Question about medicare and preexisting conditions?

peaches1

Hi- I just turned 70, and I have had a Blue Cross supplement plan F since I turned 65, and I have been really happy with it. I was diagnosed with breast cancer 3 1/2 years ago, and last year the only bill I had to pay was for an eye exam. I also had to pay $120 for a med check with my psychiatrist. She is not a medicare provider, and she lets me see her once a year to get my antidepressant renewed. I also see a therapist who is not a medicare provider, but she has lowered her fee to $75 for me. I see her about 20 times a year. The only reason I am considering switching is because they are getting rid of plan F starting 1/1, but people who already have it are grandfathered in.

I have been paying $180 a month for my plan F, but I am afraid it is going to go up on 1/1 since I turned 70. Mutual of Omaha has a cheaper plan F, but I am worried that they will deny me coverage because of the breast cancer. I am almost positive if I switch to United plan F, my rates will go to $399 a month. Has anybody tried switching to a different supplement plan after they were diagnosed with breast cancer? Should I just keep the BCBS medigap plan that I have? I live in the Chicago area. The medicare enrollment period ends on 12/7, and so I have to decide soon. I am seeing an insurance agent this next Wednesday who would be able to answer my questions, but I am worried that if I have to go through underwriting that won't be enough time. I would have seen him earlier, but I am taking a friend of mine too so one of the agents can help her, and we have had a hard time finding a time both of us can do it. They are closed on Friday, and on Tuesday I am scheduled for a colonoscopy, and so Monday and Tuesday I am not available. Thanks

MinusTwo

peaches - what ever you do, don't switch to a Medicare Advantage plan. Once you do that, you can NOT switch back w/o qualifying. Pre-existing conditions are often refused.

Prices don't go up because you are 70. Prices just go up every year no matter what. If your plan F provider has been paying in full and you can afford the premiums, I would not switch. I'm fairly sure that Plan F is one that has been discontinued, so you would never be able to have that option again.

JosieO

peaches,

MinusTwo is right and giving you good advice.

Although Medicare Advantage plans may seem more attractive, they are actually more restricted and in the end more costly than a Medigap F.

Think of it-what if you needed to see a doctor that was not part of your Medicare Advantage network? Why put yourself in that position?

I agree with Minus-stick with your current plan F

jessie123

I used to understand all about supplements as I worked for Medicaid, but I've been retired so long I have no idea what's going on these days. I have retired state insurance and it is Blue Advantage which is a PPO. I was really worried when the state changed from regular Blue Cross to the Blue Advantage, but I will say it was wonderful through my recent cancer treatment. In my day I don't remember any Medicare supplement policies denying applicants for pre-existing conditions. Things have evidently gotten really bad -- only old or disabled people purchase supplements so the fact that they deny coverage based on health sounds crazy. What's this world coming to?

MinusTwo

jessie - Yes things have changed since the start of private Medicare Advantage plans. Essentially they were created in 1997 but started with the 2006 coverage year.

Traditional medicare (Parts A & still pays 80% - as it did for my parents when created in 1965. Medigap supplements pick up the 20% difference. Everyone purchases a supplement it they can afford to - as I have and my parent's did before their deaths once such plans were offered. I can go to any doc I choose, anytime I want. No gate keeper to see specialists. And any hospital I choose. I can choose my treatment - with in reason of course.

In my case, I chose a supplemental plan that requires me to pay a deductible once a year ($183 last year) and after that the plan picks up the entire remaining 20% for anything approved by Medicare for Part B. I have a friend who chose to go with a $10 co-pay for every visit but she has no deductible. This plan saved my butt when I was in treatment for breast cancer. At one point & was having 4 infusions at a time that would have cost me $10,000 each x 4 x 6 cycles. And I didn't have to argue about the chemo my doctor ordered being covered.

There is also a deductible for a Hospital stay, that was $1000 when I last used it and $1340 last year. I found that extremely reasonable for my surgeries with 5 & 3 day stays.

Medicare Advantage plans (Part C) on the other hand are managed plans that usually have restrictions about what physicians you can see or hospitals you can go to. They require a referral from a primary care doc (gatekeeper) before seeing a specialist. On the positive side, they do pay something towards vision & dental care and drugs are included (or whatever drugs are on their formulary) Many people are very happy with this version and if it works for you - great.

