Medicare Enhanced Plan or a Supplement

[lawphi]

My husband will exhaust his COBRA coverage next month.  We have looked at the various plans and determined BCBS to be the best bet until my husband finds employment. 

Does anyone have any strong opinions on whether we should purchase a supplement plan or a PPO with RX coverage?  Is a supplement worth the extra cost?  He has been transplanted, but may have to have a preventative biopsy in October. 

Another funny note, he never lost his Medicare coverage when he was transplanted as a child.  I believe he may be grandfathered in.  I would like to preserve that if possible. 

[cariad]

Another funny note, he never lost his Medicare coverage when he was transplanted as a child.  I believe he may be grandfathered in.  I would like to preserve that if possible. 

Was he too unwell? This does not really make sense to me. Has someone paid premiums all this time?

I was off Medicare at exactly 3 years post-transplant, and this has caused me no end of difficulty, not from an insurance standpoint. On my social security record it lists DOD for 1979, which has been widely interpreted to mean 'date of death'. It actually stands for 'date of discharge' as in the date I was taken off Medicare.

That being said, in my experience, anyone on their second or higher transplant should have no trouble keeping Medicare so long as they do not work. Since your husband was on COBRA, I am going to assume he had a job that was too highly-compensated to retain Medicare through disability. Are you suggesting that Medicare would be responsible for 80% of every health procedure he's had since his first transplant? Oooo, that gives me a headache just thinking about trying to unravel such a mess. If his insurance gets even a hint that they should not be responsible for payments, I would not put it past them to chase up reimbursement from 20 years ago. Sorry, I am just really confused how it happened that he was never taken off Medicare. I don't think Medicare laws have changed substantially that he would be operating under any different protocol, so I don't think 'grandfathered in' would come into play. I certainly was not told this from any social worker I spoke to, but Medicare is an endlessly surprising program, (to say the least). 

Insurance is all so different - I would never buy in to part C or D because it requires so much calculation, and a bit of crystal ball consultation, to know which one is the right option. I would go with PPO prescription coverage unless it is outrageously expensive. If you are going for an individual plan, I would be curious to see how that turns out for you both as those are such minefields. Caveat emptor! And best of luck!

[lawphi]

He has always been double insured and the insurance benefits have coordinated since his first transplant in 1995.  His BCBS paid first and medicare picked up the copays and any out of pocket expenses from 1995 until 2010.   After 30 months of dialysis, Medicare began to pay primary and BCBS paid secondary. 

At this point, it looks like his 2011 transplant is only going to cost $69 dollars out of pocket. 

The Medicare PPO plan is not very expensive and is far cheaper than the COBRA coverage.  We have never had out of pocket expenses before and have no idea what to expect. 

A Supplement is several hundred dollars more.  I live in a state with a high risk insurance pool with reasonable coverage, but he would have to give up medicare to qualify. 

[lawphi]

Actually, he does not qualify for the state's high risk pool because he would still be medicare eligible. 

[cariad]

Actually, he does not qualify for the state's high risk pool because he would still be medicare eligible. 

Yes, that happened to me as well. It's bollocks. I assume you do not have access to an employer plan that you could put your husband on?

I still do not understand why he retained Medicare with a successful transplant, but it sounds like there were quite a few extenuating circumstances with his case, and I certainly do not mean to pry. For me, the only time I have co-pays with my insurance and Medicare is with prescriptions. Co-pay amounts should be clearly delineated, and for me it is $25 for some drugs and $10 for others, a few very pricey drugs I have to pay at 30%, but this is the first plan that I've ever seen that provision for. The thing with Medicare prescription coverage, at least my understanding, is that you have to know every last drug you will need through it because plans will only offer a limited selection of drugs, and certain plans will not accept people with certain conditions. ESRD is in its own classification, so when I researched this for myself there were a number of plans that pointedly excluded ESRD. This is not even to mention the gap. lawphi, this is so complicated and the stakes are quite high. I would phone his social worker and try to get some guidance from people who know your situation and are paid to know the plans available in your state. And then, because social workers can be wrong, I would probably get a second opinion on everything as Medicare is going through some massive changes right now.