Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
I would greatly appreciate guidance to fill the gaps in my lack of knowledge about Medicare Parts B and D. I have wide gaps.
I have a sister who was T-boned by a drunk driver and was left with a TBI (traumatic brain injury) and some other health issues. She is 55 and now lacks the mental capacity to work through the decisions she has to make about Medicare. She did not even know, until end of last year, she was eligible for Medicare and continued to pay in excess of $700/monthly for a non-Medicare health plan under her former employer.
I am no where near 65, so I know little about Medicare. I now have two months to get up to speed on "everything" Medicare to help my sister choose a Part B and Part D plan and get out of her current Advantage plan which has been a disadvantage to her.
Her current Medicare status and plan:
1. Has Part A
2. Has a Part B Advantage plan with an enrollment date of July 1, 2020. She is still within the 6-month window where she can leave the Advantage plan and move to a Medigap plan, with guarantee-issue and no underwriting, which is what she will be doing. She will choose Plan F, which is available to her given her eligibility for Medicare prior to January 1, 2020.
3. Choose a Part D drug plan.
Questions I need guidance on:
1. Best insurance company for her to go with, e.g., Humana, AARP UHC and so on?
2. Best insurance company for Part D?
3. What am I missing for her?
I know (BIG "thank you" to Ariadne22 and your wealth of knowledge) to enroll her into an "issue-age" or "community-rated" plan and to avoid "attained-age" plans.
She lives in California, and I have found only one policy that is not "attained-age," which is the AARP UHC community-plan. I have read the laws in California, so I know she is eligible for guaranteed-issue of the AARP UHC plan and UHC has confirmed that.
My sister does not require much on-going medical related to the collision because there's nothing to be done about her TBI.
Any guidance will be welcomed and greatly appreciated.
^^ Absolutely. Medigaps for under-65 disabled are not available in every state and are expensive when offered.
As an under-65 disabled person, your sister would have Medicare eligibility after she has been officially disabled for two years (i.e., collecting SSDI).
For Part D, use the tool on Medicare.gov to choose the best plan for her, based on the medications she is taking.
For a Medigap, do you know for a fact that AARP UHC offers a community-rated Medigap for under-65 in CA? Medigaps for under-65 are very rare - and very expensive. At least $300/mo., probably higher.
Most under-65 disabled choose an Advantage plan which includes drugs and which have much lower premiums than any Medigap which might be available for the under-65. Of course, there are provider network limitations to Advantage. And, again, her formulary is important, here.
Strongly suggest you consult with the SHIP people in your state for her best options - SHIP can be very helpful to the disabled:
Let us know what you learn. Availability of Medigap for under-65 varies widely by state. Medicare.gov lists many carriers for the under-65 in CA, but I don't trust that data. Medicare.gov is often incomplete and inaccurate in my experience.
Last edited by Ariadne22; 10-08-2020 at 03:34 PM..
Thank you both, flashlight and Ariadne22 for helping with this. And, Ariadne22, I will absolutely pass along what I learn re Medigaps for under 65 in California.
Here's what I've learned so far.
California Insurance Code Article 6, Section 10192.11 makes it compulsory for any insurer (insurance company) to offer a person under 65 the same polices that the insure offers to over 65. The are a few caveats that are not pertinent to my sister's case.
I read that law and spoke with a AARP UHC agent who acknowledged and confirmed the above law and requirements in California. Very helpful and kind woman.
My sister can get the Plan F within 6-months of her initial enrollment in Part B, which was July 1, 2020. The word "enrollment" IS the key term. She is within that time period.
SHIP in California has been of ZERO help. California contracts out SHIP counseling to county non-profit organizations, and none have returned her calls or mine. They all have messages about "going home" related to Covid. I will not rely upon them.
Yes, her monthly premiums will be high, but then again, she was paying over $700/monthly for health insurance before she learned she was eligible for Part B. She doesn't have the mental capacity, at times, to understand.
No, I will not rely on the Medicare.gov website for much anything. I do agree its information tends to be outdated and incomplete.
I'm leaning toward AARP UHC for her as the provider because its plan is community-rated. My sister will be moving to Idaho when I do which will convert her Medigap plan to an issue-age policy, given that Idaho is an issue-age state. Additionally, Idaho requires any insurance company that offers health insurance to residents of Idaho over 65 must also offer the same polices to resident under 65, with an increase of the premium capped at 150%.
My sister's experience with her current Medicare Advantage plan has been and continues to be that of delay, obstruct and impede any reasonable medical, including an annual physical exam. The HMO will not allow that. She happens to be in a Advantage group plan with a large government agency and yet is still faced with denial of even basic medical care. I would not recommend an Advantage plan to anyone.
I will research on and find the best plan I can for Part B and Part D.
^^Well, thanks so much for the detailed update. It appears you've covered all the bases.
Indeed, if she's paying $700 for her current Advantage, the Medigap would be a price improvement - not to mention eliminate the provider network and gatekeeping issues you've encountered thus far.
It angers me no end to continue to read about Advantage delay, obstruct, denial, impede services which are offered without question under Original Medicare. This is not new news by any means. Nonetheless, it is infuriating - and so wrong.
Your sister is fortunate to have to you navigate this for her. Original Medicare + Medigap + Part D is really the best way to go.
^^Well, thanks so much for the detailed update. It appears you've covered all the bases.
Indeed, if she's paying $700 for her current Advantage, the Medigap would be a price improvement - not to mention eliminate the provider network and gatekeeping issues you've encountered thus far.
It angers me no end to continue to read about Advantage delay, obstruct, denial, impede services which are offered without question under Original Medicare. This is not new news by any means. Nonetheless, it is infuriating - and so wrong.
Your sister is fortunate to have to you navigate this for her. Original Medicare + Medigap + Part D is really the best way to go.
You bet, and I will update on CD as I find more information. I hope the information helps others in California.
My sister was paying $700/month plus for a non-Medicare plan, under a group plan, because she did not even know she was eligible for Medicare. Given her TBI, she just didn't understand that. She does now, though.
She pays about $330.00 for her current Advantage PPO group plan and still faces denial of care even with the group oversight by her former employer. That's why I told her I think it's time to let Sis, me, step in and help her figure out better and best Medicare options. She still wants to live a life of independence, and it bothers her she can't figure Medicare out given her struggles re the TBI. But, I'm glad I can help her, or anyone for that matter.
I agree with you, Ariadne22. What these insurance companies appear to be doing to some less-than-knowledgeable people is criminal in my opinion. This experience makes me want to start a website devoted to flow charts that outline up-to-date Medicare information for Part B and Part D for each state so the average bear has a fighting and fair chance at consuming impartial, up-to-date and valid information to help each person make a well-informed decision about which plan is best for him/her.
I have found the insurance brokers I have contacted to all lack the fundamental basics of the California law and simply try to sell you the policies and plans from the "companies they trust." Don't get me started on that subject.
Each under 65 Medigap plan has its own community-rated pool. A 55 y/o pays the same under 65 community rate as a 59 y/o.
Here are the Medigap rates from the CA DOI website. Recent rate changes may not yet be posted. The point is that each under 65 Medigap has one community rate.
Here are the rates from the ID DOI website. Whether she is 55 or 61, she pays the under 65 community rate for that particular plan which is capped at 150%. The concepts of attained-age and issue-age only apply to 65+ Medigaps. When she turns 65, she will be eligible for the age 65 Medigap Open Enrollment Period and lower preferred rate just like everyone else.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.
Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