When you originally sign up for Traditional Medicare A & B, there are no tests for pre-existing conditions. The new trick is, yes they want you to switch to an Advantage Plan. But if you do and aren't happy, you can't just switch back. a) Your old plan may have been retired and b) you will have to qualify for pre-existing conditions to get most medigap insurance.

Note - none of this discussion applies to Medicaid, which is income based for those who can't afford other care.

marijen

This is a little off topic but today I compared drugs plans at Medicare and found a better plan that will save me $1000 in 2020. It was so easy to switch plans online with an agent on the chat function. Dec 7 is the last day for open enrollment.

https://www.medicare.gov/plan-compare/#/questions/?year=2020&lang=en

AliceBastable

I have an advantage plan and I'm happy with it. I live in a large enough urban area that the choice of doctors and facilities is quite good. If you live in a smaller area, it would probably be an issue. I had several years with no medical use, so I didn't want to pay premiums (actually, I couldn't afford them). My premium for the plan I have is my Part B amount, diverted to the Advantage company. I don't have a deductible, and there is a cap on co-pays, which has been going down the last few years and again next year. I switched primary care physicians recently, in part because it was difficult to get referrals from her office. My new doctor stays on top of it and I don't have to request the referral; they send it automatically to any doctor I will be seeing in the near future.

rockymountaingirl

Minus Two is correct. If you have a Medicare Supplement plan (also known as Medigap), and you want to switch to a different Medicare Supplement plan, you will likely be subject to medical underwriting and any pre-existing conditions that you may have will count against you. With a history of breast cancer, you may find it difficult to get a new Medicare Supplement plan to accept you, and if it does accept you, you will likely have to pay a significantly higher price for it. A Medicare Advantage plan is also an option, but, as JosieO observes, Medicare Advantage plans are more restrictive and often prove more costly in the end. So, if your Plan F is serving you well, your best option will probably be to stay with it. Prices do go up every year, but any increase will not be nearly as much as you would have to pay for a new policy with medical underwriting. A knowledgeable insurance agent can help you sort through your options.

If anyone reading this is new to Medicare, please note that your options may be different. If you sign up for a Medicare Supplement plan during your original enrollment period, you can get a Medicare Supplement plan without worrying about being denied coverage or charged higher premiums because of pre-existing conditions. And although Supplement Plan F will not be available to those who become eligible for Medicare in 2020 or later, Plan G will continue to be available to new enrollees, and it is just like Plan F except that it does not cover the Medicare Part B deductible ($185 in 2019).

DivineMrsM

I appreciate the discussion. I started on Medicare this year as my dh was forced into early retirement by his employer.

The first thing I learned was because I'm not yet 65, in Ohio I can only get a Medicare Advantage plan. When I'm 65 in a few years, I'm eligible to get a Medigap plan. Am I going to have trouble tho due to mbc? I continue to be appalled at how confusing and often costly Medicare is.

Artista928

good to know. It's not just bc but all kinds of things could be considered pre existing. I don't trust the government to change the adv plans. The premiums are cheap for a reason. My dad was about to fall for one. Free vision, dental, and some other small bills stuff. But wait till something big happens and how much you'll pay! Talked him out quick.

AliceBastable

Arista, I had a lumpectomy, re-excision, a total nephrectomy, and radiation, with all the attendant tests and exams, from June - December last year. My Advantage plan paid its share with no problem. Yes, I have co-pays, but no deductible, and with no out-of-pocket premiums, I am quite happy with my coverage. And it covers my Part D with no premium.

Artista928

From what my medicare agent said you pay for it when catastrophic illnesses happen and some other issues, otherwise if it's that great and cheap no one would pay for regular Medicare and supp. It's important to review with a fine tooth comb what you may think you need. Seniors are lucky they can change each year. Not so for people on disability. You can only go down in benefits. So at 50 yo I had to think what could happen till I'm 67 yo and choose. I wasn't about to risk going bankrupt with a lesser plan than Medicare with plan F supplement. With all my stuff, I haven't seen 1 bill. Nothing to fight. I think it's only dialysis that there's a snag with Medicare and maybe a couple of other stuff that's not on my radar of current concerns.

