A little help from the old guys in the house🤪😜😄! I’m officially becoming one of you (becoming.... right!!!). Turning 65 in Nov (25th if you’re planning on getting me a little something) and was automatically enrolled in Medicare being on early SS with disability. Going into my 4th year of this shit and have the Cadillac health care for all that time. I had to pay for it the last two years..... that really stung!! Hopping that expense gets mmmmuuuuuccccchhhhh better. I digress!!!
The short question is what is the best (while somewhat affordable) supplements to carry for people in our boat?!! Being inundated with sales pitches left and right and no longer having the ability to sort it all out, I thought I would go to the experts!!! I‘ve got an free advisor coming to the house this week as well, but I’m skeptical that he works for one of the big Co’s. Pretty sure you still get nothing for nothing in this world!!!!
I currently am on 2 x BP and 2 x Cholesterol meds and will assume that Murphy’s law will kick in with my PC..... that is holding in bay (for now) while on my ADT vacation!
Also assuming that the family plan is a thing of the past so the Mrs. will need her own supplements. No health issues there but I want to be covered with her being much older than me (12 days)!! Did you just use the same supplements for your spouse as what you chose for yourselves?!!
THANKS in advance
Jc
Written by
Jimhoy
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I know it is non-intuitive. I talked to an insurance agent specifically about it. An agent that specializes in Medicare Supplemental.
You have to apply to the new plan. They can elect to reject you for preexisting conditions or charge you more. They can do anything they want. And I am not certain how you make sure you keep your old insurance in place as you go shopping for a new policy either.
ACA was never extended to cover medicare unfortunately. They barely got it passed if you remember. And the Repubs blocked every attempt at a technical corrections bill to fix any oversights, which in my opinion this is one of them.
Here is the agent's name. Though I don't think he can help anyone outside of Illinois: Joel Shalin 773/368-6222
He was exceedingly knowledgable. I would encourage anyone in Illinois to use him.
That only applies if you try to switch outside of the 6-month open enrollment period. During open enrollment:
"However, even if you have health problems, during your Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health."
My reading of this is that you get one "6-month Medigap Open Enrollment Period" after "you're first eligible
"
During that one time "Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health."
Otherwise "Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. "
And that would be consistent with what the insurance agent told me.
Now I agree, your reading of it is what it should say. But that is not how I read it, nor what the agent told me. Don't forget that is just a summary of the actual regulations. Perhaps they could have written it more clearly.
If anyone can show me I have it wrong, I would love it. Becuase this is just bad policy. Unfortunately I think that I have it right.
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Buy a policy when you're first eligible
The best time to buy a Medigap policy is during your 6-month Medigap Open Enrollment Period. You generally will get better prices and more choices among policies. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you're 65 and enrolled in Medicare Part B (Medical Insurance), and it can't be changed or repeated. After this enrollment period, you may not be able to buy a Medigap policy. If you're able to buy one, it may cost more due to past or present health problems.
During open enrollment
Medigap insurance companies are generally allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the Medigap policy. However, even if you have health problems, during your Medigap open enrollment period you can buy any policy the company sells for the same price as people with good health.
I don't read what you are saying. It says nothing about first-time purchase. I don't see that anywhere. It just says that there can be no pre-existing condition clause as long as you buy it during any open-enrollment period. Either your agent was wrong, or you misunderstood:
Once again, what Medicare says is this:
"During open enrollment [they do NOT say during the FIRST open enrollment]
"However, even if you have health problems, during your Medigap open enrollment period [again, they do NOT say that it is only during your FIRST open enrollment] you can buy any policy the company sells for the same price as people with good health."
I know this from personal experience because I switched to a different Medigap provider during my second open enrollment. They did not even ask about pre-existing conditions.
"During your 6-month Medigap Open Enrollment Period"
I believe there is only one "6-month Medigap Open Enrollment Period" which occurs are the beginning of your eligibility. If you fail to register then, you end up permanently paying an extra penalty premium for the rest of your life. That is to prevent adverse selection by insureds. That is waiting until they see oncoming medical expenses, and then signing up for the extra expense of Medigap insurance.
Again, I would love it if I were proved wrong. As I would really like to change plans. And if I could, I would do it in a heart beat.
So if anyone can help prove me wrong, I would be grateful.
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Everyone, please note that this discussion is NOT about part D drug coverage which you can change with impunity once a year, with no problem.
"I know this from personal experience because I switched to a different Medigap provider during my second open enrollment. They did not even ask about pre-existing conditions."
hmmm that's enlightening.
Do you remember which plan you switched from and to? I really would like to switch.
