Medigap Policies

[Shaks24]

Has anyone had any experience in purchasing medigap or supplemental medicare when under the age of 65 due to ESRD? I think certain states mandate that companies offering these policies to 65 and older must offer them to ESRD applicants under 65 as well. I know this was mandated in Tennessee in 2010. I am just wondering about the cost of purchasing this supplemental coverage to medicare when you buy it under these circumstances. 

[Jean]

Well, that is a good question. I don't know, but I would think that if you can get Medicare due to ESRD, you should be able to get the Medigap also and it should be free. Well, it is here in Ca. I don't know about other states. I will be interested if any one can answer this for you.

[Zach]

In NYS, the Medicare supplemental insurance (Empire Blue Cross/Blue Shield) is about $200 per month.
I believe there are also higher costing plans available that will cover out-of-country dialysis--which Medicare does not cover.

[Shaks24]

From my research there are some 30 states or so that require insurance companies to offer medigap policies to ESRD patients under 65 if they sell medigap policies in the state. If you do not have private insurance to go along with medicare this may be a solution to cover most of the deductibles and 20% copays associated with medicare. Unfortunately the federal government does not have this mandate for all states so it is up to the legislature of each state as to if insurance companies offering medigap to the 65 or older folks must also offer it to ESRD patients under 65. Again the big question for me is what they can charge for it as it looks like each state has different policies on the matter.

[nursey66]

From my experience in MN, you can get some plans as long as you are NOT on dialysis.My hubby got a plan to go with his Medicare ,he had to have his Neph write up a statement to the ins co. that he had a transplant and was not currently on dialysis.He is only 60 , started Medicare due to ESRD, but stayed on due to other disability issues. He was also on my work plan untill I retired and did not have any other ins. ,so I was really worried he wouldn't get a suppliment. The insurance agent is the one who found the plan, and it's a BCBS for only $109 a month. It's a type of Advantage Plan called a Cost Plan. They pick up everything Medicare doesn't pay. He did have to get a part D drug plan as well, that is only $27 a month. Each state is different, the ins people are the ones to contact. I spent hours talking to Medicare, Insurance companies, Social workers ,Social Security, got no answers, untill I contacted an insurance agent that handles Medicare Plans.They are well trained in all the rules for your state.I avoided them at first because I thought all they want to do is sell a plan, but, they really do know how to help, at least ,that was my experience.

[Shaks24]

Thanks for that information nursey66. I think that is where I will hone my search. On medicares website they have a link to state insurance assistance programs that are supposed to help answer these types of questions. I am going to start with a call to the Tennessee number on Monday. If I get the run around I am going to call some local brokers that specialize in medicare. This is a huge thing for me as I have no private coverage and plan to train for home PD to get medicare from the first month. I would like to supplement the medicare to help cover the 20% copays and deductables and other potential costs uncovered by medicare.. The way I see it for myself is that I will need medicare A, B, D and a medigap policy. Then maybe I won't go broke. The big question is what they charge for medigap in Tennessee to ESRD patients under 65. It is hard to find this information online. Hopefully those premiums will be reasonable. 

[jeannea]

You will get Medicare A and B when you sign up for Medicare. Part B costs about $100/month. You will need to purchase Part C and Part D. You can use the search on the Medicare website to find out what is available to you. You are NOT eligible for the Advantage plans if you are under 65 so uncheck that box in your search. Then ask the available plans to send you info and sign up for something. I pay $283.80/month for Part C and another $100/month for Part D but the costs and coverage levels vary. You have to choose what you want. You can get coverage if you are on dialysis. I was on dialysis when I got my plans. No problem with that.

[Shaks24]

So I have done a lot of research on this. Bottom line each state is different. About 30 states force insurers that sell these policies in their respective states to offer them to under 65 year olds with ESRD. In my state of Tennessee they are available by state law but they charge much higher premiums than they charge to folks 65 or older. Just trying to read the rate chart gave me a headache  as you can see here:  http://tnmedicarehelp.com/Images/rates2012.pdf  I think the bottom line is everyone must check out their states laws on this. There is lobbying going on to make the federal government mandate medigap coverage in all states for ESRD patients under 65. Who knows where that will go. For me when the time comes, I will go with the High Deductable  Plan F from Colonial Penn Life with a current yearly premium of 1470 and a yearly deductible of about 2000. This along with medicare A, B and D should cover everything for about 500 a month if you average in the yearly deductible. Of course if you have employer or private insurance along with medicare this issue is probably moot to you.