rockymountaingirl

Divine, my understanding is that when you turn 65 and become eligible for Medicare on the basis of age, you will be able to get a Medigap policy without medical underwriting, so pre-existing conditions will not be a problem for you. I think you will have to sign up for a Medigap policy within a specific time period to get a policy without medical underwriting, so be careful about that. The usual rule is that you can get a Medigap policy without medical underwriting if you get it within six months of signing up for Medicare Part B, so maybe for you it would be within six months of turning 65? Like you, I'm appalled that Medicare is so complicated. And I don't know why having a pre-existing condition is still a problem for anyone anymore, but until we get more enlightened laws, we are stuck with the "system" we've got.

peaches1

Hi- I am reporting back. I went to see the insurance agent on Wednesday, and he confirmed my suspicion, and told me to keep my current BCBS plan F plan. He also deals with United and Mutual of Omaha, and he told me that they would both make me go through underwriting, and would either deny me, or charge me a whole lot more than I am paying right now. Apparently my monthly BCBS plan F goes up $7 a month each year. For example if I am charged $180 a month when I sign up for medicare at the age of 65, I will be charged $187 a month a year later. The agent also told me that BCBS in Illinois does not penalize you if you wait to sign up for one of their plans past the age of 65. It might be the only company in the state that does that. If you have a Medicare Advantage plan, and then at age 70 decide to switch to a BCBS plan F, they do not put you through underwriting, and you pay the same amount as the people who signed up for the plan when they were 65. I also learned that people that are already on medicare can sign up for a plan F. It is just people who have not turned 65 by 1/1/2020 who will not be eligible to sign up for it. He did help me sign up for a new plan D though because my Humana Walmart plan D was going up to $52 s month. I signed up for another Humana Walmart plan D plan which was only $13.42. I will have to pay a 12% a month penalty though because I did not sign up for part D until I turned 66. There is a 12% a year penalty for each year that you do not sign up. The agent does not represent Humana, and so he did not make any commission on me. He told me that there are 30 different plan D plans in Illinois, and one of the plans that he used to have wanted to charge him $50 for remaining as an agent, and insisted that he attend a half day training session.

A friend of mine came with me though, and he was able to help her, and hopefully he will get lots of commission when she signs up for a plan. She is retired and has been covered under part A and part B, but she has also continued her hmo plan that she had before she retired instead of signing up for a supplemental plan. She pays $474 for this hmo plan which is not as good as the supplemental plan she can get. Hopefully she will switch over before 1/1/20, and will then save a ton of money. He told her exactly how much money she was wasting by not switching over.

I have a question though about a gastroenterologist I would like to see for a colonoscopy. I had a colonoscopy on Tuesday which a surgeon did. The surgeon removed a huge anal polyp over three years ago when he did one one me, and told me to see him again in three years for another colonoscopy. When I went for the colonoscopy on Tuesday, I just knew I was not cleaned out enough, and while I was waiting to be wheeled into the room for the colonoscopy, I passed some more BM. I then suggested that maybe I should reschedule, and I was talked out if it. They said it was probably okay and to go ahead with it. He found something else but did not find a polyp, and I wonder if it was because I was not cleaned out enough, and maybe I should have another colonoscopy done by a gastroenterologist that two of my friends love. The surgeon says that he does not think that I need to do that, but he is going to discuss this with my sister who is an endocrinologist. I have a really bad family history of colon cancer, and they have always found polyps before.

The problem is the gastroenterologist I want to go to does not take medicare assignment, and I called her office, and I was told that I would have to pay her $250 up front, and would not get the money back. Her office is located in Kenilworth, IL, which is one of the wealthiest suburbs in the country, and they can get away with doing that. Has anybody else here paid an additional amount of money that medicare would not cover. One of my friends that goes to her also told me that the internist that he goes to in Winnetka which is right nest door to Kenilworth charges him an additional $750 for an annual physical beyond what medicare pays. Thanks

peaches1

I forgot to talk about Medicare Advantage. I have no desire to switch to medicare Advantage. Two of the doctors I go to do not accept the 0 premium advantage plans. They do accept the more expensive medicare advantage plans, but with those my premium would be just as expensive as it would be under my plan F, and I would have to pay a copay. The only advantage would be that my advantage plan would pay a small amount for dental, vision and hearing.