You switched your Medicare supplement plan, and no questions asked? That is not in agreement with what I have read. Yes, if no pre-existing conditions. If you switched and no health questions on the app........what company??
My first supplemental plan didn't pay my doctors and pissed them (and me) off. No questions with Anthem. I think I just applied on their online form. No questions about medical history that I can recall.
I wonder if they have a long memory. So far this year I've had over $850,000 in claims with them. I wouldn't be surprised if my file has red or black flags all over it.
Can only share my experience. Was enrolled thru AAPR in United. I use eyedrops for glaucoma and the copays were huge. Switched this year to BC/BS POS with no additional premium and virtually no Co pays. OK for me. You have to read thru those charts and *compare.*. Not pleasant but necessary. Compare your likely expenses. In my case pharmacy co-pays. Good luck.
It gives you maximum flexibility to have a supplemental plan (Part F), but you also need a drug plan (Part D). If you are on this site, I assume you have advanced prostate cancer and you are taking some very expensive drug (like Zytiga). Drugs that are infused or injected by doctors in hospitals are covered as part of your basic Medicare plan). The co-pays on pharmacy-dispensed drugs can set you back up to $6,350 until "catastrophic drug coverage" kicks in. The advantage of a Medicare Advantage Plan (Part C) is that they often include the full cost of the drugs, but they may not have all the drugs you want.
Medicare supplement insurance is different in every state. In your condition you will want Plan F. Go thru the companies that provide Plan F and pick the less expensive.
I have prostate cancer and my wife has MS. We have been on our current plan for 10 years and we are afraid to change. We know of one neighbor who was placed in plan and as the pool shrank her premiums went through the roof. She ended up with kidney failure and could not go to any other company. Pre-X may be out the window but nothing says the insurance providers can't charge you an arm and a leg.
Perhaps this confusion about changing plans and pre-existing conditions could be cleared up by some one, eg me, calling a few of the insurers? On my to-do list!! It can't be that complicated? The ACA provisions SHOULD have applied to Medicare !!!
But in most states, you will not have guaranteed issue access to a Medicare supplemental insurance (Medigap) plan when you leave Medicare Advantage to switch to Original Medicare, although there are some exceptions to this.
You can enroll in a Medigap plan, but you will generally be subject to medical underwriting unless you qualify for a Medigap special enrollment period or guaranteed issue right — which does include some limited situations in which the enrollee is switching from Medicare Advantage to Original Medicare during the trial right period.
But some states have regulations to ensure ongoing access to Medigap plans, outside of the initial Medigap open enrollment period:
New York and Connecticut don’t allow medical underwriting for Medigap plans.
Maine requires Medigap insurers to offer at least Medigap Plan A on a guaranteed-issue basis for at least one month each year.
Massachusetts has an annual window, from February 1 through March 31, when Medigap plans are guaranteed-issue.
Missouri requires Medigap insurers to allow enrollees to switch to the same letter plan from another insurer on a guaranteed-issue basis during a 30-day period each year preceding the anniversary of when the plan was originally purchased (this is known as the state’s “anniversary rule”).
California and Oregon have “birthday rules” that give Medigap enrollees a 30-day window each year (following the enrollee’s birthday), when he or she can switch to any other available Medigap plan that has equal or lesser benefits, without medical underwriting.
Washington state allows Medigap enrollees to switch to another Medigap plan at any time, as long as they’ve had Medigap coverage for at least 90 days. People with Medigap Plan A can only pick another Plan A. But people with Medigap Plans B through N can switch to any other Plan B through N.
and this from Blue Cross........ I don't see anything about any right , other than in the situations outlined below, to switch coverage without underwriting. I hope I'm wrong...some here say I am.... and I will investigate this some more.
Medicare supplement plans don't have annual enrollment periods, so when you apply is very important. If you're new to Medicare or you're losing your current coverage, you may qualify for a Medicare supplement special enrollment period. Sometimes, we call this a guaranteed issue period. It's the best time for you to apply because it guarantees you'll get coverage and you may get a better price. Learn more in When should I apply for a Medicare supplement plan?
Why special enrollment periods matter
When you apply for these plans outside of a special enrollment period, we use medical underwriting to process your application. That means certain factors may affect your monthly premium and whether you're approved.
So, how do you know if you qualify? If any of the situations below apply to you, you're eligible for a special enrollment period.
Are you new to Medicare?
You're eligible for a Medicare supplement special enrollment period if you're age 65 or older and you apply within six months of enrolling in Medicare Part B.
Did you recently lose your employer group coverage?
