question about Medicare

[grasswire]

I'm working through Medicare issues with an older relative just eligible this summer, and can't seem to find an answer to this question: Can a medigap plan or a supplemental plan refuse to cover a preexisting condition?

What should we know about differences between the two?

[elfin]

1. First check with whatever company they were with before

if any ---- I had no problem sticking with the gap policy provided by my previous main provider - UHC.

Second - or even first -- call Medicare - even though it is a bit of voice mail hell -- they are very helpful - as is Social Security for those related questions as of last year.

Make sure they sign up with Plan B which comes out of their Social Security - the gap policies kick in AFTER the Plan B.

Good luck - it shouldn't be too bad unless they were never covered in the first place - then Medicare SHOULD point you in the right direction.

[napi21]

2. My husband is in a similar position as your relative.

I suggest you make an appointment to meet with a rep. at the SS office. tried to check everything online myself too, but there's just too many things that can't be answered that way. The guy at the SS that we met with last week was VERY KNOWLEDGEABLE...and yes I was shocked by that.

i can tell you what little I did find out. My husband will be 65 in Sept. and he has to continue to work until January 09 BECAUSE I won't be eligible for medicare until then, and we can' afford for him to retire and also pay for a private ins. policy for me. He MUST sign up for Medicare Part A NOW (2-3 months before he turns 65) because if he doesn not, the BCBS policy he has through work will refuse to pay ANY bills and of course so would Medicae! Seems it creates quite a mess, so make sure your relative signs up at least for that! Oh, and if your relative does continue to work, and has ins. coverage, there is NO CHARGE for Medicare Part A.

We were also told that he can sign up for SS benefts as soon as he's reached full benefit status (age 65 + 10 months) and collect SS & his paycheck without any penalty as long as he earned less than $35,500 between Jan. & July.

For what it's worth, we made our appointment for a Tuesday and we were in and out of the SS office in less than 15 minutes!

Really, your best bet is to make an appointment and ask the rep. there all your qauestions. GL!

[grasswire]

5. thanks for your input! (eom)

[charlyvi]

6. Why were you shocked by that? n/t

[napi21]

7. Well, I swear I've heard a million time about how many problems

people have when they try toget info from the SS dept. THEN, I called the 800# on the SS summary report my husband received to find our what we had to do to sign up for Medicare, and I got some (I'll be kind) far less than capable person attempt to explain some things to me. She set up a telephone appointment for m husband for this past Monday at 2:00PM at out home. The phone rang at NOON and the gentleman said he was XXXXX from the SS office here in Ga. and he needed to speak to Mr. XXXX. I said "OH, I didn't expect your call until 2!" He told me that the person wet up the appoint had done quite a few things wrong! Fortunately, my husband was here at noon, and all went fine after that.

BTW, when I told the SS rep that our ins. had said if we didn't have that Medicare # BEFORE my husband turned 65, BCBS has a flag that triggers a stop on an payment requests, he said "yes, and of course Medicare would also refuse to pay any of the bills, and you end up with a mess that is extremely difficult to get resolved!"

[charlyvi]

8. A million times?

Are you sure, or are you dealing in hyperbole? Local offices call early on leads if they have an opening in their schedule, then if the claimant asks why, they say the 800 number operator slotted the wrong time. I know this for a fact. After all, the 800 number operator has no way of disclaiming this.

Social Security employees are highly trained, efficient and hard working employees. If you got a bad apple, sorry, but they are few and far between. They work very hard, as you can tell by the constant foot traffic in the district offices. And for millions of checks sent like clockwork, Medicare questions being answered correctly and efficiently, rendering a complex and intricate program understandable to the general public, they are too often met with the flippant Reaganesque attitude of government employee = imcompetnet fool. It's unfair and terribly incorrect. And many times "bad service" translates into a claimant hearing what they don't want to hear. I also know this for a fact.

[petersjo02]

3. I'm from Iowa

In Iowa that law is that the supplement provider MUST provide coverage, without consideration for pre-existing conditions, if you sign up within first six months after turning 65. I suspect that it is the same in other states, but I don't know that for sure. I turned 65 last December, so went on Medicare Parts A and B as of December 1, 2006. I was able to sign up through the mail because Medicare sent me all necessary forms--not complicated at all. Also was able to sign up for my supplemental through Wellmark BC/BS online 60 days before my birthday. The premiums are regulated. Altogether I pay just over $100/month for Medicare, which is deducted from my Social Security payment each month. My Wellmark BC/BS supplement is also just over $100/month and is deducted from my checking account each month.

Just FYI, I had to have special high risk health insurance sponsored by state of Iowa the last 18 months before I turned 65 (was on COBRA from work before that) because I had a history of two heart attacks in my early 50s. I paid over $10,000 for health insurance premiums for that last 18 months before Medicare + supplement and it was only catastrophic coverage at that. Really hurt my pocketbook but I had no choice. When I applied for the BC/BS Medicare supplement, by law I didn't have to fill out any information about pre-existing conditions. If I'd waited for more than six months, for some reason, pre-existing conditions would have been a factor and I would have had to pay a higher premium or be refused service for a long period of time.

You should be able to find information about supplemental insurance in your state on line or call a local BC/BS provider. In Iowa, at least, they provide the best converage for the lowest premium. My husband has been on the Medicare + BC/BS supplement for over 5 years and has yet to pay one cent out of pocket for his care during that time (including brain surgery).

