Medicare Supplement

[mpnatx]

I know this has been discussed many times! Sorry!
I just received my Medicare card in the mail today that will go into effect on 12/1. I did a search for Medicare supplements in the forum and have read about all kinds of supplements. Such as Medigap and advantage plans. It's still very confusing to me.

One of my concerns is DME in the future.

I do recall reading a thread a while ago that mentioned SHIP for help with insurance. But, I don't remember if this would be the people I would contact for help with Medicare. Or, if I should even be looking into this yet.

Any help steering me in the right direction would be appreciated.
Thanks,
Marty

 

[Nikki J]

Yes the SHIP program should help you. Yes you are very smart to look into this ahead of time
One thing to realize is the things that renew annually will change on Jan 1 so you need to research both for December and then again in January.
You need to look at the medicare advantage programs in our area and compare how they meet your needs and the potential costs with the medicare supplement plans. If you do the supplement you will definitely need separate prescription coverage through part d. Medicare advantage plans often have the medication plan built in.

Medicare advantage plans are apparently very different by region. One would never work for me because the provider networks are too restrictive. But others really like them. List your meds and also what you might take in the future ( like nuedexta) the doctors you see or might want to see. The dme is probably going to be a percentage maybe after a deductible. Once you start looking things will start to narrow down naturally. But SHIP should help if you know what you are looking for

 

[nebrhahe53]

One other thing: If you are under 65 you may not be able to get a Medigap plan. Only people over 65 are assured a gap plan. Also what you can get, if anything depends on the satate you live in. Half tha states have no allowance at all for disabled people under 85 on Medicare. Many of those who do , likt Texas where I live, only require insurance companies to offer plan A, which is basically worthless. you want to get plan F if it is available, but only some of the more socially liberal states like Oregon require companies to offer this to people undefr 65.
Another thing with Medicare advantage plans. Although you cant change your plan during the year, they apparently can remove companies from their in network coverage during the year.
We had this happen to the company that we use fot DME, and neither we nor they were told about it. So now our bills are much higher. We are thinking of suing Humana over this, but I would stay away from Humana if you can.
They are forcing everyone to go with Aprica for DME. Look up their yelp reviews. One star.

 

[notBrad]

Ditto for the plan F. We live in Oregon and it's an incredible plan, covers everything, no deductibles, no copays and all for $120 per month.

 

[Lynk]

I'm so envious of people who live in Oregon.

 

[tripete]

Plan F Ditto

 

[mpnatx]

From what I've been reading, I would need a supplemental plan with plan F. I don't think an advantage plan would be good like Nikki says. Too restrictive.
I'm assuming medigap is a supplement plan?
Neil, I also live in Texas and will be avoiding Humana. Thanks for the warning!
Marty

 

[lgelb]

Don't rule out Medicare Advantage plans until you've checked out each of their networks. We had one that gave us access to anyone in the Blues network.

The Medicare site allows you to easily compare. If you enter your rx, you get a better cost basis for comparison.

Also check out the BCBSTX site and probably the national networks for options/benefits by county.

 

[Chumpy]

Any info on Texas plans would be great! My PAL is only 46, we have Medicare and just lost my insurance through work!

THANK YOU AND GOD BLESS!

 

[nebrhahe53]

You can find information on which Medicare advantage plans are in your area here, by typing in your zip codr

https://www.medicare.gov/find-a-plan/questions/home.aspx

Be careful you look at all the drugs rhey cover, and the restrictions. Also be prepared for many frustrating hours on the phone. For instance, my plan is claiming that an IV used to drip saline during recent surgery wasnt medically necessary. Who ever heard of surgery without an IV, but these are the cheapskates and idiots you will have to deal with.

 

[akaal]

I agree plan F is the way to go. I live in Vermont and my cost is $240/month. But, with all the equipment I use which Medicare pays 80%, the other 20% would bankrupt me. Plan F covers all that 20%.

 

[mpnatx]

After doing research, plan F would be the best. I've found these plans to be from $150/month to $200/month here in Texas. Also need a D supplement for drugs which is an additional $30 to $55/month.

Now the problem is selecting which company to go with!

 

[scaredwifetx]

Hi mpnatx,

I also live in Tx and do not understand all of this about insurance. My husband has applied for Medicare but has not received it yet. When he does I guess we will need to look for a supplement insurance. I see that you found some information so if you would not mind sharing some info about the plan F and D you found that would be great. Right now I insure him through work so not sure what happens when he receives his Medicare. If my insurance can be the secondary or if it would be better to pay for the plan F and D. Hopefully I can keep my job through all of this and keep him insured but it may be better to cancel him off my insurance once he receives Medicare. The insurance part of this has been my weakness and i guess I do not understand it all. We had a visit today from the home health care providers nurse and she said that Steve would start having a PT come to the house a few times a week for 6 weeks. What happens after that? I am so unclear about all of this. Not even sure if he should see a doctor more than every three months at clinic. We don't have any appointments until clinic.

 

[Nikki J]

Again be careful about the pt. if they start talking about building muscle they are dangerous. At least in Massachusetts there is a time limit after getting Medicare after which they can turn you down for a supplement (6 months) if they think you are a bad risk. I think in Texas the supplementchoices are very different for someone who is 65 and extremely limited for those under. It has been discussed before I know

 

[notBrad]

ScaredWifeTx, contact your local ALS advocacy group, they will help find the people you need to talk to in order to make the best decisions.

I don't know what we'd had done without them. We found them to be compassionate, informed, connected and tenacious.