OPEN ENROLLMENT PERIOD, IF YOU DO HAPPEN TO WANT TO CHANGE.) It will depend on what companies offer the coverage for under age 65 in your State and also which plan you hope to get. Mutual of Omaha is a wonderful company it is the one we have but it may not offer the same plan under the disability plan with Medigap that AARP or other companies offer, they DO NOT all offer the same plans when it comes to the under 65 age group. Once you get on the 65 age open enrollment my choice of the plans is Plan F. It will not matter at that time which company you choose because the plans cover the same no matter which Company you go with, it just depends on the plan you pick. My way of thinking is that plan F and then Plan D for the RX coverage is the best overall. Plan F may not be offered under the AARP for disability or with Mutual of Omaha, they may either require you to pick a less plan or a higher plan. Let me know which plan you are looking at and I will try to help you from that point.
Jane, Thank you very much for your advice. We live in Indiana...I will research which companies provide Medicare supplements for under 65. Surely there is something out there less than $600 a month that I am paying now. I appreciate your explaining that once he reaches 65...however, I doubt that will happen, I can enroll him in something else. Thank you again. Kadee
Our wealth of informed people amazes me. Jane, how about Plan J? I always used plan F for my Mom and Dad and recently found plan J to cover a little more for slightly less money. Is this plan only avail in CT?
I forgot to ask you something Jane. A few years ago (just before dh was diagnosed) I volunteered with our local Agency on Aging in the Choices program. We were trained to help seniors with help in assessing medicare supplement plans as well as other info for seniors. Is this a national program so that every state has an Agency on Aging? They are an invaluable gem and can help with many "senior" problems.
Kadee, I was in the a position much like you are in now. When my husband got Medicare I foolishly thought I would be able to drop my expensive group coverage thru my job and get him a supplement. But I didn't count on the fact he was under 65. We live in Virginia and only one company offered it here and at a price of almost $800. per month. Well there was so way I could retire and pay $800. per month ( that was two years ago) and so I remain at work and he remains on my group policy.
The issue for you is going to be finding one that covers people under 65. It doesn't matter how good the company is for people over 65. I am going to suggest you contact the local Agency on Aging and ask for the name and number of their person who handles Medicare questions. In my area she was able to send me copies listing all companies in the area that offered supplemental insurance. It was a long list until you got to those that offered coverage for people under 65. They do not have to offer coverage to disabled people under 65 and those companies that do can charge what they want. Once my husband is 65 he will be eligible for the insurance at the same reasonable rates as anyone else.
I'm sorry that this isn't the information you want to hear. Perhaps in your state there will be something better.I hope so.
Kathyrn0907, Yes, most states do offer the Agency on Aging, and as I am sure you already know the information you get is only as good as the people who offer the help, some are more informed than others.
As for Plan J, it is offered in most if not all States, it is a wonderful plan and usually more expensive than plan F. Sometimes it is less if offered or underwritten by a newer company and not yet had many claims so therefore the premiums are not yet higher. Plan J offers the At home recovery and preventative care and Foreign Travel emergency care, which is not covered by Medicare. Medicare covers skilled care at home but the plan J will pay for about a couple of months longer after skilled care ends yet it only pays a small amount not the full price. Most people do not use those benefits due to the extra co pay they would have to pay and therefore opt for plan F.
divvi, I absolutely laughed out loud when I read your post. Yes, it is really hard not to respond about Medicare and Medicaid, I try to wait until I am asked. You made me laugh and I have not laughed in a long long time. Thanks.
Kadee, The States that REQUIRE a medigap policy to be sold to those disabled with Medicare are :
California Connecticut, Kansas, Louisiana, Main, Maryland, Massachusetts, Michigan, Minnesota, Missouri , Mississippi, New Hampshire,New Jersey, New York, North Carolina, Oklahoma, Oregon Pennsylvania, South Dakota, Texas, Washington ,and Wisconsin.
Other States may also sell the policies but are not required to. You will find them very pricey for the underage 65 group.
Let us know what you end up doing. Hope we have helped.
Jane, we do depend on you for questions about Medicare and Medicaid and I'm glad you're willing to respond. Could you update us on your situation at home?
