Medicare vs. Cobra coverage?

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Michael_67

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Hi All,
I’m realizing with increasing weakness in my hands, arms, and legs, I need to start researching home health care options. I’m currently still working, though soon I will go on short term disability, which will last for a few months until SSDI kicks in. Then, as I understand it, within 5 months I become eligible for Medicare. At that point I will have to decide whether it is worth it to pay the cobra coverage premium through my private insurance, Aetna, or switch to Medicare. Does anyone know to what extent Medicate covers home health aides? Is it comparable to private insurance? Do either cover a significant percentage of the cost? Any thoughts greatly appreciated! Take good care all.
 

Nikki J

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Medicare does not pay for custodial care only skilled care. If you have an rn or pt or something for a specific reason you often get a bathing aide for the duration. Hospice too will often send someone.

you would have to check your insurance to see what they cover but I think custodial care coverage is rare

for medicare be aware you need either an advantage plan or a supplement plus part d for meds. It is faintly possible ( though unlikely) cobra would be a better deal as supplements for under 65 tend to be very expensive and in my experience part d coverage is less good than private insurance for meds. States have ship counselors- trained volunteers to help you figure this out
 

swalker

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I did COBRA and medicare simultaneously.

If you go this route, you will find that one will be considered primary and the other secondary. The primary one will process a claim and decide what they will pay. Then, if there is any amount remaining to be paid, the secondary provider will process the claim and pay what they think they owe.

The initial months were a sea of confusion. Some thought Medicare would be primary and others though United Healthcare (my COBRA provider) would be primary. It took close to a year to get a firm reading that in my case Medicare was primary (this is not typical, but was in my case).

With Medicare being primary, I was regularly confronted with United Healthcare saying they would only cover what Medicare would cover, even though my United Healthcare policy said otherwise. We spent countless hours on the phone trying to get things covered, but in the end we often lost the battle.

It was a major and expensive headache. As things turned out for me, I think I would have been way, way ahead to have just used Medicare and skip COBRA. Your situation may be sufficiently different make keeping both be a good decision.

Steve
 

KimT

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In New York State, the supplemental plans are averaged in with everyone, so the premiums are less expensive than backward states like Florida. At least they were when I applied. In Florida, Advantage plans are not good and I would have had huge out-of-pocket expenses for co-pays. I went on Medicare as my primary and Blue Cross as the secondary. The premium for Blue Cross was three times what it was for 65 and over but I had no other option. I was only 60. This year, I turn 65 and my $600 a month premium will be reduced to $185 because you get a second open enrollment under which they cannot ask medical questions.

The same plan in New York State would have had a $300 premium because the pool is larger and there is no discrimination between disabled people and age 65 people.

So, the answer depends on what the law is now in NY, your age, and what will happen when COBRA runs out.

Of course, it also depends on the election.
 

Michael_67

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Medicare does not pay for custodial care only skilled care. If you have an rn or pt or something for a specific reason you often get a bathing aide for the duration. Hospice too will often send someone.

you would have to check your insurance to see what they cover but I think custodial care coverage is rare

for medicare be aware you need either an advantage plan or a supplement plus part d for meds. It is faintly possible ( though unlikely) cobra would be a better deal as supplements for under 65 tend to be very expensive and in my experience part d coverage is less good than private insurance for meds. States have ship counselors- trained volunteers to help you figure this out
Thank you Nikki! This is very helpful!
 

Michael_67

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Thank you Steve! This is really helpful!
 

Michael_67

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Thank you Kim! This is hugely helpful given that I live in NY State! I will look into the details re the supplementals. I appreciate you taking the time. Take care.
 
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