Medicare Supplement Plan: Recommendations for stage iv?

DivineMrsM

A couple years ago, I qualified for disability and received a medicare card. As I am insured through my husband’s employer, I haven’t needed part B or to purchase a medicare supplement plan. That may be changing and I may have to pick up the medicare health coverage due to possible changes with my husband’s employer.

Can you recommend certain supplemental plans? What can I expect to pay on a monthly basis for this? How hard is it to get supplemental coverage for the pre-existing condtion of stage iv bc?

LoveFromPhilly

hi MrsDivine!

I am not sure if this will help answer your question but I can share with you what I do.

I was on Obamacare through the Marketplace when I was diagnosed in 2017. My insurance was $300/month payment with a $7500 deductible. You can imagine what a financial mess that was for me all of 2017 (I am not rich with money I am rich with love!)

Anywho - in the beginning of 2018, I had to decide which Obamacare/marketplace insurance I was going to get. I really couldn’t make sense of any of it - it’s meant to confuse the heck out of us, sadly.

The hospital where I see my MO has a social workers/financial support office and team of individuals. They told me about a Medicaid program for women with breast cancer who make under a certain amount (I think it’s $45K/year?? But don’t quote me!) for which I qualify.

The insurance is called Keystone First and so far it has covered everything and I have not had any copays except for $1 when I got my wisdom tooth extracted at an oral surgeons office.

I wonder if this is sort of close towhat you are looking for?

bigbhome

Following. Great questions!

DivineMrsM

Philly, thanks for your story, which I find interesting. I’m so glad you found such good health care coverage. How smart of you to consult with the hospital’s financial support office. I think our situations are different, tho, as I’m on disability. I think others might be helped by your information, tho, so I’m glad for your reply!

Hudson32700

Hi my overall suggestion is to avoid if possible an HMO Advantage plan which can be both restrictive and expensive.....since offerings vary by state, consider calling the SHIP number for your state. They can't recoomend a specific plan, but can help you understand what is available and the differences among them

I can’t post links Google Medicare plus SHIP

Hudson32700

if you are not of retirement age you may have fewer options if you don’t have a trusted health insurance broker maybe a friend does. Brokers who deal with everyday are knowledgeable and can explain what each option entails.

Hudson32700

Hi my overall suggestion is to avoid if possible an HMO Advantage plan which can be both restrictive and expensive.....since offerings vary by state, consider calling the SHIP number for your state. They can’t recoomend a specific plan, but can help you understand what is available and the differences among them

https://www.medicare.gov/contacts/#searchresult&searchType=org&stateCode=ALL|All States&orgTypeByName=F|SHIP —%20State%20Health%20Insurance%20Assistance%20Program

rockymountaingirl

Medicare is more complicated than it should be, so I join Hudson in recommending that you seek out some expert help in navigating it. Either a State Health Insurance Assistance Program (SHIP) counselor (every state has them, see the Medicare website) or, especially if you are under 65, a broker who knows Medicare inside and out.

As for which plan to choose, Medicare supplement plans are standardized and you pick the one that offers the level of coverage that you want. Plan F, which pays your share of the charges for all Medicare-approved services, is probably the most popular, and Plan G, which pays everything except the annual deductible, is also popular.

In some circumstances, you can avoid having your pre-existing conditions considered in determining whether you can get supplemental coverage and at what price. Obviously, this is highly desirable if you actually have a pre-existing condition, especially a serious one such as breast cancer. For example, under federal law, insurers offering Medicare supplement policies cannot refuse to sell you a policy or charge you higher premiums because of a pre-existing condition, if 1) you are over 65, and 2) you apply within six months of enrolling in Part B. If you are under 65, or if you aren't covered by the federal law because you aren't within the six-month window for initial enrollment in a supplement plan, then you need to check and see if your state provides some protection against the pre-existing conditions problem. Some states are more helpful than others in that regard. You can see why an expert might come in handy in figuring out what your options are.

You are very wise to start thinking about this before you need to make a decision. I hope you will find the coverage that you want without too much trouble!

DivineMrsM

Oh, definitely a headache trying to figure this all out. How confusing.