Divvi, we depend on you to answer questions about poop duty and it's absolutely no disrespect to your DH because your love for him shows through in all your posts. I'm sure he has always enjoyed your sense of humor.
Joan would have to respond to any post about LO not driving.
Bluedaze can give valuable advice about violent behavior and reasons why it's impossible to keep some of our LOs at home no matter how committed we are or how much we love them.
The nurses, doctors, scientist and others on the board have been wonderful to share their knowledge and experience. My heartfelt thanks to all of you.
Jane, So far the only Medicare Supplement for those under 65 in Indiana is United Health Care (AARP) Golden Rule Insurance only has A,C,F,& G & Humana, which I need to gather more information.
We just redid our health insurance coverage and my DH (on disability) is 57. He has Medicare part A & B, a medigap policy with Blue Cross Blue Shield of Michigan and AdvantraRX, a prescription drug plan. We haven't had a chance to see how it will work yet.
Jane, if you starting joining in on other posts without requiring a direct request, i bet we will give you a belly laugh now and then.:) everyone here has missed your input and not just advice about the 'system'! my best -divvi i sometimes have to take the batteries out of my keyboard to keep myself from replying certain subjects..haha. and now unfortunately for us both! the boards have the 'bait' to snag us..
Dazed You asked for an update We are in stage 7b and seem to be stable at that stage. We are still being cared for at home and hope that will be the case until the end.
We're in IN and have Medicare plus State Farm supplement plan F. My understanding from attending a workshop and talking w/hospital staff who specialize in insurance, is coverage for supplements is same for all insurers, but pricing is individual. We changed from AARP because even w/discounts, it was becoming more costly. We changed from Humana Rx to AdvantraRx for the same reason. We're happy w/the changes. As I've mentioned before my biggest surprise was that the supplement only covers a cost if medicare approves it; I'd thot a supplement paid anything medicare didn't. I'm sooo naive. Medigap insurance is a different ballgame w/Rx included w/medical and most are $0 premium (Secure Horizons is one), but I was told it's difficult to switch back if you choose that one. So many muddied waters. I'm glad we have folk like Jane.
Zibby, Thank you for your suggestion. Is you husband under 65? My husband is 58, I am finding that not all plans include people under 65 which seems unfair to me.
Zibby, You state you thought that Medigap policies paid anything Medicare did not pay, It is correct that Medigap policies only pay if the charge is approved by Medicare, Example: You go to a Doctor who does not take assignment, (This means that the Doctor can charge more than Medicare allows but with plan F it will pick up the difference, if your visit is one that Medicare does not allow, meaning not necessary according to the Medicare guidelines or either is a charge that Medicare just does not allow payment for such as a routine Physical, then neither your Medicare or Medigap will pay. Sometimes Doctors will order a test not really having a diagnosis to warrant the test is necessary and therefore Medicare nor Medigap will pay. Sometimes the Insurance Department will not code the billing with the correct ICD9 or CPT4 code and this will cause the claim to deny, in a case where you feel the charge should have been approved by Medicare be sure to question the diagnosis code that was submitted and request a re-billing. I have had to do that many times and then the claim is paid.
A perfect example of the statement by Jane to Zibby is the PET scan. It's very expensive and Medicare will fight it every time, dismissing it as an approved test for Alzheimer's Disease. We went 'round and 'round with them,...and finally our secondary insurance (Aetna) picked up a 'negotiated' charge. I can't remember exactly how much that test cost, seems like it was between $5,000 and $10,000. It was well worth the time I spent to get it paid by our insurance.
Kadee, my husband is 71 and was diagnosed w/vascular dementia a couple years ago tho' in retrospect I know we've been on a downhill slope since his first stroke at 48 years.
And, Jane, what's the simple big difference between a medigap policy and medicare supplement? I know the medigap includes Rx and one like Secure Horizons has 0 premiums.
My understanding was at the workshop I attended that if you had medigap, you didn't get D. If you got a supplement, you got D. See, I am confused! And today I got a letter from State Farm saying their underwriting was too low (too many claims); so our premium's going up NOW not next enrollment period. :(
Jane, I'm glad your DH is stable but stage 7b must be very hard. Aren't you also caring for another relative with AD? Sorry this is off topic but didn't know if you read the other threads.
