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KimT

Extremely helpful member
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Joined
Nov 18, 2014
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4,873
Reason
PALS
Diagnosis
08/2015
Country
US
State
South
City
The Beach
I was approved for SSDI and Medicare this week. It will take effect in March. I am still on the payroll at the college so my premiums for Florida Blue will be paid until the end of the year. Then, I have the option to continue the Florida Blue (Blue Cross) at my own expense until I start getting Medicare. I will do this because both Shands and Mayo are covered, my deductible is very low and the co-pays are good. It's a great policy.

My question is, living in Florida, not a veteran, does anyone have any advice/info/recommendations on what type of insurance I need once I start getting medicare? Do I have to apply for Part B (I saw the form online) and get a Medigap policy? I take five or six different prescriptions each day.

If anyone has a recommendation, I'd love to hear it. I want to make sure my local neurologist is covered, both Mayo and Shands are covered, and I'm not paying a fortune for my prescription drugs.

I appreciate all comments. Thank you so much.
 
As well as parts a and b you need either medigap and part d or a medicare advsntage plan that covers the places you want to go. With that you might get separately d or occasionally medicines are included in which case CHECK THE FORMULARY fo r what you might take as well as what you currently take. In Massachusetts There is no medicare advantage that could possibly work for me due to doctor and hospital restriction. If you go with medigap you want one with good coverage. An F plan is often recommended. For checking which part d for medications there is an online tool at medicare dot gov. The pharmacy plans are not going to be as good as what you are used to most likely
 
I believe in FL you can buy a Medicare Advantage plan (part C), that improves on Medicare's services coverage and has a drug benefit as well, even <65. Those are usually the most coverage for the best deal.

Check Shands' and Mayo's Web sites for MA plans they accept. Then look at plancompare at medicare's site for options and costs and call plan(s) you're interested in to confirm future eligibility. So when your Medicare coverage begins (parts A&B are included for you), you can then sign up for an MA plan and drop your group coverage. You might also run the numbers on keeping your own plan as secondary, after you check that if you did need to drop it, you would be eligible for a special enrollment period for the MA plan.
 
Thank you both! Mayo doesn't take Medicare Advantage. So, I guess I need both a Medigap plan and Part D.
 
Kim,
I begin medicare on 12/1. I automatically got parts A nd B from medicare. I also purchased a supplemental plan to cover co-pays and deductibles. I think this is the same as medigap. I chose an F plan because it covers the most and was recommended by many here.
Also, I purchased part D for medication. In addition to going on medicare.gov where you can enter your prescriptions and compare plans, I also went to walgreens pharmacy, my local pharmacy where they had a record of all my medications and ran a comparison in there system and made recommendations.
Very confusing at first. But all came together.
Marty
 
Kim,
Actually, it's a bit more complicated than that. They do take MA PPOs, just not HMOs (which I wouldn't encourage any PALS to sign up for anyway). But the kicker is that they are nonparticipating in Part B, so even w/ a Medigap plan you might still have greater costs than one of the MA plans they take. I would look into this closely.
 
Before I did anything I checked with my local ALS chapter. They can you great advise. For myself I chose part G it has a 147.00 deductible and picks up the remaining 20% that Medicare does not pay. My powered wheelchair cost 45,000.00 with Medicare cost was about 30,000 . If I didn't have part G my out of pocket would have been 6,000.00. And that's just the chair. As ALS progresses you will need a lot more stuff.
Patrick
 
Might be worth finding your options for plans and calling Mayo. I found the referral department for my clinic's hospital extremely willing to answer questions about insurance. And again triple check formulary coverage for whatever plans you consider. Look for prior authorization rules too
 
Kim,
Actually, it's a bit more complicated than that. They do take MA PPOs, just not HMOs (which I wouldn't encourage any PALS to sign up for anyway). But the kicker is that they are nonparticipating in Part B, so even w/ a Medigap plan you might still have greater costs than one of the MA plans they take. I would look into this closely.

Thanks, Laurie......I went back and looked.....again. You'd think my being a CPA and having lots of experience helping others with insurance would make it easy. It's not. I feel so worn out. I've been trying to help some other people with their health issues and I just overdid it.....for the past 6 weeks. I'm trying to put on a happy face, then I go home and have my own private pity party :confused: One thing I know for sure is that you, Nikki, and everyone here on the forum have made dealing with this easier.

Thank you again....everyone. I will get this figured out.
 
Has anyone used AARP United Health Care Plan F Medicare Advantage. I don't know if they will accept anyone under 65.
 
Might be worth finding your options for plans and calling Mayo. I found the referral department for my clinic's hospital extremely willing to answer questions about insurance. And again triple check formulary coverage for whatever plans you consider. Look for prior authorization rules too

I'm probably going to go with Shands (Dr. Pulley) Mayo is great and I go back next week for another ENT/speech appointment.
 
Not related to medical insurance but rather life insurance that you probably have with your employer. You should be able to carry over your employer sponsored life insurance when you leave work. This is a big biggie since you will no longer find anyone to insure you once diagnosed with ALS. However, since you likely have life insurance via your employer the insurance company can't deny continuing to insure you. Good luck ! !
 
I never took out an individual life insurance policy. I only have a small policy with work $130,000 because I have nobody to leave it to. I've been separated from my husband for 8 years, no kids, no grand kids.

I'll check into continuing it because it could be assigned to someone in return for something.
 
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