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scaredwifetx

Very helpful member
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Joined
Jul 25, 2015
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1,606
Reason
CALS
Diagnosis
07/2015
Country
US
State
tx
City
Dallas
Hello, I have been paying Cobra since I left my previous company and started at my new company. I needed to keep Steve insured and my insurance was very good with no deductibles.

His disability was finally approved today and he now has Medicare A and B. I am having a hard time figuring out what to do about the rest of the coverage and if I need to put him on my new companies insurance in Feb when I am approved. Paying for his will be quite expensive but not as bad as Cobra. I know there are plans D and F. I want to make sure we have full coverage with prescription coverage and make sure we are 100% covered for any of his medical needs. I also want to make sure anything he needs will be covered and he is able to keep the Trilogy machine that was approved by my insurance and is on a monthly rental paid for 100%.

The Medicare site is so confusing and with my working full time it is very hard to take time to figure it all out. I want to also make sure we can choose our doctors in order to keep the ones we have.

Does anyone have experience with the plans and know what ones are best to cover all the medical expenses he may come across? I would rather pay more then not have enough coverage. Not sure if it would be best to insure him through my job as a secondary insurance or if it would be just s good and cheaper to go through one of the Medicare plans.

Any help is greatly appreciated.
 
Up until January 1st of this year, I was on my wife's employer plan and Medicare was secondary. We had a 5 grand deductible and her plan would not cover all of my DME. So, I dropped off her plan. I know have Medicare A and B and a plan F which covers the 20% that Medicare doesn't pay. I pay $174 per month for the plan F and $34 per month for my part D prescription plan which covers all my meds. For us, that was the best way to go.

Best of luck on your decisions,

Vince
 
my husband had his primary insurance from his job he retired from and once he was approved by social security he got medicare part A and B and his primary became his secondary. So the 20 percent medicare does not cover Anthem picks it up. We do still pay a copay for his meds we did not get the prescription coverage from medicare. The highest we pay is about 10 bucks so its not too bad so far everything else is cover. But medicare is very confusing. Hope it all works out for you.
 
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Different employer plans handle "coordination of benefits" with Medicare differently so it's hard to generalize, and then there are the premiums. This is a new plan for you so I would read the plan certificate on that issue carefully. And, of course, look up the docs/drugs on its Web site. Generally, a Medicare supplement is easier to manage than unrelated primary/secondary plans, but you will need to see what is available in your county and how actual costs will match up. Less time coordinating isn't necessarily worth it if costs go up.

As far as the Trilogy, it is probable that your former plan (that's who approved it, right?) will come looking for it at some point. You don't own it. So I would start with the list of approved Medicare DMEs in your area and then look for crossover with your employer plan, and so on. Hopefully the one you are already using is on both lists, if you go that way.

We have had Plan F discussions on other threads so you might look at those, and of course, at a list of what's available in your county. You can probably eliminate some right away because of their physician networks and/or reputation, so you can get down to an apples-to-apples choice between your new plan and a supplement fairly quickly. If you PM me your County and the drugs he's on, I can help you build a possibilities list if need be.

Best,
Laurie
 
I think I remember Neil saying medigap plans are very limited for those under 65 in Texas? Plan A only? Or a medicare advantage plan
 
Medicare Advantage is Part C. I wasn't mentioning those for that reason (lack thereof in TX for under-65s).

Supplements are available in all states; they are essentially "gap" coverage for the Medicare deductibles. MA plans are usually a bit richer/sometimes more liberal.
 
I found this
Medicare Supplement Insurance Handbook

Texans with Disabilities
People under age 65 who get Medicare because of disabilities have a six-month open enrollment period beginning the day they enroll in Medicare Part B. This open enrollment right only applies to Medicare supplement Plan A.

Note: People who have Medicare because of disabilities have another open enrollment period during the first six months after turning 65.

And I am confused. Yes medicare advantage is Part C for which I thought the only disqualifier was renal failure/ dialysis. Is not plan C ( which is not available under 65 in Texas ) a different thing?
You said yourself Laurie on a thread started by another Texan. "anyone w/ Medicare Parts A & B who lives in a plan's service area and doesn't have end stage renal failure is eligible for _either_ "Medigap" (helping with deductibles and extra charges from providers who don't accept assignment) OR "Medicare Advantage" in which you get a richer version of Medicare, usually with Part D (drugs) included, in return for a narrower network (PPO) or more PCP control (HMO)." Quote lifted from this thread https://www.alsforums.com/forum/people-als-pals/26600-secondary-insurance.html
 
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I live in Florida and my health insurance with my employer will end on January 31. I got approved for Medicare A & B beginning February 1. Since I'm under 65 my premium for Plan F will be around $600 but I have no choice. I compared it to an advantage plan and found the supplement was the way to go (for me.) I also need Part D for drugs. I found a plan that covers what I take now for $25 a month but there are co-pays. Again, I have no choice. I decided to go with Florida Blue (Blue Cross) because that's what I have now at work. Aetna was cheaper but because of their acquisitions, their earnings per share went down and usually that means premiums will go up.

I've been very blessed to have great insurance coverage from my employer for some time.

I'm glad I finally made the decision.
 
Yes, Plan C is a supplement type and Part C is Medicare Advantage. MA replaces traditional Medicare if you have it, essentially, except in hospice, and includes a drug benefit so you do not need to do Part D separately. MA is generally a better deal if/as available (see below) so that's why I'd look at those options first.