Now I AM confused. I thought the medicare supplement plans were a-f (or more), and medigap is a different insurance--locally Secure Horizons was presented as medigap w/Rx included. Oh, well; it really doesn't matter I guess sooner or later we'll be on medicaid at the rate health insurance premiums are going. Of course we'd be there NOW w/o any insurance. Can you tell I'm down today? Sorry.
Zibby, The simple difference in a Medigap and Medicare supplement is that the are the exact same thing. A Medigap is a Medicare supplement. Plan J use to have the drug plan attached to it but laws were changed when Part D Medicare plans became available. If you get the Medigap (Medicare supplement) and not a Medicare Advantage plan then YES you do need to get Plan D for the drug coverage.
I am not absolutely positive but I think you are becoming confused between a Medigap (Medicare supplement) and a Medicare Advantage Plan, If I am not mistaken I think the Secure Horizon is a Medicare Advantage Plan with the supplement and drug plan all in one. You need to check this out and not become confused because they are different than a regular Medicare and Medigap (supplement) With a Medicare Advantage plan, you have Regular Medicare Part A and Part B and the advantage plan contracts with Medicare to oversee the coverage, therefore you are governed by their rules and their in network providers. The zero premiums you speak of with Secure Horizons is not as it appears, you still have the Medicare part B premium to pay because you must have Medicare part A and B to have a Medicare Advantage plan. (If you can, just stay away from the advantage plans) The regular plans are more expensive but in the long run you have better protection.)
I do not recommend the Medicare advantage plans because of having to use their in network Doctors.
Zibby your higher premium with State Farm is an example of when a Company is underwritten by a new company which has not had many claims and then as the company is in force longer and has more claims the premiums go up, that is what I was talking about in the example I gave to Kathryn0907 above.
Zibby, I hope I have helped and not confused you even more.
Jane, If I am not mistaken, you are not recommending the Advantage Plan correct? I was researching the Humana Advantage Plan, so maybe I should forget that one. There just isn't much to pick from for those under 65. This is just way too confusing for my simple mind.
I've read several places that Advantage plans are likely to be targets for raising prices or reductions of service in any health care reforms. Some have got a very dodgy record; they bring you in promising no payments but then it changes. If you are in them and find them okay, or if they're all you can find for under 65, then obviously you go with them, but remember YOU USE THEIR DOCTORS.. it's "managed health" a lot more than the "socialized medicine" some claim we'll be getting through any health care reforms.
Kadee, No, I do not recommend the advantage plan, but remember, I am not a professional, this is just my opinion. I worked as a Medicare Specialist in a very large hospital for many many years and do know some but by no means all, and what works for one person is not necessarily right for the next person. I do know this, I do not like being told what group of Doctors or Hospitals I can go to. I would opt for the Original Medicare plan with a Medigap (Medicare supplement) all the same thing just called different names, the plans A-J and some New plans have been added called K-L. Of these the F plan would be what I would recommend.
Many of the Advantage plans do not even pay the co-pay for skilled NH care if that becomes needed. I do understand that you are limited in your choice for under 65 but if you are still working, why not just keep the plan at work on your husband until you retire or quit work? You may find it cheaper in the long run and better protection??? You will still have Medicare part A for him and can post pone the Part B until he looses his coverage through your employment. Once that happens you will still have an open enrollment period for him for the part B Medicare as long as you do it within the required amount of days after loosing the employee insurance.
Jane, Again, thank you for your advice. The insurance he has now is with the company he retired from, on a self pay basis. Insurance was part of his retirement until this year...was suppose to be for life. I guess nothing anymore is for life. I no longer work due to his condition.
Jane, you are right; I went back to look at notes. I confused "medigap" w/"advantage." The hospital worker who talked w/me had also said she didn't recommend the advantage plans because of network requirements and said something about difficulties switching back to regular supplement later if I wanted to, but I'd already decided I wanted to be able to see who I wanted when I wanted; so guess I quit listening to the last part. Aha! It makes sense that companies new to the coverage start w/lower rates, reel us in and then charge more "realistic" rates. THANK YOU, Jane, and others who've clarified this health insurance business for me.