You're eligible for special enrollment in a Blue Cross Blue Shield of Michigan Medicare Supplement Plan A, Plan C, Plan F or Plan HD-F if you apply within 63 days of your employer canceling your employer group health plan ending. This situation does not apply to Medicare Supplement Plan D, N, G or HD-G.
Did you recently lose your Medicare Advantage coverage?
You're eligible for a Medicare supplement special enrollment period if:
You no longer live in the Medicare Advantage plan's service area.
The organization offering your Medicare Advantage coverage lost certification to sell the plan.
You canceled your Medicare Advantage plan within 12 months of enrolling in Medicare Part A.
For the following situations, you're only eligible for special enrollment for Medicare Supplement Plan A, Plan C, Plan F or Plan HD-F, not Plan D, G, HD-G or N if:
You canceled your Medicare Advantage plan because it violated its contract with you.
You canceled your enrollment in a Medicare supplement plan and enrolled in a Medicare Advantage plan for the first time. Then, you canceled the Medicare Advantage plan within the first 12 months.
Did you recently lose your supplement coverage?
You're only eligible for special enrollment in Medicare Supplement Plan A, Plan C, Plan F or Plan HD-F if:
The organization offering your previous supplement coverage went bankrupt.
You canceled your previous supplement plan because it violated its contract with you.
You canceled your supplement plan for a Medicare Advantage plan for the first time, and within the same year decided you want to switch back to your previous supplement plan.
These situations don't apply to Medicare Supplement Plan D, N, G or HD-G.
I have been on Medicare for 5 years. (As mentioned in the above thread within the 6month original enrollment time frame) I selected a medicare supplemental policy plan G. All my pre-existing conditions were waived. I am now 70 years old and have had multiple mri's, cat scans, steroid injections for degenerative disc disease and spinal stenosis, not to mention my pc that involved the biopsy, surgery etc. Under my plan G I have an annual deductible of $188 dollars. That is the only cost that I have incurred in addition to my monthly premium of $151.43.
I know there are many good supplemental plans and providers out there. I went with Mutual of Omaha and they have been fantastic. Their customer service is excellent and I have had not one problem with them picking up the 20% that Medicare does not cover.
I have changed providers a couple times for my Part D drug plan. Basically during the annual open enrollment period my agent calls me to get an updated list of my meds and she finds the best plan for me.
My husband just signed up for Mutual of Omaha as well. For all the reasons above. We were looking at an Advantage plan but then read if you start out with Advantage it's almost impossible to switch off.
"OLD GUYS "? young punks these days have no respect - 72 here and can still slap a guy around if needed (wink)
So my experience
yes you are inundated with info from the insurance companies - everyone wants your $$$ - you will learn to just pitch the stuff in the recycle bin. It never stops and the amount cranks up as open enrollment season comes up each year.
Check with your local Senior Citizen council to see if they have a non-company connected advisor.
I went with Blue Cross Blue Shield plus the Medicare Rx . When I first started the premiums were just under $200 /m. They are now $ 300/m.
I had a pre-existing condition - they never asked. I have a bunch of medical issues - PCa being only one. They pretty much pay everything. Occasionally there is a glitch and a funky refusal - but it has been easy enough to clear up. The donut hole thing can be expensive but you learn to get the expensive meds refilled with a 3 month supply BEFORE Jan 01.
The MedicareRx likes you to be on generic versions of meds - unless your Dr insists in writing, on the brand name
It is a crazy bullshit system. My advice is don't try and read all the stuff every company sends and I feel lucky that BCBS seems to work for me.
I was living in Thailand when I turned 65 and unbeknownst to me, my estranged wife stopped paying for my Humana policy. Since then I have had two very expensive surgeries, one at Baylor in Dallas and another at UCI. I only have Medicare part A & B and so far I have been thrilled with the paltry amount that I had to contribute as copay. A supplemental policy would have cost me far more than what I have paid.
Hubs just signed up for the Mutual of Omaha Medigap plan G. We looked for hours at the Advantage plans, which have a cheaper monthly premium, but were afraid that you have to go within their network for everything. For PC this seems super scary to me, especially if you want another opinion. For example MD Anderson, who is our cancer treatment center doesn't take any Advantage plans. Ugh. It's all so confusing.
My agent advised against the advantage plan for that reason.
Additionally, they also paid for a genomic test as well as a 2nd opinion from Epstein at Johns Hopkins for my prostate biopsy and subsequent pathology after surgery.
By the way, the premiums have only increased by around $25 a month in 5 years.
My company, Thrivent, offers competitive premiums for Medicare Supplement Plans. All companies in the USA are required to offer the same Med Supp Plans. Give Thrivent a try 800-847-4836 (say health insurance and you will get a live person to assist you).
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