For the person who is being forced to go on a medicare Advantage plan, would her husband be able to get insurance through COBRA which would cover her until she turned 65? I ran across an insurance agent's website a few weeks ago which discussed Medicare Advantage plans, and he listed what percentage of people on medicare in each state were signed up with a medicare Advantage plan. The state with the lowest signup was Montana, where only 2% of people on medicare had an Advantage plan. Minnesota had the highest participation. 80% of people on medicare in that state have an Advantage plan, and so it sounds like Advantage plans vary from state to state. In Illinois where I live 27% of people have an advantage plan, and in Louisiana where one of my sisters is turning 65 in January, 50% of people have an advantage plan. Hope this helps.

AliceBastable

Peaches1, Medicare Advantage plans are not good in rural areas, which is the majority population in most of the areas you mentioned. I live in a fairly large city, and my plan covers the major hospitals in the city and surrounding suburbs and even farther out. The physician's directory has a huge selection of primary care and specialist physicians. For those of us who cannot afford expensive monthly premiums, and live in an area with good choices, it's a great alternative to basic Medicare. I'm sorry you think you know more about it than someone who actually has it and has been satisfied with it for several years.

MinusTwo

Alice - I agree with Peaches. I live in a BIG city and none of the Advantage plans cover all my docs and/or hospitals. As you said, it is often an economic decision. I'll scrimp & save and as long as I can afford it I will stay with my Plan A & B and a medigap plan. That way I can choose my treatment options.

I have not been refused treatment or turned away from any of the docs or specialists I have chosen - no matter what my health status. On the other hand, many docs will not accept new patients with Medicare Advantage plans.

Peaches - it doesn't surprise me that people are paying extra. A number of docs here have converted to a "concierge plan". You pay so much per year and supposedly get guaranteed access to your doc 24/7. Ten years ago my PCP converted and wanted $1500 up front before he processed any future visits. Needless to say, he is no longer my doc.

Artista928

My pcp too. Lots of really good docs are going concierge. Too much for me so I switched pcps. You're lucky if you have all your docs and treatments covered. I went to a Medicare class and heard cases of being bill shocked for big stuff. I can't risk that with my tight finances. In most cases the addage of you get what you pay for is true. My advice for looking into MC Advantage plans is read all the print. Make sure you know everything about it. I feel so bad about seniors who watch all kinds of ads and jump for the bargain. My dad is one. Fortunately he listens to me. The latest is Colonial Penns life insurance for 10 bucks a month. Your rate will never change and you'll never be dropped. Awesome! No. Have you looked at how much you get for what you put in at your age? And Alex Trebek who has pancreatic cancer does these ads. Shameful. It's in the fine print for a few seconds in a big paragraph. Sneaky. I also love how aarp keeps sending me get life insurance for 15 bucks a month. Same speel as colonial penn and no prexisting conditions concerns. Looked into it and saw at age 55, I'd be ahead keeping money in my 401k and being frugal. No way would it be 100k at my death. I think we need to teach kids young to invest in investments, life insurance, long term care early. After 30s and definitely 50 the way it is doesn't make sense to do. Always read every fine print.

AliceBastable

Gosh, I guess I'll have to tell my Advantage plan that they're treating me too well. Maybe I'll do that the next time their nurse calls to make sure I've had a blood test I need. Or last year, I guess they shouldn't have told my hubby (who was handling the bills) to not pay certain hospital expenses that he had questioned.

We each need to select whatever type of insurance that works the best for us, considering all health, financial, location, and range of physician choices. And it would be nice to do that without maligning or using scare tactics to disparage other people's choices.

MinusTwo

Alice - sorry if I sounded critical. I really didn't mean to do that. You are right. It's most important for us to support each other. I do have friends who are comfortable with their advantage plans and I'm glad it's working for you.

DivineMrsM

This is what I want to see regarding Medicare prescription prices: a cap on what Medicare recipients pay. Democrats propose a cap at $2,000 a year. Republicans suggest $3,100. Next year I may be paying close to $10,000 for Verzenio because currently there’s no cap on Medicare drug copays.

It sounds like it has a while to push something through, but both political sides seem to have understood that voters are demanding something be done with drug prices.

