The new Medicare Drug Plan goes into affect today, November 15th in the U.S. If you are eligible for Medicare, you will need to choose a plan by January 1, 2006. Because there are many plans to choose from, it can be confusing finding the right plan for you.
Here are the questions asked by community members. Read on to see the answers provided by the ThriftyFun community.
My mom is 73 years old and is on Social Security. She's been relying on COBRA as a secondary insurance since my stepdad passed away, but she's going to be losing it in the next month or so. She hasn't chosen a new secondary insurance because she's confused over which one to pick from. She's concerned about the cost of the insurance and the out-of-pocket expenses.
She has a kidney disease, thyroid disease, and fibromyalgia, so she has fairly frequent doctor/specialist visits and blood tests. I don't know if it matters, but she lives in a small town in Arizona that doesn't have a large choice of doctors.
Everyone here has such terrific advice and resources, so I'm hoping that I can get some good suggestions on the best secondary insurance that would be the most cost-effective, along with maybe an explanation of why, so that I can pass it on to her?
Thanks so much ahead of time!
By Judy = Oklahoma from Tulsa, OK
Check and see if there is something called SHIINE in your state. They help senior citizens figure out things like social security and medicare. Or else another place to call would be 211, that is a program called Helpline. I'm not sure about the SHIINE program being nationwide, but the 211 program is nationwide. Helpline is clearing house for all kinds of agencies that can help find sources of help.
She should have got on AARP insurance when she first went on Medicare. She may still be able to do it. The best policy they have is expensive but she will have no deductible whatsoever and the policy will cover Medicare deductible.
You or she should go to Medicare.gov. You can compare the plans that are in her area. There are several carriers that have plans that do not have a monthly premium.
Most states have a program to help seniors. It is called SHIP, which mean "State Health Insurance (assistance) Program. Google SHIP for your state and there will be a number to call to help you.
There are also some insurance businesses that specialize in Medicare coverage (secondary health ins) & they search for the best ins. for you. Also contact your local hospital(s) & ask if they have someone there who can help them choose their secondary medicare health insurance & if they don't, I am sure they will be able to steer you to the appropriate person or state agency. I know PA has "Apprise" which helps seniors with their medicare ins plan choices. I am sure each state must have a similar service if only under a different name. Good luck. Search online "choosing medicare secondary insurance" & check the different links that come up.
from another website: What is the best secondary insurance with medicare? I'm shopping for insurance to go w/my medicare.
In some states such as New York certain areas, usually rural the second care provider is free. You need to get a hold of the Medicare book for 2009 for your state. The books were just mailed out. In the back of the book are a list of free and small copay second providers. This benefit is not income related. It has something to do with the availability of medical care in your area. We are in upstate NY.
Just from experience Humana is a bad deal all around and there is not enough room on here to tell all the reasons. The representative will tell you anything, then after it is too late to change for a year, you find out the truth. AARP rates are quite expensive.
Find an insurance agent that you like and he can direct you. I think the best choices are with Mutual of Omaha, Medico (I'm with them) or the AARP. You will have to join the first year, but do not have to renew the AARP after that.
My brother let my 91-year-old mom's insurance lapse and the cheapest we found for her was AARP. I think it turns out to be around $180 a month for Plan F.
I for one do not know any senior who can afford insurance. I am a disabled senior with the income of 600 a month and can't afford the 95 a month that the AARP insurance costs.
Yes, find a good agent and I've found that AARP is NOT cheaper on any insurance they offer. That goes for auto insurance, life insurance, etc. AARP is the last place you should go to look.
American Pioneer is one. I do not like the bundled packages (HMO's) they for the most part stink! You need to hook up with a knowledgeable agent and they can help you.
Marcia S, you may be eligible for state assistance with your insurance and drug coverage; it would definitely be worth it to check into it.
Caraing, you are correct in that an agent is best because cost of coverage does depend on health issues and type of drugs that are being used.
