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Texans 2014

New member
Joined
Sep 2, 2014
Messages
9
Reason
CALS
Diagnosis
09/2011
Country
US
State
TX
City
ARLINGTON
My husband has ALS. He was diagnosed 3 yrs ago. He has medicare and our medical expenses have not been too much....yet. He will be getting a feeding tube within the next few months. My question is...Does anyone know what the best supplemental insurance is for those of us with ALS?
 
Hi and welcome. I am sorry about your husband

Here is a link
Medicare Supplement Insurance Handbook and Rate Guide

Read about the open enrollment period. You do not say how old he is but if he is just turning 65 I think he MIGHT be able to get something older or younger if he has had medicare for a while you will run into the problem of pre existing conditions. I do not think the ACA rules apply here but you need to research it to be sure
 
Is your husband a veteran? If so, take his diagnosis papers to your nearest pva rep. They'll get him in the system. ALS is assumed to be service connected and they will cover everything 100 percent. Plus he will get a sizable disability check from them that is exempt from SSDI consideration and taxes
 
I also do not have a secondary ins suggestion, but I seem to recall someone mentioning that medicare would provide Boost/Ensure for folks with feeding tubes. Not having to spring for the supplements would be $$ nice.

But I cannot find that post ---- can anyone confirm?
 
Greg, I remember seeing it also. Maybe in the PEG feed?
 
Thank you for your replies. He is 56 and is not a veteran. I just would like to know if PALS have secondary insurance that they use that helps pay the 20 percent that Medicare does not pay. Feeding tube, vent, etc........ AARP, United Healthcare, BCBS.
 
Did you read the link I posted? If he has had medicare for more than 6 months you missed open enrollment ( which for Texans under 65 is for part A only) and when you apply out of open enrollment they can refuse you and with an ALS diagnosis they will. I am sorry to be brutal but no one wants to insure us if they do not have to. You should look into medicare advantage plans to see if there is one that takes your doctors and covers the things you need covered better than standard medicare. If he just got medicare ( it did not sound like that but maybe I misunderstood- I hope so) maybe one of the texans here can advise about a plan

Please read that whole link and see whether what I said applies to you
 
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I have been struggling with this too as I need to choose soon. For medigap, as you say Nikki for under 65 we can only get plan A coverage-I am not sure what this covers its all very confusing, but it is the least effective of the medigap plans. If we were over 65 we could chose a much better plan. I was thinking that a Medicare advantage plan would be best-does anyone have any other ideas?
 
Part A is hospital type things and I think home pt ot. I am pretty sure wheelchairs are part B. Remember always do not have medicare pay for scooter and regular wheelchair you get one in 5 years so save that chance for power chair ! ( sorry for digression). If you search for what medicare part a covers you will get info
 
I was thinking of medigap plan A which is different than Medicare A I think. There are plans A through I I think but I would only be eligible for plan A, not sure what that covers but i know its much less than all the other plans I could get if I were 65.
 
I thought the Affordable Care Act eliminated the "preexisting conditions" problem already. What don't I know?
 
It does not apply to medigap policies. At least not currently.
 
even worse, it does not apply to medigap policies for people under 65- if I was 65 or older it would not be a problem.
 
For clarification, 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). Being over or under 65 only matters in terms of open enrollment periods that are connected with changes in status, like starting Medicare due to disability or turning 65.

The next nationwide open enrollment period to change from traditional Medicare (which it sounds like the Arlington OP has) to Medicare Advantage begins Oct. 15.

From an actuarial perspective, IMHO Medigap plans are generally not worth the $ whereas MA plans often are, but you can do your homework well before Oct. 15 with the tools available on the Medicare site, to compare both types of plans in your area, see all the options and the cost structure.
 
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