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My MIL only receives SS. She gets about $1842/month. She is currently in the process of trying to sell her home because she cannot afford or maintain it anymore. I believe she is sixty-seven. She lives paycheck to paycheck and barely covers her bills. Once she sells it, although she won't have as many issues, she'll still be living paycheck to paycheck. Her maintenance will be high in the apartments she could move to. She will have some money leftover if she buys an apartment but I can slowly see that savings draining out. Currently she has no savings and we live in a high COLA.
She only has Medicare Part A. She removed Part B but now she is adding it back on because she now has to go to dialysis two times per week. The only way for her to currently do so is to go through the ER at one of the city hospitals. Once she adds on part B, I'm not sure how she'll cover even more of her bills. She gets too much money to qualify for many of the programs that are out there, but I'm not sure if there are more things that I'm not aware of out there.
In addition to this, someone was suggesting that she get a supplemental insurance policy. I'm not sure how she is going to afford this either but my husband tried calling around yesterday and he was being told because she has a preexisting condition (renal failure) they would not give her one. He is having difficulty getting through to anyone about anything.
We really have no idea where to start with all of this.
Are you thinking in terms of qualifying for Medicaid? I don't know how that works for seniors on Medicare. Although I do know it's called "Medi/Medi" (Medicare/Medicaid). Robyn
Are you thinking in terms of qualifying for Medicaid? I don't know how that works for seniors on Medicare. Although I do know it's called "Medi/Medi" (Medicare/Medicaid). Robyn
OP has a history of NY posts, so I was wondering if MIL was located in NY. NYS - because it is a guaranteed issue state - might - repeat might - allow enrollment in a Medigap (albeit with a waiting period) or an Advantage plan outside Initial Open Enrollment. Normally, Advantage isn't possible unless one has had a kidney transplant. But, NYS is different, per this:
Quote:
Originally Posted by Never2L8
From the NYS Dept of Insurance website (bolding mine):
“New York State law and regulation require that any insurer writing Medigap insurance must accept a Medicare enrollee’s application for coverage at any time throughout the year. Insurers may not deny the applicant a Medigap policy or make any premium rate distinctions because of health status, claims experience, medical condition or whether the applicant is receiving health care services.”
“Federal and state law allow Medigap policies to contain up to a six (6) month waiting period before pre-existing conditions are covered. (Federal HIPPA law at 42 USC 300gg). A pre-existing condition is a condition for which medical advice was given or treatment was recommended or received from a physician within six months before the effective date of coverage. However, under New York State regulation (11 NYCRR 52.20), the waiting period may be either reduced or waived entirely, depending upon your individual circumstances. Medigap insurers are required to reduce the waiting period by the number of days that you were covered under some form of "creditable" coverage so long as there were no breaks in coverage of more than 63 calendar days. Coverage is considered "creditable" if it is one of the following types of coverage:
a. A group health plan; b. Health insurance coverage; c. Medicare -- In New York, credit for Medicare coverage is only given if you apply for a Medigap policy before or during the first six months after you turn 65 and are enrolled in Medicare; d. Medicaid; e. CHAMPUS AND TRICARE health care programs for the uniformed military services; f. A medical care program of the Indian Health Service or of a tribal organization; g. A State health benefits risk pool; h. Federal Employees Health Benefits Program; i. A public health plan; j. A health benefit plan issued under the Peace Corps Act; and k. Medicare supplement insurance, Medicare select coverage or Medicare Advantage plan (Medicare HMO Plan).
New York’s Open Enrollment and Portability provisions protect you whether you are Medicare eligible by reason of age or disability. The provisions also apply to Medicare beneficiaries with end stage renal disease. Again, not all of these protections are nationwide. New York's protections are more generous than those required by federal law, which only apply to those who applied for Medigap during their initial open enrollment period (within 6 months of turning age 65 and enrolling in Medicare Part B).
If OP's MIL is in NY or another guaranteed issue state (there are only a few), or not, for that matter, it would behoove them to contact SHIP for guidance.
I'm also wondering about MIL's age. Does she really want to buy a property with something as serious as dialysis/possible transplant looming??? I wouldn't be tying up virtually all of my money that way with such a serious illness and possibly no way to cap the 20% Medicare copays.
Are you thinking in terms of qualifying for Medicaid? I don't know how that works for seniors on Medicare. Although I do know it's called "Medi/Medi" (Medicare/Medicaid). Robyn
Quote:
Originally Posted by Ariadne22
OP has a history of NY posts, so I was wondering if MIL was located in NY. NYS - because it is a guaranteed issue state - might - repeat might - allow enrollment in a Medigap (albeit with a waiting period) or an Advantage plan outside Initial Open Enrollment. Normally, Advantage isn't possible unless one has had a kidney transplant. But, NYS is different, per this:
If OP's MIL is in NY or another guaranteed issue state (there are only a few), or not, for that matter, it would behoove them to contact SHIP for guidance.
I'm also wondering about MIL's age. Does she really want to buy a property with something as serious as dialysis/possible transplant looming??? I wouldn't be tying up virtually all of my money that way with such a serious illness and possibly no way to cap the 20% Medicare copays.
Thank you for your PM Ariadne and yes, you are correct, she is in NYC.
Buying another place will actually be cheaper than renting for her. Because my husband's father and mother were terrible with money, she still has twenty-five years left on her current mortgage, even though she bought the house over thirty years ago. I do not even know how many times they refinanced or did whatever nonsense they did back in the day. When she sells the home, she will pay off the mortgage, buy the apartment and still have money leftover, putting her in a far better financial place than she is currently. Whenever there is an issue in the house, my husband and his brother have to pay for it, which we are tired of doing since we can't even afford a house here and are trying to save for one eventually. Senior housing lists are probably endless here, though my husband might try to put her on one anyway.
She did put in an application for Medicaid but I don't think it will be approved. My husband thinks she has a better shot once she shows them her inevitable medical bills.
I will definitely forward the information you have provided to my husband. Thank you.
Your husband needs to be very aggressive in securing coverage for her. From what I've read on dialysis boards, her monthly Medicare copays and drugs will run, at minimum, over $1k/mo. Frankly, I think that's just scratching the surface. And, then there are drugs. If she has no Medicare Part D, she has another issue. However, Part D can be secured once she knows her medication - but there will be a late-enrollment penalty, similar to Part B. ESRD is serious, and can be hideously expensive over time.
In addition to contacting SHIP, hubby should search out a good medicare insurance broker - and not take no for an answer. Based on NYS website, it appears there should be Medigap coverage available with a six-month waiting period. You can live with six months. Until she has a transplant - not so much.
Also, Medigap prices in NY are all over the map for the same identical policy. In her case, she needs a Medigap G or F - nothing else - or, as a second choice, an Advantage plan if that is doable under NY law. Advantage plans cover drugs and cap annual out-of-pocket costs usually between $5-$8k.
NY website site provides links to the various plans and pricing by zipcode here:
If all else fails, he needs to call NY Insurance Commission Office for clarification on what coverage - and when - your MIl is allowed to secure under NY law. And, also talk to NY social services.
Keep us posted on how you were able to resolve this.
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