In our case, according to my agent, the insurance that AARP uses was best for my mom. He has me with Medico and he has my husband with Mutual of Omaha - all because those are the best prices for each of us. I feel like he's doing a pretty good job in doing research for the three of us.
Thanks to everyone for the advice! I had forgotten to mention that my mom lives in a small town without a lot of the resources that were suggested. She also has an old brain injury that makes it difficult for her to understand things sometimes, and she can't deal with much stress. This is what she finally did:
She went through the ins. co. list in the Medicare pamphlet & called one that is supposed to be one of the best (un-named here for a reason). Spoke to a rep & told him what she was looking for & he said 'no problem, we can do that,I'll send you information & application for just what you want'. What she got in the mail was nothing like what she asked for,after she read it, she sat there & cried hysterically (part of her brain injury, she gets emotional & didn't think to call me so I could talk her through it). With great timing, she got a phone call from a rep with that insurance, to 'follow up' & see if she was satisfied, little did he know what he was getting himself into, LOL!
Between anger & tears, she told him why she was not happy with what they'd sent her, she also explained her injury. He was able to calm her down, reassure her they had a policy she wanted & made arrangements to drive up to her town to speak to her personally about it a week later. They arranged to meet at a cafe & she was going take her cousin, to go over it & help her understand. So, when they met, the ins. rep. had a "friend" with him, who sat & listened to the presentation of what policies they had available. Then this "friend" was introduced as an agent from another ins. agency who wanted to show her what his company had to offer.
Turns out "Ins. B" had the same policy at a lower price than "Ins. A", my mom got exactly what she wanted, at a lower cost to her!! The agent from the 1st company went above & beyond in trying to help my mom get what she needed without stressing out. He told her that when he 1st started out in the business, his old boss told him that no matter what, he needed to remember to always think about the client & what was better for them, to put their needs above everything. He certainly did that when he brought an agent from a rival agency to talk to her and that's why no names are mentioned! I think I would have signed with him for that reason alone, even if it was a bit more!
I recently requested info about Medicare supplemental plans. Thanks for the replies I received so far. However, I am still wondering if anyone can explain something called medicare advantage plans, and how they work? I have to choose either a Medigap plan, or a Medicare Advantage plan along with Medicare A and B. I just need some detailed information about Medigap versus the Medicare Advantage plan.
I have a few months before I am eligible, but I am trying to do the research now, since it is so complicated. I cannot go to medicare.gov site because I am not 65 yet, and to get the info on that site you have to put in your birth date, etc. Thanks for any information anyone can provide.Medigap plans (or Medicare Supplement plans) supplement both Parts A and B. They usually cost on average $100, and now do not include drug coverage. (some of them used to). With supplement plans, you can go to any doctor and don't need referrals or anything like that. The Medicare Advantage plans are a fancy name for the HMOs you see. They usually have very little if any, monthly premium. They can include drug coverage. If you don't mind the HMO, then it's the cheaper way to go. If you prefer freedom, than you'd probably like the Supplement plan better. With the supplement plan, your still going to have to decide on a drug plan.
Try http://www.medicare.gov again. You don't have to enter any personal info to get answers to general questions. I just tried it again. I clicked on the question "what is medicare advantage?" or something like that. The one where you put in your personal info would still work too. They don't keep the info. It's just for calculations. So you could lie about your birthdate. But you really don't need to. Sometimes it takes a few tries to navigate a large website like that. The next problem is understanding their answers.hehe. I am 68 and still sort of hoping I have made the right choices.
Medicare Advantage is the managed care option for your Medicare benefit, rather than the traditional fee-for-service benefit (where you go to any doctor and they bill Medicare directly on your behalf for each service they provide.) Medigap is supplemental insurance over and above your traditional Medicare. Part D is the new drug benefit- you can get that either from a stand-alone drug plan or through a managed care organization. You don't have to be 65 to visit the website, www.medicare.gov, and you can get a lot of info there. I know it seems overwhelming, but if you visit the website and maybe call the local SHIP, you should be able to figure out what you want to do when you are eligible. Good for you for thinking ahead!