[Zach]

So I have done a lot of research on this. Bottom line each state is different. About 30 states force insurers that sell these policies in their respective states to offer them to under 65 year olds with ESRD. In my state of Tennessee they are available by state law but they charge much higher premiums than they charge to folks 65 or older. Just trying to read the rate chart gave me a headache  as you can see here:  http://tnmedicarehelp.com/Images/rates2012.pdf  I think the bottom line is everyone must check out their states laws on this. There is lobbying going on to make the federal government mandate medigap coverage in all states for ESRD patients under 65. Who knows where that will go. For me when the time comes, I will go with the High Deductable  Plan F from Colonial Penn Life with a current yearly premium of 1470 and a yearly deductible of about 2000. This along with medicare A, B and D should cover everything for about 500 a month if you average in the yearly deductible. Of course if you have employer or private insurance along with medicare this issue is probably moot to you.

Looks like Blue Cross Blue Shield of TN is better priced at $2,508 for a male nonsmoker or $2,759 for a male smoker.  No?
 

[Shaks24]

I think your looking at Medigap A. I am looking at HDF or High Deductable F cause it offers much more complete coverage after the deductable. Colonial Penn offers it for 1470 a year but it has a 2000 yearly deductable. I have a meeting set up for next monday with a broker to see if this is my best option. Thanks for looking though.

[Marsh]

I live in Florida and I pay $600 a month for Blue Cross.  I also have Medicare and on dialysis.  I've had several hospitalizations and never had to pay out-of-pocket.

[Zach]

I live in Florida and I pay $600 a month for Blue Cross.  I also have Medicare and on dialysis.  I've had several hospitalizations and never had to pay out-of-pocket.

$7,200 per year just for Medicare supplemental insurance?
I guess some States just let these insurance companies rip-off the public.

 

[Jean]

Wonder what Obamacare will do to all of our carefully laid plans??

[Shaks24]

Obamacare will at least enable us to purchase private insurance without any limitation on pre existing conditions. For those of us without private insurance this could be a good thing when coupled with medicare. The big question will be the cost of the premiums for the bronze, silver, gold and platinum plans. What is really decent is that they all have out of pocket maximums and no lifetime limits. It would probably be a good idea to compare this option to a medigap policy. One key point is that we will not likely see all the premiums until October and then these new Obamacare policies will not take effect until January 1, 2014. I found some proposed rates for Tennessee from about 5 or 6 insurance companies and they were a bit pricey.

[Shaks24]

FYI if you are in a state where the feds will be running the exchanges, you can go to the federal HHS website and sign up for updates on Obamacare. You can also go ahead and establish the account that you will use to shop for a policy on the exchange. I did so today just incase I start dialysis after January 1, 2014. Tennessee chose not to run the exchange here so it will be run by the feds. I am looking at all options.

[tigtink]

For those of you who live in Michigan, there is Blue Cross Blue Shield policy called Legacy Medigap for people under age 65 who are already enrolled in Medicare.  The premium is $123 per month and it covers all Part A and Part B deductibles and coinsurance.  They also have a cheaper plan for $40 per month that covers only Part A & B coinsurance.  There are many other companies that offer similar plans for those under 65, but they are allowed to charge much more and require a waiting period.  Blue Cross is the only company in Michigan that is prohibited from charging more for being under 65, and you cannot be denied coverage for age or health reasons.  The plan is open to anyone on Medicare who is a resident of Michigan and not covered by an employer plan.  There is also no waiting period for coverage to begin.  The enrollment application can be found on the Blue Cross Blue Shield of Michigan website.

I just found out about it and enrolled.  For me, it is a lifesaver.  It only takes a few procedures a year to get buried in all the copayments and deductibles.

