Loss of insurance question

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New member
Oct 27, 2022
Does anyone have any insight:

I was employed until December 2022. My employer covered my insurance through January 2023. In February 2023, I began COBRA.
I applied for long term disability and Medicare in December 2022. I am on radicava ors. Each month, I would ask accredo, my pharmacy, if I had a co-pay. Each month, the answer was 'no'. I had the grant through Journeymate.

I called Accredo this month and the said I had a balance of $500+ from February 2023. The balance for March and April are pending.
Because I called, I found out this information: my COBRA insurance was canceled February 2023 because I was approved for Medicare on December 2022. I believe the insurance company made the decision retroactively because I have seen that services that were billed in March 2023 were approved and not outstanding on the horizon blue cross/shield website. Had I not called, I would not have known that I no longer had insurance

I was approved for Medicare BUT not for a part D. Those 2 months of radicava ors may cost me 26,000.
And the other question I have is, what do I do for medication now? I don't have medication insurance. I am due to pick up multiple medications at the pharmacy.

Can anyone recommend a part D insurance or any advice? I have an insurance broker who will look into it tomorrow. I also plan on calling Journeymate and the health well foundation
I am confused Not approved for part d? If you have medicare and signed up for a part d plan when you got your medicare approved I didn’t think they could reject you? I certainly had no underwriting for part d and signed up online -I think through the medicare site that then redirected to the insurance site when I chose the plan.

coverage for radicava ors ( and relyvrio) is another issue. No plans in my zip code cover either. They might in yours you would have to search medicare has a search tool for meds. Your neurologist can request a formulary exemption and appeal denials. I would also ask at clinic if they have any insurances that seem to be easier to work with. Cigna had a blanket policy against reyvrio but I think walked it back a little

do you have a medicare supplement plan?
If you had another private policy that covers drugs, you can be denied Part D. As soon as you drop the alternate drug coverage, you are eligible for Part D. As Nikki said, you will need a Medigap policy (supplement) to cover the durable medical equipment percentage that your Part B does not cover (20%.)

I don't know what State you're in but supplemental Plan G is the richest plan available now. It might be costly if you're under 65, depending on which State you live. Some States charge 3 times the premium that people 65 and older pay; others average it out so everybody pays the same.
Thanks for responding!
I just found out I was approved for Medicare on Friday, April 14. The approval date was 12/1/22. This means I missed open enrollment. I didn't get a card, no correspondence. I found out by calling accredo the specialty pharmacy on Friday who said I had a balance of $500 from February 2023 for the Radicava ors.

I called my insurance company where I have a COBRA plan, Horizon Blue Cross/Shield on Friday. They told me that my insurance was terminated as of February 2023 because I was approved for Medicare. All of this is verbal conversation. They transferred me to the Medicare line where I was able to get my Medicare policy number. She also made a request that a Medicare insurance card be sent to my house

I called Medicare this morning and they said I should have gotten a document that states my Horizon plan has been terminated. Because that would give me another 2 months of open enrollment. Except it would be 2 months from February 2023. Which would mean that I would have to sign up for a part D, this week and I might even be too late to get a part D.
I knew I was going to be approved for Medicare but I was not prepared to be approved with no one telling me and missing the window to sign up for a supplemental and a part d plan.
Another thing, when I go into the Horizon website, it says my insurance is still active. I sure hope so
I wonder if they back dated your eligibility - that is approved you later than December 1. You should have an eligibility letter viewable on the social security website. Mine has my approval date which is a little different than my eligibility date.
If you have an online ins. account, you could nose around and try to find "Documents." Maybe they've posted something helpful there. Also, you can call them.

Three tips you may want to consider:

- apply for Medicaid
- apply for financial assistance with a local hospital, switch to their (retail) pharmacy and kiss those co-pays good-bye!
- apply for the federal program called "Extra Help." They pay for very pricey meds and they pay your Medicare premiums.

Could you talk to a health navigator and/or local office for the aging? They are often quite knowledgeable.
Mupstate, most here will not qualify for any of the programs you mentioned esp. since Medicaid eligibility is reverting to more limited pre-pandemic criteria in many states -- just something to keep in mind.

The issue is not that Alissa is uninsured. She evidently has at least Medicare Part A, but like all PALS, she needs Part B + supplemental coverage + Part D, or a Medicare Advantage plan. Because she did not know her COBRA ended in favor of Medicare, she missed her two-month SEP.

Alissa, don't believe the Horizon site re still having coverage, if a person told you otherwise. The Web updates probably only drop monthly and on a lag.

From what I know of your situation, it is possible that you can ask Medicare for a SEP based on the lack of notification of your eligibility and loss of COBRA. It will be easiest if you got any kind of misinformation from your employer, like documentation of ongoing COBRA coverage, or if they are willing to document that they misinformed you. The Medicare Interactive site I linked to has a lot of good information.

However, the unpaid expenses are still a separate issue. Not knowing the size or nature of your employer, I can only say that they can change your COBRA end date if they want to -- i.e., if you induce them to want to.
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lgelb, the first time I applied for financial assistance with a local hospital, they rejected me and asked me to apply for Medicaid first. I had no idea I'd be found eligible.

But now I know, one can look up the income limit for the size of family, on the web, to get an idea whether it's worth it to apply for Medicaid.

I took two 401K distributions in 2022. I had to report them on my tax return, but they didn't reduce my refund, and I was not asked about that when applying for Medicaid.

With Medicaid, it's all or nothing, but with hospital fin. asst. programs, one might qualify for some percentage other than 100%.

I've looked at a recent scholarly article with comparison charts for Medicaid, and learned that NY is not the only state where having Medicaid can make a big difference.
Oh, no doubt, Medicaid makes a difference. Yes, eligibility criteria are online for every state. In some states, even having a 401(k) would amount to a disqualifier.

Hospital negotiations are best accomplished 1x1, at any income level.
[deleted false flag .org link operated by commercial entity]

In my local hospitals, there's a formula. The only way I can see the chart being deviated from is if there are extenuating circumstances. I personally can describe ext. circ. best in writing.
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Medicaid eligibility is state-specific, and every state has a clear set of criteria on line.

As for arrangements with hospitals, I've worked at three and can tell you with confidence that there are tables, and there are people. It is way easier to reject someone in writing than by phone or in person. Often there is a hybrid approach. Happy things worked out for you.
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