I never have understood insurances and always just went with whatever my employer provided. That said, I've been on Medicare for a couple years now and just stayed with the same insurance company I've always used to get their Advantage plan.
When I finally qualified, I also had a variation of Medicaid as a secondary insurance. We knew it was only temporary due to the Covid bonuses, and the lady told me that once the Medicaid ended I could just slide into a different supplemental policy that would only cost about $30/mo. I've been counting on that all this time, although I'm sure the price has gone up.
Unfortunately, they're now telling me that since I have a Medicare Advantage plan, I'm not ALLOWED to have any additional insurance. WTH? If I'm willing to pay for an extra policy to cover all the many things that Medicare doesn't, then why can't I do this? Is anyone out there familiar with this? Is there some federal law banning me from having more insurance or is this just my insurance company yanking me around?
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NorasMom
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But, unfortunately, I cannot explain how confusing Medicare & Medicaid rules are and each state is different too. And, if you are on it for SSA, SSI or SSDI impacts your options too.
WTF? I know. I am 56 yo, on SSDI and in Pennsylvania. I am at 136 percent of the federal poverty level, but I cannot get any dual-eligible policies BECAUSE I am on SSDI, not SSI nor SSA.
I was dx in 1994 at age 26. I worked until age 46. So, I have OVER twenty years of work experience. Because I worked "as long as I could" I was sort of penalized in my options. Doesn't' make sense either.
By, the time Medicaid was expanded in Pennsylvania, year 2012, it was up to only 133 percent AND not the ORIGINAL 138 percent of the Federal Poverty Level.
I am at 136 of the Federal Poverty Level. I have Medicare. I am on SSDI. Pennsylvania explained that I make too much on my SSDI at 136! The original intent was altered down to 133 and I am at 136.
Let's hope that Medicare can negotiate for drug prices, which are the most expensive for folks on DMT's for life, right? Be well. Ask you Medicare Supplement plan administrators and your State Medicare Department too. Good luck to you! 😅🤞🙏
Hi NorasMom. I was curious about this because I have Medicare Advantage, and like it because it covers most everything and I don't have to pay for a supplement or separate drug plan. I looked online and found this: you can choose original Medicare which covers 80% and opt to purchase a supplement to cover the other 20%, or choose Medicare Advantage which covers almost all of your medical expenses but you cannot purchase a supplement with the Advantage plans. My Advantage plan covers free primary care visits, a $20 co-pay for specialist visits, and small co-pays for certain tests or urgent care or hospital visits.
I also understand that each state offers different types of Medicare Advantage plans, so your plan may not cover some of what mine does. But from what I have read, supplement plans can only be used with Original Medicare. Maybe some others on here will be able to give you more info or verify my info. Hope you get some solid answers on this topic. Take care.
Thank you! I'm just baffled by the fact that I was allowed a Medicaid supplement but now I can't buy one. Without it, I have a $750 deductible (which I realize could be much larger), but my co-pays are in the $50-$80 range for pretty much everything, along with $250 for the ER. They only cover 20% of my CPAP supplies, and from what I can tell they don't do much at all for durable medical equipment in general. My share of most other costs will be around 20%. I'm okay for now, but it's the long haul that has me worried.
Wow. Sounds like you have much more out of pocket costs than I do. I don't blame you for being concerned. I do have a suggestion. Every year from Oct. 15 to Dec. 7, you have the right to change your Medicare plan during open enrollment. You can research different Medicare and Medicare Advantage plans and compare co-pays and out of pocket costs. You might find a different plan that works better for your needs. During this time, you can switch from Advantage to Original Medicare and purchase a supplement if that works better for you. It takes a bit of research though. Medicare has several different plans that cover different things, so you need to make sure you pick the right plan.
When I became eligible for Medicare, I sat down with an insurance rep, explained all my needs, and he and I came up with the best plan for me. I've been very happy with it, but it's good to know that once every year, I have the option to switch plans if my needs change. Hope some of this info helps. All the best. Take care.
Wow! That's terrible. Medicare Advantage Plans are better in California. I'm not on one, but I know a number of people who are and the plans here have much better coverage.