Debbie

[Shaks24]

Wow Debbie, that is a sweet deal. I imagine if it is a Medicare Advantage Plan they have a provider network. Still if its a good network (which it probably is under BCBS) it is a great deal. I estimated paying for medicare B, medicare D, and the F medigap policy in Tennessee will be about 500 a month. No network limitations though. Good for Michigan for putting their foot down.  Frensenius has a Special Needs Plan that covers Tennessee but I did not like the network. My Neph was not even on it and he refrered me to them.

[tigtink]

It's not an Advantage Plan.  It's a Medigap C plan with no network limitations.  I think it is quite a good deal.

[Shaks24]

That is indeed. It gets confusing sometimes cause Medicare C plans are Advantage plans yet there are Medigap C plans that are supplements. Leave it to government to make it confusing.lol. Actually the Medigap supplements range from A to N  with some letters missing that are discontinued medigap plans. I think F is the most comprehensive. Different insurance companies offer different plan selections in different states for different premiums. Sounds like Michigan is looking out for medicare folks under 65.   

[jeannea]

You may not join an Advantage Plan if you are under 65. I think they also keep you out if you turn 65 while on dialysis. If you start dialysis while already on dialysis I believe they have to keep you but you cannot switch to a different Advantage plan even if yours stops serving your area.

[nursey66]

In Minnesota, we have a BCBS policy called a 'Cost' plan.You must be on Medicare ,but not on dialysis to join. You can sign up any time of the year, and once you are a member, they will cover dialysis if you need it later. They cover all part B expenses  plus any copays from part A ,and the original Medicare covers only part A stuff, like hospitalizations.It is a combination of original Medcare and an advantage plan. My hubby got on it at age 59, when I was going to retire and he needed additional coverage since I would no longer have my work ins. At the time he signed up he had a transplant , he started dialysis 2 months ago. The cost is 109.00 a month , plus he has to pay the original Medicare also,and he has a part D for RX. So far it's working out well .He has had 4 hospitalizations this year alone and they have covered everything !! He spent 27 days in the hospital with aspergillosis, a rare fungle lung infection that is  fatal more often than not !! Thank goodness for the ins, 1 less thing to worry about.

[Shaks24]

You may not join an Advantage Plan if you are under 65. I think they also keep you out if you turn 65 while on dialysis. If you start dialysis while already on dialysis I believe they have to keep you but you cannot switch to a different Advantage plan even if yours stops serving your area.

Actually there are limited numbers of Medicare Advantage Plans that will enroll under 65 with ESRD. They are called Medicare SNP plans or Special Needs Plans. They focus on groups that have a special need of some sort. There does not seem to be many of these but Fresenius actually operates one in my state that focuses on those with ESRD. I looked at the material but found that the network seemed to be limited and my Neph was not listed in the network. If you use out of network services it costs a lot more. Can you guess which dialysis clinics are in network? lol. This one offered some dental and vision benefits as well. Here is a link to it:   http://www.fmchp.com/fmchp/index.htm

[obsidianom]

As a doctor and patient , I hate the Medicare Advantage plans. They are run by profit making insurance companies with many rules and exclusions and controls that Medicare doesnt have . I would never be on one or have my wife on one . We use Medicare and a companion(medigap) plan for her. It is safer as the rules are set by the govt. and a profit making CEO cannot dictate the coverage and exclusions.
I hate dealing with the Advantage plans as a doctor as they all have different rules . They drive me nuts . Medicare is much more straight forward.

[Shaks24]

As a doctor and patient , I hate the Medicare Advantage plans. They are run by profit making insurance companies with many rules and exclusions and controls that Medicare doesnt have . I would never be on one or have my wife on one . We use Medicare and a companion(medigap) plan for her. It is safer as the rules are set by the govt. and a profit making CEO cannot dictate the coverage and exclusions.
I hate dealing with the Advantage plans as a doctor as they all have different rules . They drive me nuts . Medicare is much more straight forward.

That is what my intuition is telling me too. Once I am eligible for Medicare under 65 I will go with Original Medicare A and B along with Prescription D and Medigap F to plug the holes. When you are under 65, expect to pay a much higher rate for your Medigap policy assuming you live in a state that entitles you to buy it. The federal government really needs to step in with regulations on Medigap for ESRD under 65. Currently it is hit or miss in each different state.