You're right, Nikki, there are under-65 rights to coverage if/as available, as I outlined in the earlier post, but those run up against what is actually offered in Texas or any particular state. There is no requirement that networks offer plans anywhere in particular, or that they offer good plans.

So if I remember correctly what Neil was reporting is that Part C choices in his county were either poor or non-existent. That's why I commented on lack thereof for Deb. But maybe there are more choices near Dallas (Tarrant county?) I certainly encourage anyone facing this choice (what to add to traditional Medicare, and you definitely want to add something, for a PALS) to look at what is offered both for Medicare Advantage and supplements in your county, for your docs, drugs and financial situation.

One particular thing to look at is whether there is a separate pharmacy deductible (there is, if your Part D is separate) and whether each rx has a set copay, like $45, or is a percentage.
 
Thanks for clarifying Laurie. Where I live there is an issue with MA plans too that they do not cover the range of providers / services/ formularies I need. It is not my age simply the network. From you I learned it is better elsewhere
 
It's really quite simple. If you are unfortunate enough to live in a backward state like Texas, or most of the south for that matter your choices are quite limited unfortunately. Although no one will say it here the prevailing political sentiment is "why don't you go into a corner and die and stop asking for handouts. We have to stop immigrants from coming here, they may turn the state democratic".
You have these choices:

1. Traditional Medicare parts a and b which will leave you paying 20% ad infinitum with no limit, an impossibility for a disease like this one

2. Medicare advantage plan which does have an out of pocket max but make sure the doctors you want on the plan.

If your husband is unlucky enough to be under 65 that's about it here in Texas. States are allowed to offer medigap plans to residents under 65 but not required. If your husband is over 65 federal law forces all states to offer this coverage. As you might expect Texas offers only plan A which is a joke and not worth the money you will spend on it. It will cover only the 20% of dr visits Medicare doesn't, no coverage for the really expensive stuff like dme etc. plan F is the good one.
I think once he has Medicare, it becomes primary for him, at least that was true with COBRA plans. Be very careful to check what your employers plan will pick up and if its primary or secondary.
You will also find Medicare is very stingy in some areas, for instance they will cover power wheelchairs, but not arms for the chairs. I guess they think it's fine for arms to just dangle over the sides.
My best advice to you is, if you are able, move to a more progressive state that cares more for people than the almighty dollar.
 
I want to thank each one of you for your responses and apologize for not getting back sooner. I did read all of them and was afraid to reply as I am just has confused as when I asked the first questions. Steve is 62 and we are in Texas. I am trying to figure out if paying the Cobra for my old Cigna is the best thing to do. It is a very good plan that includes DME, good prescription co pays, no deductible and a very low out of pocket cash.

Yes it will cost over 500.00 per month but if being in Texas means we will have on 80% coverage, will be paying a lot out of pocket. I did see all the different plans such as C,D, F and am still very confused.

I have already taken care of the major needs as far as DME, power wheelchair is here, bed and manual lift. The only thing that is paid for monthly is the trilogy and it is covered right now by Cigna/Cobra. I guess if Medicare takes it away,we will be ok with a bi-pap if that is what Medicare approves. My major fear is any large out of pocket expenses. We have already had so many with the van, ramps, badroom and bathroom remodel
I am the only one working and so a lot of extra expenses are not what we want. I would rather pay out more monthly on insurance then to be hit with large out of pocket.

Laurie, I would really appreciate your guidance of what would be the best choice for us. Our zip is 75137. No need for private post since we are all here to help each other. I have to decide and I am not getting all he Medicare options at all. I apologize for being so ignorant and not understanding. I an normally very good at figuring out things.
 
Our cobra plan was much better than Medicare, but when I went on Medicare that became primary for me. Our dme company was very kind and is adsorbing the charges Medicare won't pay each month for trilogy, cough assist etc. be careful of Humana medicare advantage plan. They are forming people to use Apria for dme. When you call, you get a call center in India that tells the local Apria reps what to do. No one likes them.
But from what you tell me a Medicare advantage plan with drug coverage is your best option.
Since your husband is disabled you can extend your cobra for several years.
 
Thanks for your reply. You are in Texas so that helps me. I do have further questions, so sorry. You said when you got on Medicare that it became primary so does that mean, you are still paying Cobra or did you choose a Medicare Advantage plan? I know we can pay for Cobra for years but if the coverage is only secondary and very expensive wouldn't it be better to go with medicare advantage? My plan with Cigna covered dental, eye and DME and we only have co-pays as expenses which I am fine with but don't understand if paying the Cobra keeps the benefits the same under Cigna and if they will still pay anything that Medicare does not.
 
Deb,
Happy to help -- looks like a fair number of MA plans in your zip, but still don't know:

What network(s) your docs are in
What drug(s) Steve takes

You can PM me w/ those or if you click on the MA link I posted earlier, type in your zip, enter the drugs, you'll see a list of filters on the left that can help you choose plans. Of course, the network is very important.

Your more general question (and why I am steering you to consider MA options first) is answered that in general COBRA is a bad deal if you have another primary payor (which you do, Medicare in some form). So I would take COBRA out of the equation -- it is designed for those with no other option -- and consider MA first, then if that doesn't pencil out or encompass your docs, then your new employer's plan as a secondary (if/as available) because generally speaking group coverage is preferable, and then a Medicare supplement + Part D last.
 
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