I have the advantage plan too, with the $20 & $50 copays + the $750 deductable. It actually cost me more to go with Medicare + the Supplemental plan. In my state, Arkansas if you have medicare you don't qualify for Medicaid. You can apply for Medicare help. It's in addition to SSDI. They do have an income threshold. I just recently went above it & lost the extra help. I hope you can get it straightened out.
There are so many responses here that must be helpful to you! And they certainly were to me because of my almost total ignorance. Even though I retired almost 20 years ago, I'm still covered by my old employer's health plan as secondary to Medicare. Because I merely transitioned instead of researching my options, I've been so ignorant. So thank you for asking the question and thank you to everyone else who provided tutoring for me!
it is true that every year you can switch from a advantage plan to straight Medicare but getting a supplement is not so easy. You most definitely will have to be medically qualified.
Check around for a person who sells health insurance. They cost you nothing. This person can guide you and answer your questions. I Love my guy and trust him completely.
Boy, can I identify with you! We moved from California to Idaho in 2010. I had worked for a large national company and had great insurance. When my cobra ended, I took a copy of my policy to a local agent, and said that I would like something similar. When he looked at my policy, he actually laughed and said there’s no way you will get close to that here. And we don’t!
We are extremely limited on insurance companies to choose from, coverage options, and out of pocket limits. My out of pocket limit is $6200 and that is one of the lowest. And not every medical expense qualifies toward the out of pocket limit. I can only afford an Advantage HMO which limits what doctors I can see.
We are somewhat rural and there are a shortage of doctors practicing in our area. The wait for me to get a second opinion with another neurologist was 5 months. That is unfortunately the norm with all physicians in this area.
I agree that finding a good insurance agent that will take the time to find out what you need can help you navigate through this process. Best of luck and gentle hugs.
What part of Idaho did you move to? I live in Pocatello and have a gal that that’s all she does is Medicare and supplements and doesn’t cost me a penny. The government pays her for doing it but she always finds me a plan that has great benefits. Let me know? PM me 👍🏼🙏😉
I’m sorry for the delayed reply, I had a total knee replacement and am not online as often. I’m in Lenore, along the Clearwater River. I have an Advantage plan with RX, I could not get a supplement plan because I was disabled but not 65 and now it’s too expensive for me since I have to qualify with existing health issues. My husband was able to get a supplement when he turned 65 and I wish I could have.
We have a couple of people that come to the senior center in Orofino that help to find the best Medicare insurance for each individual situation. There continue to be shortages of medical personnel in this area, the pay is low and the work load high. We also have a low income, advanced age population which doesn’t make it attractive to insurance companies
Lewiston is the largest city near me and there are 2 neurologists that specialize in MS. Each works 2 weeks on, 2 weeks off, essentially making the equivalent of one doctor. Neither were taking new patients when I moved here so I picked a neurologist that specializes in Parkinson’s. She was fine as long as I was stable, but when I started having problems I realized how unfamiliar she was with the disease. I now have one of the MS drs and am thrilled to have someone who has made MS her passion.
I really appreciate the information and time you took to share with me. May your day be blessed and filled with joy.
It is VERY difficult to understand. When I turned 65, I consulted with a AAA Medicare specialist, who took down all my health issues and figured out what the best solution would be for me. I ended up with basic Medicare plus two policies with private insurers: one a policy that covers medications and the other a policy that covers things the basic Medicare doesn't.
I know you can't have BOTH an Advantage plan and a supplemental, probably because there's some overlap, but I'd recommend talking with some Medicare specialists like I did to have them look at what you need, what you have now, and what you're paying. I will say that my supplemental plan is not cheap and I just recently got a letter saying that they've applied for a 66% rate increase next year!! Yes, you read that right. That will mean the cost of it has doubled in three years.
The sad truth of the matter is that even so, I'm better off having it because of the cost of my DMT. But I'm lucky enough to be able to afford it. I don't know how anyone on a low income can possibly manage. I wish we had universal health care like most developed countries do. My brother, who lives in Canada, doesn't have to worry about any of this crap.
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