Advice on Supplemental Medicare Insurance

richdees23

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I recently discovered that the open enrollment period between October and December only applies to Part D (prescriptions). I was told there is still a possibility that I could find a supplemental plan. I've had Medicare Parts A and B since April 2020 and I live in New Jersey. I'm hopeful I can find some general advice on how to tackle this problem. Specifically, are any providers or plans better than any other? I was told my biggest concern should be a policy that will work with me as far as acquiring equipment I will need down the road. Thanks!
 

Nikki J

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If you can sign up without underwriting that is great. Laws are different in every state. I am happy if NJ is one of the good ones. I think it is true that the company doesn’t matter so much. Medicare supplements kick in after your primary medicare has paid its share. Medicare processes first and tells you and the supplement what each owe. The supplement has to pay their share of medicare covered servicesI think you probably want the most comprehensive plan you can get. Massachusetts has a different system but I think for someone new to medicare that is plan g if you can get it
every state has ship counselors who can answer questions. Some states allow medical plans to charge those under 65 more or to limit plans available.
 

Jimi

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I'm not an expert. I believe you can sign up for a Medicare advantage plan. I'm using Scan. The good thing about the plan is that Dme (durable medical equipment) has no copay. Medicare has a 20% copay. I have gotten a pwr wheelchair (permobil f3 with 12" seat lift), two astral vents, trach supplies, feeding tube formula, trach surgery (two weeks in hospital), feeding tube surgery, lift, cough assist, two suction machines to name a few. The total I had to pay for all that is $335 for surgery.
I don't take any medication and I imagine that can be a huge expense. Just my humble experience. For me the dme would be very expensive if had to pay 20%.
I worked as a machinist and paid lots of taxes all my life for my middle to lower middle class living. As a result, I get just enough from social security to not qualify for any additional aide. The 20% dme copay would have really been tough for me. Switching to a Medicare advantage plan didn't have any additional fees. Some plans cost a little bit per month. They all use the money you normally pay towards Medicare.
I'm in CA
 

Nikki J

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The medigap supplement is for that 20 percent including dme There may be copays or deductibles in some plans. I have a 200 and something dollar deductible for part b and then I am done. Rich being in NJ if you are thinking MA look carefully at networks if the MA plans have them as I think you go to NY for care. Again a ship counselor would know about your state rules and offerings
 

richdees23

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Thank you both for the information and your advice. The last thing I want to do is make a bad decision. I appreciate your help.
 

JimInVA

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@richdees23 - You can go to Medicare.gov: the official U.S. government site for Medicare | Medicare and sign up (if you have not already done so). Once signed up and able to sign in, it will have some of the information you will need to look at plans... and what it doesn't have (and needs) it will ask you.

Because you have reached an age (or situation) that allows you Medicare, you halfway there. Typically, this is how it works...
  1. Medicare (Part A, Hospital & Part B, Medical), a public health service, and pays for the majority of your medical bills... including a power wheel chair (every 5 years), a BiPAP machine, CoughAssist, and most other items that you will need. Typically, Medicare pays for 80% and you will pay the remaining 20%. I pay $148.50/Month for Medicare (it is automatically deducted from my monthly Social Security payment). So, you can pay that 20% (and more for specialists), OR
  2. You can add a Medicare Supplemental Plan. This plan, which also has its own monthly fee (mine in 2021, for my age and location, is $183.25 through Anthem Blue Cross/Blue Shield). There are different plans that may or may not be available for your age/location. Mine, which I believe may no longer be offered to new enrollees is a "Type F". This Supplemental's main purpose is to pay for the 20% that is your responsibility and which is not paid my Medicare. These plans will have different deductibles and maximum out of pocket limits... so pay attention to those. These plans, their cost (for you) and their coverages can be found at the Medicare website I pointed you to at the beginning of this post. One thing that Medicare and Supplemental Plans don't have is your "Part D" Drug coverage. So...
  3. Medicare Part D is typically provided as its own Plan by private insurance companies. Again, based upon your age, location and that insurance companies experience, you'll get a monthly price quote (mine, through Humana, is $63.20/Month). On the website, you'll be able to enter any prescription drugs that you are taking and your preferred pharmacy(s). Each plan you look at will have different premiums, different deductibles (what you pay fully out of pocket before they begin to pay their portion) and different max out of pocket amounts. The illustration presented will also show not just annual costs, but also monthly. Monthly amounts can be important to be aware of with these plans... and especially if on a fixed budget. Part D drug plans have something called the "Donut Hole". It is a period of time (which typically ends once a certain personal out -of-pocket amount has been reached) wherein your monthly costs can be considerably higher before returning to a more desirable amount. I'llustrations will provide an estimate of monthly costs, will show how long it will take to meet deductibles and when you will enter and when you leave the Donut Hole period.
So... the describes the normal components of insurance that are available to you though your participation in Medicare. But we now have another option to the above - The Medicare Advantage Plan.