Thank you, everyone, for your replies. I will look into speaking to a SHIP counselor.

AliceBastable

I have a Medicare Advantage HMO plan. No premium beyond the Part B amount, no deductible, reasonable copays when required, and because I live in a good-sized city, lots of choices for physicians and hospitals. Oh, and pharmacy coverage is included with no additional premium.

Moissy

I went on Medicare a year ago (disability) and was overwhelmed with the choices. Very different from traditional insurance particularly when it comes to coverage for oral targeted therapies.

Options and laws vary by state. I did talk with a SHIP person but in my state it is staffed primarily by volunteers, so not always equally knowledgeable. One of the very best resources I found was Boomer Benefits www.boomer benefits.com. There is a ton of educational info on their site and they are a broker that specializes in Medicare type plans. They can sell in almost all states. (I have no affiliation with them other than I purchased my plan through them.)

I ended up with an “original Medicare" plan plus a Medigap supplement that covers the full 20 percent that Medicare does not. I pay about $140 per month for a Medigap supplement. Anything that Medicare covers 80 percent, the supplement will automatically cover. I never have copays for anything.There was no issue with preexisting condition at all as long as I signed up when first eligible. Trying to change plans later is a completely different story though, so you want to make the right choice the first time.

You may also need a separate drug plan for pharmacy drugs however if you go with OriginalMedicare. Check out Boomer Benefits and you'll be surprised at the educational info available online.

Moissy

Just adding one more point. Oral targeted therapies are covered separately by Part D if you do not choose a Medicare Advantage plan or do not have some other qualifying Drug Plan. I found the copays for the targeted therapies shocking when I switched to Medicare. But I was able to qualify for drug copay assistance through PAN foundation and Patient Advocate Foundation.

DivineMrsM

Moissy, thats a lot of great Medicare information. Thanks

jessie123

You probably already know this - but in a nutshell -- Medicare part A pays the hospital -- however there is a deductible per inpatient visit (don't know how much it is this year) Medicare part B pays the doctors at 80% - you pay 20%. A straight medicare supplement policy to help with medicare coinsurance and deductibles is over a $100.00 a month -- probably closer to $170 monthly. The medicare website has a list of coverage options for these supplements. Blue Cross used to be a popular one. Then the advantage plans began -- they are worrisome to me, but I know a lot of people who have them --- When my parents were living with me at the end of their lives I dropped their medicare supplements because we were spending more a year on the supplement than we were saving on medical care. Example - took mom to doctor -- charge $100.00 -- free medicare payed $80.00 -- the supplement payed $20.00. The supplement Insurance that month was $160.00. I got caught one time when she was hospitalized for a broken hip. Had to pay the hospital $1,500 deductible. When my mom went on hospice she kept them for almost 7 years because Medicare doesn't have the staff to watch medical stuff --- a patient is not supposed to be on hospice longer than 6 months. So it worked for me - although was taking a little chance. The very best people to talk to you about insurance are the people who file insurance claims in the doctor's offices.

DivineMrsM

jessie, thanks for the insight and examples. What a good idea to talk to the people who file insurance claims in the doctor’s office; thanks for that suggestion!

Tina2

Divine and Jessie,

That's exactly what I did when I started Stage IV treatment: I talked with the insurance claims filers in my oncologist's office. They were very helpful and happy to be of help!

Tina

Zillsnot4me

I have the advantage HMO as that’s the only one my hospital uses. There’s only two choices here and the other was Humana Gold. Slowly but surely I’m having to move to this hospital for everything. Both my pcp and onc left so I’m floating in the wind. At least I’m stable. Yes that word was used on my last scan!

I only pay the 105? That’s deducted every month. My specialist copay is $45, the scans are $170. My drugs (xgeva/xeloda) are covered by a grant. They will never be affordable. I joined sams club to get 40% of my reg rx as ins was just too much. I buy enough tp and paper towels and wipes to “earn” my joining fee back. Plus they have wonderful produce and ready to bake entrees. Their meat is good too

Have wondered if AARP would make a difference. Or just more junk mail.

Good luck