**Part of the NPR article:

Practically everyone is frustrated by high prescription drug prices. Voters have made clear they want Congress to do something about them.

On Thursday, the House of Representatives passed a bill that tries to deliver on that. It was a mostly party line vote — all Democrats voted to pass it, along with two Republicans.

The bill, HR 3, titled the Elijah E. Cummings Lower Drug Costs Now Act, is highly unlikely to get through the Senate, and the White House has announced that President Trump would veto it if it came to his desk.

But it does have several components that are reflected in other proposals in Congress, including a bipartisan bill in the Senate that might have better prospects.

"Obviously, Speaker Pelosi's proposals are the most ambitious — they're also the furthest from becoming actual law," says Benedic Ippolito, an economist at the American Enterprise Institute, a conservative think tank in Washington.

The bill lays out a vision for how Democrats would like to remake prescription drug pricing in this country, which could be seen as a promise to deliver on a bill like this if voters choose Democrats in the upcoming election.

Ippolito says he is glad to see some real proposals to address this issue. "It's not every day that we see both parties actively proposing legislation to meaningfully reduce drug prices," he says. "Whether one loves HR 3 or not, I think it's still a good thing that we have both parties taking this issue seriously."

******. Limit out-of-pocket costs for Medicare enrollees

Right now, there's no limit for how much seniors and others on Medicare spend on drugs out of pocket — unlike in most insurance plans. This bill would set a limit for Medicare patients at $2,000 a year.

It's not just seniors who get a break here. Right now, after enrollees have spent several thousand dollars on drugs, they're on the hook for 5% of ongoing costs, their prescription drug plan pays 15% and Medicare pays 80% — drug companies don't pay any part of it. Under the bill, that splitting gets changed around: Patients pay nothing after they hit the new cap, drug companies pay 30% and Medicare and health plans pick up the rest.

Stacie Dusetzina, a health policy professor at Vanderbilt University who has written extensively about Medicare Part D, says that drug prices were overall "much lower" in 2003, when Medicare Part D became law. (Before that, Medicare didn't cover drugs at all.) And, she says, many new, high-cost treatments have entered the market since then.

"In areas like cancer or multiple sclerosis or hepatitis C, all of these treatments are very, very expensive," she says. "So even if you only have to pay 5% of the drug's price, it gets incredibly expensive for the patient, and there's just no limit."

There's widespread agreement in Congress that this needs to be fixed. The bipartisan bill in the Senate has a similar redesign of who pays for expensive drugs, and it has an out-of-pocket cap for enrollees, although it's set a bit higher — at $3,100 per year

Artista928

10k a year for a drug? Insane! Cancer shouldn't make people go bankrupt! I'm not mbc but I am on Medicare. Of all people seniors and disabled folks can't afford this the most!

Yogatyme

I dropped my AARP membership when I realized that as far as insurance goes, they do seniors no favors. Their supplemental plan is lousy....worse than any of the others I saw as a provider. Many of my senior patients dropped their AARP plan for BCBS or Mutual of Omaha bc of better coverage, cheaper rates and less out of pocket.

Artista928

I love Aarp plan F. Never had any problems.

DivineMrsM

Artista, the new chemo pills like Ibrance and Verzenio for metastatic breast cancer come with hefty price tags. One month's prescription is about $12,000.

If you have private insurance through an employer, the drug manufacturers offer a copay card and you end up paying nothing for the drug.

If you are on Medicare, though, you aren't eligible for the copay card. If you meet certain income restrictions, the drug companies will offer financial assistance to pay for the drug.

What happened in my case, and others, is dh and my income was too high to qualify for financial assistance. Earlier this year we had private insurance and paid zero for the drug. But dh had to take early retirement. I went on Medicare, but since they use last year's Income tax adjusted gross income, when dh was working, we show a higher income. I exhausted all possibilities looking for financial assistance, but for me, none.

I am not 65, so in Ohio, I only qualify for Medicare Advantage plans and poor prescription coverage for these pricey drugs. One month cost of the chemo pills automatically puts me past the prescription donut hole into the catastrophic coverage. My first copay last month was $2500. This month is wil be about $640. Then it resets in January, back to the $2500 first payment and $650 a month thereafter. If the meds work and I'm on it all year, its close to $10,000. Fortunately, I have saved money and can pay it. But its a tough pill to swallow (pun?) when its been free up to this point. You know. When we were making more money!