Medicare Advantage Plans - These plans may or may not be available in your particular area. If available, Medicare's site will show them as an option. These plans include Medicare Part A and Part B, Medicare Supplemental and Medicare Part D drug plans. They also will list additional coverage items not included in many of the Supplement only plans that I talked about in 2., above. Examples would be coverage for Prescription Glasses and Exams, some dental work, memberships to certain fitness clubs, transportation get to medical appointments (i.e. taxi, Uber, bus, etc.) and for ambulance transport. It will also include much the same drug coverage as your Part D.

Many Advantage Plans have a "ZERO DOLLAR PREMIUM". Yep... you read that right... $0.00 Monthly Premium. Basically, as I understand it, Medicare passes oversight of your Medicare benefits off to the private insurance company. They additionally pass on the $148.50/Month Medicare premium to them. So that was the easy part to explain. The rest becomes a bit more challenging as you evaluate plans and try to apply what you might anticipate for medical needs and possible hospital differences. Along with no monthly premium comes an agreement to pay different costs, deductibles and max out-of-pocket costs. Basically, you'll pay certain amounts for services that you actually use... versus the other plans that provide a specific set of coverages for an age/location related set premium. It can get tricky... but for some, there are definite potential cost advantages. I have a personal insurance agent that helps guide me through all of the intricacies of health insurance. I'll meet with him by phone on Monday and anticipate that for 2022, I'll move to an Advantage Plan.

I hope at least some of this has been a help to you... or to others. I've tried to keep it simple and as accurate as I could. But know that I am not an insurance agent... and there exists the possibility that my understandings might be in error. It is always a good idea to let a licensed insurance specialist help guide you. Whether you do it all yourself through the Medicare site and then enroll online or via phone with the individual companies... or use an agent/specialist... the premium is going to be the same. Good luck in finding that which works best for you!

My best...

Jim
 

avnl

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My husband was suddenly switched from Medicare with a supplemental BlueCross Blue Shield to a Medicare United Advantage Plan. We were unaware of the switch until we started being billed for 20% of his durable medical equipment. The realization of the change occurred in a non enrollment period. It took hours of phone calls and a SHIPs councilor to correct this. So there are some Advantage plans that charge a percentage of DME.
 

sassy

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Jim, you did a fantastic job explaining the Medicare options. Thank you!
 

JimInVA

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Yeah... I'm not sure that an Advantage Plan would be in the best interest of a PALS. But I don't know enough to be sure.
 

richdees23

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Thank you, Jim! The information you've shared is very helpful.
 

ph115

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We have AARP plan F and have no copay. We’ve never had to pay any portion of doctor or hospital bills and we’re both in our 80’S Medicare and AARP paid the full amount of my wheelchair and Hoyer lift. They will pay for a hospital bed as well.
 

lgelb

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Just a reminder that there is a time clock on a PALS' ability to add or switch to a Medigap supplement, since pre-existing conditions can be used to deny eligibility and set premiums after the clock runs out.

In most states, after your initial enrollment period, absent special factors like moving, you can no longer switch from Medicare Advantage to the supplement + Part D strategy without medical underwriting, which no PALS is likely to "pass."
 

jonico

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Great advice from everyone Rich. Can't offer any better. Hope it works out well for you! Jon
 
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