I have just done all the research for my mother in-law and we decided to go with the medicare advantage plan. The medigap plans were much more expensive. The main thing to look for in the medicare advantage plans is if your doctors take the plans (you need to call them). Also, if you are taking perscription medications - whether they are covered or not. We checked on every perscription before applying to be sure each was covered. Most of the Advantage Plans have a "gap" or "donut hole". This means that you are responsible for paying the full price of the medications once the cost goes over a certain dollar amount (usually $2,510). Some of the new plans (Anthem BCBS) will cover select generics even during the gap - which is a very important thing if you take a lot of meds. Just check on each medication to be sure it is covered during the gap.
Some of the information shown here is inaccurate. Advantage plans may be comprised of an HMO but that is not a given at all.
If you have 40 quarters into social security, or have a spouse who has 40 quarters into social security you are entitled to part A of Medicare. Part A is your inpatient and hospitalization portion. Part b is your outpatient and diagnostic test portion (doctors, blood tests, etc.). For 2009 the cost for part B is $96.40/month. If you are collecting, or will be collecting social security when you turn 65 then this amount will be deducted directly from social security. If you will not be collecting by the time you turn 65 then Medicare will bill you quarterly.
A medicare supplement fills in the holes and gaps of medicare (deductibles, copays, etc.) that parts a & b don't pay.
Medicare Advantage (also called Medicare Part C) is an alternative to a supplement. Medicare advantage are not supplements.
When you elect to go the route of an MA then you are dis enrolled from Medicare and you are in a Private company policy that must, at a minimum, must give you the same benefits as if you were still under parts a & b of medicare.
There are pros and cons. With supplements you have a premium, with MA you may not have a monthly premium. The 96.40 that comes out of your social security goes to the private company that you have your MA thought instead of to Medicare.
With supplements you don't have a network or referrals or need to name a primary care physician. with an MA you may or may not have to name a primary care physician or may or may not need referrals.
There are also more copays and deductables with an MA. Also, they are usually HMO's but you can get an PPO.
Supplements have a greater number of physicians tht accept them than accept the MA plan. Also, supplements are federal so they are good everywhere. MA's are only good within your local coverage area (generally).
Also, you can get a medicare part D plan as part of your plan where as supplements do not include prescription coverage (unless as an inpatient).
The questions you need to ask yourself are generally:
what is my present health condition?
any family history of illness or disease run in my family?
Is choice of physicians important to me?
Do I plan to travel or move?
The premum for supplemental plans average $200 a month now. Advantage plans or Part C plans are supplemented by the government with what are called capitation rates. The minimum for 2010 is Toto Guam which is $443.37 per month and the maximum is $1361.16 in Issaquena Mississippi. The average for all counties in all states is $785.85. This is one of the reasons why the government wants to get rid of advantage plans.
I am 60 years (Dec.) and would like to get a better understanding on my options before the time to make changes to my BCBS/FEHB Standard Self +1 being my secondary insurances and Medicare being my primary and which of the other options best fits me. What is offered in Medicare Advantage, (Part C), Prescription Drug Coverage (Part D), Medicare Supplement Medigap) and
I have no major health issue as of yet (husband 56 and self (60). Both have ongoing medications costing approximately $75.00 every six months. I do understand it is sometime to think about now is better. Also do they send a letter to suggest making changes and if not do I have to remember notify them June 2024 or 3 months before (Sep 2024) and the grace period will end after Mar 2025. There is conflicting information, 6 months before my 65 birthday or 3 months before my birthday and no later after my birthday 3 months. Will my 80% coverage be lower as told 20% for Medicare?
