MEDICARE INSURANCE

[karen335]

Not sure where to post this question. How does Medicare A & B work with Medigap or supplimental insurance. I have had an HMO for the last 3 yrs and all my medical expenses have been paid through there (HMO, Cobra) It runs out end of the month (April), They called me, insurance. No advance letter or anything.

My question is, how do I do this and make sure I am selecting full coverage. I can't pay a lot out of pocket. What does everyone else on Medicare do, your suggestion and what you have done would be greatly appreciated.

Thanks All,

Blessings and prayers,

Karen

[mamasbabygirl]

I thought Medicare was for older people than yourself. Maybe I am wrong. I'm interested to see what everyone has to say...

How does insurance just run out? I am confused...

[karen335]

It usually is for older people. Once you are Stage IV, you become eligable for Medicare, just like SSD , Stage IV is eligiable for SSD money. My private insurance I had was Cobra from my former employer. It runs out the end of April. 36 months

[cindy0519]

I am sure there are others on here way more knowledgeable about this than I am, but I have done some research on this for my Dad. As I understand it:

Medicare Part A helps pay for hospital bills and Medicare Part B helps pay for doctor bills. You will be required to pay a monthly premium for Part B, however if you recieve SS or SSD this premium will be deducted from your monthly check.

The Medicare health plan choices include:

1.) The Original Medicare Plan, available everywhere in the country.

2.) Medicare + Choice Plans, available in certain parts of the country.

3.) Medicare Managed Care Plans such as:

a) Medicare Health Maintenance Organizations (HMOs)

Medicare Preferred Provider Organizations (PPOs), and

c)Medicare Private Fee-for-Service (PFFS) Plans

If you select to enroll in the traditional Medicare, you may want to have some type of additional coverage to pay for care that Medicare doesn't cover. If you are in a Medicare + Choice plan, such as a Medicare Health Maintenance Organization (HMO), you don't need a Medigap policy, in fact in these instances it is illegal for anyone to sell you a "gap policy".

As if all this isn't confussing enough, you also need to select a prescription plan (Part D). If you are currently on Medicare you must enroll in a Medicare prescription drug plan by May 15, 2006 or you will be subject to higher premiums when you do enroll.

Important things to consider when selecting a plan:

1) What is available in your area and what is important to you?

2) Compare cost, benefits, rules for doctor choice and what each plan offers

Here is a link to the Medicare website's "Medicare Personal Plan Finder", it will walk you through a series of questions aimed at helping you to find the "best plan for you."

http://www.medicare.gov/MPPF/Include/DataSection/Questions/Welcome.asp?version=default&browser=IE%7C6%7CWinXP&language=English&year=2006&defaultstatus=1&pagelist=Home&user=&MPDPF_zip=

Another great source for information on Medicare, Medigap insurance, and Medicare prescription plans is the AARP website. http://www.aarp.org/health/medicare/

I know this is a VERY confusing, we are trying to navigate it too as Dad's insurance through his employer laspes on April 13, 2006. I hope this helps!

[karen335]

Hi Cindy,

Thanks for your help, very much appreciated. Is your father under age 65. It is my understanding that if a person is under age 65 and on Medicare. It alerts the insurance companies that you have a chronic disease. Have you ever heard of this? Thought they couldn't discriminate. This is so confusing, never dealt with insurance before. Very confusing...

[hollyanne]

Hi Karen -

Does your cancer center have a patient advocate who can advise you? My mom was on Medicare A/b with supplemental insurance as well -- everything was covered for her except for Duragesic pain patches. Yet, she was over 65 (if that makes a differece.) i was shocked at how good the Medicare coverage was!

Good luck,

Holly

[cindy0519]

Karen - My Dad is over 65 -- 66 to be exact and he had signed up for Medicare right before he was diagnosed at the age of 65. I have never heard of any ability to "notify" insurance companies of a your having a chronic disease. I too would think this would be discrimatory, except that I do know that the insurance industry has a whole operates under an entirely separate set of laws which regulate that industry, so indeed it may well be standard pratice to assist with insurance fraud prevention. Or at least that is the only logical explanation my brain can muster. I know that if you apply for coverage under a group policy (such as through your spouse's employer) you cannot be denied coverage based on a pre-existing condition. They may have a "maximum benefit" as defined by the plan terms but they cannot deny you coverage.

Holly - you mention that your Mom had both A&B and a Medigap policy and that it covered everything, except her Duragesic patches (which I know are quite an expense for my Dad at $119.00 per 5 patches). Do you know if she had other additional co-pays under A/B with the "gap insurance"? Dad has signed up for Cigna Senior Care (an HMO version of Medicare) and he is being told that as of April 13 when Medicare becomes his primary insurance that he will have a co-pay of $150.00 per CT/MRI/PET scan. As you can well image this will add up very quickly! Wondering if it would be more benifical for him to look into regular A&B with a Medigap insurance. This is why I started researching the plans, trying to decide the best (reach least out of pocket expense) for him.

[karen335]

Thanks Holly and Cindy,

Holly, I have a private onc. for my trefollow ups. There is no advocate for insurance.

Cindy,

I have Cigna Ins. now. I wonder if I can use them as a supplimental ins. and also for prescriptions. I guess I'll have to check with them. Don't have much time.

I am under age 65, but I have part A & B Medicare due to this illness.

Appreciate all your help, if you think of anything else, please post...

Need all the info. I can get.

Hugs,

Karen