When the pharmacist called about the copay and I told her I had to pay the $2500, she gasped and I could hear the sincerity in her voice when she sadly said, “I’m so sorry you have to pay this amount.”

Our taxes for 2019 will again show too high of an income, but when we file the 2020 taxes it will be lower and I should qualify for help.

But no matter. Why in hell have there been no pay out limits on the prescription payout part of Medicare? It does sound like the tide is finally turning and Congress is getting the message. Not sure how long it will take for change to come, but it can't come soon enough!

LoriCA

$10,000 a year for drugs is insane, but you know what's even worse (if you're under 65)? IV drugs under Plan B, not just chemo but also all of these new pricey biologics. My H&P was $14,000 every 3 weeks, and most of the time I also had a chemo drug with it. 20% co-pay under my private insurance is same coverage as Medicare, but under Medicare you can't get co-pay assistance unless your income is low enough to qualify for charity and there is no annual out-of-pocket max. That co-pay alone comes to just under $50,000 annually that I would have had to pay out of pocket if I was on Medicare. Kadcyla is being billed to my insurance company at $10,500 every 3 weeks, or $35,700 co-pay annually. And that's just part of my treatment/costs. If you are middle-class and don't quality for charity, you are screwed if you go on Medicare before age 65. At least at age 65 you can get a supplemental plan.

That's why I won't collect the SSDI I am entitled to and be forced onto Medicare. It's also why I don't support "Medicare for All" unless I see some drastic changes made to the program for people under 65.

Artista928

For stage 4, ssdi fast tracks folks. You get Medicare and can get a supp at least in CA.

Anyone know what the max income is in order to get help on rx drugs on regular Medicare?

DivineMrsM

Artista, this might give you the information you seek:

Understanding the Extra Help With Your Medicare Prescription Drug Plan

https://www.ssa.gov/pubs/EN-05-10508.pdf

LoriCA

Even in states that do require we be sold a supplemental plan under 65, we are still subject to medical underwriting and the company can charge whatever premium they want due to our pre-existing condition. Disabled (on SSDI) can mean different things, not all disabilities may have the high medical expenses that come with a Stage IV dx and some supplemental premiums may be affordable, but with how high my medical expenses on HER2+ treatments have been I'm sure my supplemental premiums would be outrageous. What stinks is that you can't even get a quote unless you already know your Medicare effective date.

Artista928

Thanks Divine. I saw an AARP article that the house has passed that 2k cap bill for Medicare. I'm scared of the Senate...

DivineMrsM

Lori, I'm sorry to hear of the trouble you've had with medical care costs on Medicare. I don't have the triple positive bc, so my treatment's been different. Why Medicare makes things so complicated is beyond me. As with many things, I seem to understand it better once I'm in the middle of it. At the onset, I try my best to comprehend and then hold on tight hoping I've made the best choices I can for my situation.

I live in Ohio, and since I'm under 65 on disability, I don't qualify for Medigap but do get Medicare Advantage. I did not have to get any underwriting for a pre-existing condition. The plan I chose has no monthly premium. I pay the monthly Part B Medicare cost, I think it's $135 monthly. I have a deductible and coinsurance which I think I must pay up to about $3500. But they cover many procedures for low to no cost. I think one Zometa IV cost me $60. A CT cost $150 and specialty doctor visit is $25. Since I only went on the plan in September, the medical costs were low for this year.

What bit me in the ass was the Verzenio copay. $2500 for November and $650 for December. Then reset in January and pay $2500 again. The Medicare Advantage plan covers prescriptions and Medicare literature actually says, “most people never reach the catastrophic phase of drug coverage." Whelp, I weren't “most people". So next year, providng Verzenio works, I will pay $10,000 in prescription costs. Plus $135 x 12 for Medicare Part B. With the possibility of deductible/copay up to $3500. Dh pays about $4,000 in medical premiums from his employer and that insurance doesn't cover my Pennsylvania doctor and costs quite a bit more for me to be on it. Six of one, half dozen another. Complicated.

I am fortunate that I've saved money to cover these costs but my gosh. The price we pay to stay alive.