Having worked in the health insurance industry for many years, I have the following recommendations:
1. Things change so often, that your best plan is to keep an eye on the Medicare.gov site and the FEHB sites.
2. Keep track of your medical bills in a simple spreadsheet, following the benefit offerings...for example, number of PCP visits each year, what it costs each year, your deductibles, etc. Do this for all of your labs, specialists, hospitalizations, durable medical etc. I have a spreadsheet developed I can share with you if you would like.
3. Keep this data for every year for you and your spouse then when you move from plan to plan or phase to phase, you can easily see what plan will be the best option for you.
4. You can use this calculator to figure out when your open enrollment will be for when you turn 65.
Post back if you need more info. Wishing you all the best. Insurance is a crazy road to navigate, but there are lots of resources out there to help you.
Find a good trustworthy insurance broker. He/she can give you information that can guide you through the process. He/she will get a commission, but in most states their license to sell binds them to a code of conduct that is to give you all information and not steer you to one program or another. This is for brokers NOT affiliated with one company of course...if the person is affiliated with an insurance plan, they will state you that way. You need an independent broker.
I believe it would be difficult to add to anything that Pghgirl has added as she seems to have covered all the bases.
I agree that insurance changes over the years (including Medicare) could affect your present needs as well as your health condition now and in the future before it is time for you to sign up with Medicare.
You do not mention your husband's age but is it possible he will be signing up for Medicare before you are eligible? If that is the case then you will probably need the answer to your question about Medicare plans before you are eligible.
Here is a link to an independent Medicare agent that has information on obtaining the information you are looking for. There is no cost for their service - it is free and they are very good but there may be others that can help you find the best solution.
With Medicare, once you are signed up, you can usually make changes to your Medicare plan once a year (in November/December) so you are not locked in to one plan forever.
You do not say how you became a Blue Cross member but if it is work related, you may also be able to acquire some information from your representative at your work place (or former work place) but unless they are a true Blue Cross "expert" I would not place all of my decisions on their recommendations. One of your main decisions with Blue Cross is to be sure you have a big reductions in premiums as Medicare will be your primary insurance.
This does mean that BC will be paying your yearly deductibles with Medicare which are climbing every year. BC will also be paying the difference in what Medicare pays (80%) so you should not have to pay those charges (as long as you go to a doctor that takes Medicare (and this is changing all the time as some doctors no longer take Medicare/Medicaid). This is what your BC insurance premium will be paying. BC may also have a better plan for prescriptions and that is one of the reasons you need an insurance broker.
There is no harm in checking some of these things before you are eligible, especially if your husband will be on Medicare earlier than you as this could also affect your BC monthly premium.
I am a federal government retiree and continued using Blue Cross Blue Shield Standard + One. My husband is a government contractor and he was born 1962. (56 todate)
I know a lot of people use the AARP as their secondary insurance. It is affordable and good.
Sorry, I missed your husbands age in your first message.
This means you will be signing up for Medicare first.
Being a government retiree myself, I would really like to urge you to continue your research even though you cannot sign up for Medicare until you are 65 years old.
Be sure to do a lot of research on secondary insurance - such as your BCBS - before you make any changes. There are sometimes pitfalls that occur when changing health insurance within "so many" (?) years before retirement.
Government BCBS is probably one of the very best available so when you compare be sure you do not make a change just because one policy has a minor "perk" (such as free or reduced rates to a health club) that another does not.
There are comparison programs you can use but I have not checked those out lately.
I do know a big difference in some policies is coverage of rehab services and extended stay in a rehab facility. Medicare only covers extended stay for a certain number of days (was 21 days but this changes) and as you age this can turn into a major expense (although this may sound out of the question to you right now). I know some who made the wrong decision with their choice of plans and sadly had their entire savings wiped out due to an accident that sent them to a rehab facility.
It always makes me feel good to see someone trying to obtain important information before they have to make final decisions.
Good luck to you and your husband in all your future endeavors and stay healthy.
