Living in a senior community

[Robyn55]

You wrote - I am eligible for Medicare next year - and said you were currently receiving Social Security - so I assumed you were 63. Normal Medicare age is 65. Perhaps there is a program for getting Medicare at age 62 - but I'm not aware of it. Robyn

P.S. Are you talking about Medicare disability as opposed to regular Medicare? If so - that has its limitations.

[jenny1951]

Yes, I am. I receive SSDI (Social Security Disability Income) and was told that in two years from when I first became eligible, I would then become eligible for Medicare. That would be next May. Is SSDI Medicare different in some way from regular Medicare?

[Robyn55]

I'm not an expert in the area. I know that one major difference relates to the availability/price of Medigap policies:

Medigap Disability Insurance Eligibility with Social Security Disability [can't vouch for the accuracy of the article]

I think you'd be allowed to participate in a Medicare Advantage plan. But many providers don't accept Medicare Advantage patients (none of mine do). I would think in general that the less affluent the area where you live - the more providers you'll find who accept Medicare Advantage patients. But I could be wrong.

Also - most MA plans are HMOs that may have a limited number of "in-network" providers - especially when it comes to specialists. The only medical problem you mentioned was RA (so I'll assume that is your most serious medical condition - perhaps it isn't - but you'll get the general idea how to approach things). If you have bad RA - you'll need/want a rheumatologist. So you'll want to explore if a particular MA plan has any rheumatologists in network (it is in general very hard to find any rheumatologists - there are only about 5-6 in my metro area of 1 million+ - and 2-3 aren't accepting any new patients).

If you have bad RA - you will also want to explore your drug options in terms of coverage. Either through a MA plan - a Part D Medicare plan - a low income drug assistance program - etc. I know that drugs like Enbrel (end of the line RA drugs for severe cases that haven't responded to other drugs) are far from cheap.

It is something you'll have to explore where you live now - and also every place you might consider moving. Note that there are insurance agents who specialize in this kind of thing - and it won't cost you anything to use one. The one we have used is pretty good IMO. Robyn

[jenny1951]

Thanks for all the infomation. I couldn't afford any Medicare Advantage plan anyway, so I guess it won't much matter where I wind up. What a sad state of affairs, that every little move in life is based upon health care, or lack thereof.

Lucky for me I do have a great rheumatologist right here but I will need to find out if she will still see me when I am on Medicare!

[Robyn55]

Medicare Advantage is usually the cheapest way to go if you're on Medicare - so I don't understand why you say you can't afford any MA plan. Unless there is something that's peculiar about Vermont in that regard. People move to various places or stay put for all kinds of reasons. From jobs - to school systems for their kids - to the cost of living - to health care. As I age - I've become happier with where I live - because our local health care system has gone from so-so to excellent.

Note that if you're low income - you might be dual eligible for Medicaid/Medicare. That is a can of worms that I read about - but don't know a whole lot about from a practical POV. The Supreme Court will be hearing oral arguments on Obamacare next week - and should issue an opinion by June. One of the big issues to be addressed is the new Medicaid requirements in Obamacare. So if I were eligible for Medicaid (with or without Medicare) - I'd wait until the Supreme Court rules before doing anything major. Robyn

[jenny1951]

Originally Posted by Robyn55

I'm not an expert in the area. I know that one major difference relates to the availability/price of Medigap policies:

Medigap Disability Insurance Eligibility with Social Security Disability [can't vouch for the accuracy of the article]

I think you'd be allowed to participate in a Medicare Advantage plan. But many providers don't accept Medicare Advantage patients (none of mine do). I would think in general that the less affluent the area where you live - the more providers you'll find who accept Medicare Advantage patients. But I could be wrong.

Also - most MA plans are HMOs that may have a limited number of "in-network" providers - especially when it comes to specialists. The only medical problem you mentioned was RA (so I'll assume that is your most serious medical condition - perhaps it isn't - but you'll get the general idea how to approach things). If you have bad RA - you'll need/want a rheumatologist. So you'll want to explore if a particular MA plan has any rheumatologists in network (it is in general very hard to find any rheumatologists - there are only about 5-6 in my metro area of 1 million+ - and 2-3 aren't accepting any new patients).

If you have bad RA - you will also want to explore your drug options in terms of coverage. Either through a MA plan - a Part D Medicare plan - a low income drug assistance program - etc. I know that drugs like Enbrel (end of the line RA drugs for severe cases that haven't responded to other drugs) are far from cheap.

It is something you'll have to explore where you live now - and also every place you might consider moving. Note that there are insurance agents who specialize in this kind of thing - and it won't cost you anything to use one. The one we have used is pretty good IMO. Robyn

I am pretty confused about the Medicare Advantage. I thought it was some sort of supplemental plan that you bought to enhance your Medicare coverage. My mom has a very good supplemental plan, but it sounds like you are talking about something that is part of Medicare? I am really going to have to educate myself on Medicare before next year.

[Robyn55]

Originally Posted by jenny1951

I am pretty confused about the Medicare Advantage. I thought it was some sort of supplemental plan that you bought to enhance your Medicare coverage. My mom has a very good supplemental plan, but it sounds like you are talking about something that is part of Medicare? I am really going to have to educate myself on Medicare before next year.

Sounds like you are really confused about Medicare Advantage. I suggest reading about it - and then starting a new thread with regard to any questions you have about it. Robyn