Supplemental Insurance

[Chickie]

What is the best medicare plan and/or supplemental insurance plan for PBC? I will soon be divorced ,after 33 years, and I must find my own insurance plan. I'm at a loss as to where to start.

[ninjagirlwebb]

There should be healthcare navigators or brokers in your location who can help you walk through insurance options in your geographic region. Ask some of your local friends or neighbors or even the Social Security office to see where these resources can be found.

All the best to you.

Haley

[Chickie in reply to ninjagirlwebb]

Tanks for your reply.

[SunnyXXOO]

I did months of research and spoke to many professionals and found what is good for me, maybe for you also.

I’m not sure what state your in but every state differs. I live in Massachusetts during summer months then down South for the winter. My coverage is good anywhere, I use in New Mexico all the time.

I found Medicare A+B and Medex Blue Cross Blue Shileld Bronze Rx Plan, plus Medicare Extra is the best for me. They pay for everything for me. Medex Bronze a little pricey but not bad. Covers RX everything except $3.20.

Although they will not pay for supplements.

Chickie, I can tell you were to get supplements at decent prices, all supplements are clean, no fillers or crap.

Funny, Chicky was a nickname that stuck with me forever. 🙂

[Chickie in reply to SunnyXXOO]

Thanks for your reply.

[EileenUSA]

Hi,

First, I'm sure the adjustments for you are many after 33 years. I hope you have good supports around you. Big hug.

I'm on Medicare and I understand your concerns-- there is SO much info coming at you- it's overwhelming.

Couple things - how long have you been dx'd with PBC

and are you responding to URSO?

Here's what I considered when choosing a supplement- I absolutely want to choose the doctors I want (don't want choice restrictions or out of network situation with specialists). Also with PBC I've needed MRI, biopsy, other imaging tests- so don't want to be hit with high out of pockets-

And with my Rx coverage , while I'm doing okay with URSO, I considered "what if I need to use Ocaliva"?

The United Health Care rx plan I had last year would not cover Ocaliva. So I have a different Rx plan this year (just in case). My share would still cost me significant $ annually BUT 1/10 of what it would cost without coverage.

I used an insurance consultant- he sells no product so his advice is not swayed by commissions etc. I told him names, location of my specialists, hospitals, drugs I currently take and concerns about new drugs like Ocaliva

He came back with my 3 best options and costs and out of pocket exposures for each so I could make good choices.

He charges hourly fee- best money I ever spent! And will use him every year to decide on my supplemental and Rx plans.

[Chickie in reply to EileenUSA]

Actually, its been nearly 17 years since my diagnosis.

[Chickie]

I am in stage 3. I was diagnosed approximately 10 years ago. Urso seems to be working. I got sick on Ocalvia and had to stop taking it. I have frequent esophageal varices and blood transfusions. I am currently bleeding in my stomach and they are considering TIPS surgery. So, as you can see, I need really hood insurance. I live in a very small town in Illinois but have surgeries, etc. done at Barnes in St. Louis. An insurance consultant is a great idea. I hope I can find one here. Maybe Barnes can help with that. Thanks for your reply.

[cebe in reply to Chickie]

Hi

I live in St Louis and have Coventry

( Atnae now it changed names )

Total Care

This gives me my Primary Doctor at Mercy Hospital and if I need to go to my specialist Dr Bruce Bacon

All I ever need is my primary doctor to do a referral to this doctor or any other doctor or specialist

[EileenUSA]

I'm in Chicago. I will PM you the info for my insurance guy. He can definitely help you! Again, the beauty is that he does not sell any of the plans- so his guidance-info is not influenced by that. Will PM you

[mrspeffer]

Morning...I've had Medicare A and B for over 20 years now. Due to financial constrictions, I chose to roll my Medicare over to an HMO. I use UnitedHealthcare Medicare Complete.

My providers have been very good and with the right primary care physician, I get referrals to top notch specialist. I have had this insurance both in California, and now in Arizona. Monthly premium is very low as well as my co-pays. Good luck in finding the option that fits your needs the best. Be.well

[Chickie in reply to mrspeffer]

Thanks for your response.

[joe4san]

1. An agent is a good idea. I work with a gal in Florida dealing with medicare questions and issues - she has saved me from many potentially bad decisions.

2. If you are just now signing up for Medicare, or have within the last six months, there is an important option that doesn't get much airplay - Medigap Supplemental insurance. Under original Medicare, you cost share on an 80/20 ratio; they pay 80%, you pay 20%. If that's the only coverage you have, any serious health issue is likely to destroy you financially. However, you have a 6 month window (measured out from your date of entry into Medicare), during which you can sign up for a Medigap plan to supplement Medicare, and you can do so regardless of any pre existing condition. IOW, there is no pre existing condition limitation. These plans essentially pay for the 20%.

There are several Medigap plans to consider, paid for via monthly premiums (they are lettered; we have the G plan). Your agent can present them to you and help you decide which is best for you.

3. If you go this route, you have to purchase a separate plan to cover your medications (so-called Medicare Part D). You shop for these during open enrollment each year (starting in November). There are good tools on Medicare.gov which can help you decide which plan you need (again, a good agent can introduce you to the process and help learn how evaluate the various plans and make a good decision). The premiums for these plans vary dramatically base on many variables (e.g. deductibles, and drugs covered), so a good agent's advice and guidance is absolutely essential in terms of moving you in the right direction.

My wife was diagnosed with breast cancer 45 days before her eligibility period (the 6 months window I mentioned) expired; and she is also a PBC patient (diagnosed 1996). We signed her up for a Medigap (F) Plan just in time, thanks to the advice of our Blue Cross rep (a breast cancer survivor; we had a Medicare Advantage plan at the time that would have been useless given what we were facing). At that time, we had never heard of Medigap insurance; hadn't seen a single reference to such a thing in any of the literature sent to us regarding Medicare insurance.

We owe that Blue Cross rep (and the young working people in this country who are subsidizing out healthcare via Medicare) our lives.

[Chickie]

Great information. Thank you