Another thought: in order to get the supplemental at age 65 without filling out health history form, applicant must have had health insurance coverage within a 60-day period before turning 65. In other words, can't go directly from no insurance to Medicare supplement unless you've had previous coverage of some sort within 60 days before turning 65.

We DID NOT sign up for Part D. We go to Mexico each winter and also sent scripts to Canadian pharmacy on line. MUCH better prices than you can get with Part D. We may sign up if that program ever gets straightened out and Medicare can get competitive bids from pharmaceuticals for drugs. If you don't have access to Mexico or Canada drugs, talk to a trusted pharmacist to find out if there is a plan to will be helpful.

Please PM me if you have any questions or this information doesn't seem clear to you.

jp

[grasswire]

4. ah, this is interesting

The person has not had health coverage for about ten years. So you think he would not be allowed to go directly to a supplemental in that case? This is precisely what I was wondering about.

There are no apparent significant health issues that would be disclosed on a questionnaire, simply because the person hasn't been seen for a couple of things that he intends to seek attention for under Medicare -- some heel pain and bunions, and a cardiac evaluation simply because there's an old murmur and family history.

And part D is a no-go for this person. His monthly bill for meds is $23.

[petersjo02]

9. Well, I'm not so sure about what happens in this case

I just found some info on the State of Iowa Insurance Dep't page. It says plainly that one cannot be turned down for a Medicare supplement policy if the application is made within 6 months of applicant turning 65. You apparently do have to fill out a form consisting of yes-no questions to apply for supplement. I can't find anything definite on that 60 day thing, and I've spent some time searching. All Medicare supplement providers have to provide the same set of about 12 policies with a range of coverage available at different premiums. We signed up for Plan F, which has left us with not a dime of out-of-pocket expenses except for drugs. Main difference between different insurance companies will be cost of premium and customer service issues. Sounds like he's in good shape for drug costs. With no recent big health problems, it shouldn't be a problem for him at all. Find the provider he wants to go with and start the app process on line. If he's on Social Security, he'll get forms to sign up for Parts A and B in the mail. If going on Social Security for first time, then he'll have to go to SS office and sign up for both SS and Medicare. Was quick and easy for both of us. Check your state government's Web site for the Insurance Commission. I'm sure they'll have information on there or booklets of info you can order. Ours also offers a pre-Medicare check list of things to do to get enrolled. The supplement premium will be no higher for someone with a pre-existing condition than a person without. The premiums are regulated.

FYI, I have the heel pain thing myself and only recently went to a podiatrist. She gave me a foot brace thing to wear at night, and after the very first night, I had about 75% relief from the pain I'd suffered with for probably five years. The office visit and foot brace, which is very comfortable, didn't cost all that much in the scheme of things, so I wish I'd gone sooner and gotten relief sooner.

Good luck with the sign-up. It isn't as bad as people claim. A local insurance agent could help you also, if you don't want to sign up on line. From my experience, stick with the Blues. They've taken real good care of us.

P.S.: You know, I'm embarrassed to admit this, but now that I think about it, I think the 60 day thing was when I switched from my COBRA insurance to the high risk insurance I had to go on for 18 months pre-age 65. It just came to me now. Sorry about the confusion.

[grasswire]

10. thanks for all the info

The thing with the supplement as opposed to medigap is that your choice of physician is restricted, I think. And maybe there are problems getting to see a specialist.

They sure could have made things easier for the consumer instead of what seems to be deliberately confusing so as to benefit the big insurance companies.

[pinto]

11. Don't know about supplementals, but Medicare ought to cover

*any* medical condition. One option is to suggest your family member request "assignment" from all health care providers. That means they agree to take the Medicare payment as is.

i.e The provider has a usual charge for a procedure of $1,000. Medicare sets the reimbursement at $700, pays 80% of it - $560 - leaving a possible charge of $140 to the Medicare recipient, or, in a worst case scenario, $440.

In my experience, most providers will accept assignment, write off the difference or request a small co-payment in addition to Medicare.

I'm not a fan of supplemental insurance plans for Medicare. I don't think they pay out enough to justify the premiums. Just a personal opinion, though. Encourage you to get more professional opinions than mine. :hi:

[grasswire]

12. really!

The more I read the more convinced I am that deliberate efforts were made to confuse seniors regarding Medicare options. It's outrageous, really.

[FooFootheSnoo]

13. I hope I can help

Medigap and supplements are the same things. Everyone has a "Medigap" open enrollment period for the first 6 months after they turn 65. During that time no insurance company can refuse to cover you. They may be able to deny coverage on preexisting conditions for up to 6 months. Furthermore, they have to issue policies at "preferred" rates rather than "standard". There are other situations when you have "guaranteed issue rights". These situations are things like loss of group coverage, your old supplement company goes out of business, etc. Here is a pretty good guide from Medicare on supplements and how to choose: http://www.medicare.gov/Publications/Pubs/pdf/02110.pdf

Information on Medigap open enrollment is on pages 12-13 and guaranteed issue rights information is on 17-18.

Also, the plans are standardized from Plan A to Plan L. The coverage on each plan is the same in all companies. For instance, Plan A with blue cross and blue shield will be the exact same coverage as Plan A with Aetna. The main things that are going to change is the name of the company,that company's customer service and the premium.

I just recently quit a job where I sold these kinds of plans. I quit because I couldn't stomach pushing the elderly into plans they didn't understand. But, I will be happy to use my limited knowledge to help anyone if I can.