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Originally Posted by southkakkatlantan
I'm 44 but my mom turns 65 in 3 months and 1 week.
I'll be helping her apply for her Medicare coverage.
I'm still researching options but I can say off the bat I really prefer she have as much flexibility as possible. She's one year post stroke and prior to that event she never had any established PCP or care team ever. So it's highly possible she may go through a 'trial and error' period of docs for a bit as we find who to establish future care with.
I'm currently thinking Part A/B + D + G.
I know no one individual can advise me as to exactly what to do, but any tips on how to select the right plan for her?
Of note, she is pending both Medicaid and disability fyi which I do (prayerfully) believe she will eventually get.
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You're smart to have made a thread for advice because leaving it until it's time to pick can leave you frazzled, trying to understand everything.
Those not familiar with your mom's health issues can see your two threads in caregiving. It still blows my mind that she has not been approved for medicaid in all of this time. I believe May was one year, you're not quite one and a half years since her stroke when you originally filed for them. She should have been approved at least for medicaid as she had no income what so ever. Thankfully the nursing home has been getting her care covered.
I've been researching medigap plans since before COVID for my hub who had no coverage from his main employer. When COVID happened, he lost that job (delivering new cars) as there was no work, he officially retired a little over a year ago. He got a job with Sam's club who eventually qualified him for insurance benefits so now thankfully he doesn't need the medigap yet.
As was mentioned, if your mom has medicaid, that will end up being the main coverage. I'm not sure if you can start researching the plans offered in your state. I just did a quick google search,
South Carolina medicaid providers, one of the first results that are in bold under People also ask,
What are the different types of Medicaid in South Carolina?; There are five South Carolina Medicaid plans, all of which are very similar. Plans are Absolute Total Care, Healthy Blue by BlueChoice of SC, First Choice by Select Health of South Carolina, WellCare, and Molina Healthcare of SC. Specialized services: Alcohol and drug abuse. The results are my first link below.
As was mentioned, you would need a part D drug plan. You'd have to go on the medicare site, don't log in, add her meds, then look through them. You can only plan so much, it's very possible her meds could change, then you do not know if they even cover it. I normally help my older friend, this is the one I've mentioned in your mom's thread who also had a stroke after your mom. Her hub is on various meds, one being Oxycontin which normally two companies cover until recently when only Aetna offers a plan with coverage. Not only is there only one company, you'd think they cover a generic drug but for this med, they only cover the brand. So keep that in mind when searching moms drug list, they may only cover a generic, but they also may only cover a brand. With oxycontin, I know when scanning over the results because it is normally about $1,000 a month out of pocket so if I see the cost per year is over $12,000; I know they do not cover the med, so I have to go back and change from generic to brand, then redo the search. Best tip I can tell you is if you do find a med that no one seems to cover, just open the search in another browser if you have two, only enter the one drug so you can easily see.
3 years ago I had a plan by Clear Spring, health value RX at $28 per month. They were fairly new, so I was on my own, not having input on how good they were. The were wonderful until month 4 came around when they decided not to cover a med when filled on day 28, it would be day 29 or 30 which was a pain because my doctor appointment always fell on day 28. I had to use the local pharmacy in the same building which was 40 minute from home. I then had to make a second trip to pick it up, then I had to reschedule my doctor appointment to fall on day 29 or 30 which sometimes did not work out depending on when the doctor was in. She only worked a few days per week.
I had the plan for two years, then they stopped covering the med I was on so I had to switch companies, going instead to an Aetna, silver script choice which was the same price, $31.60 per month. Some years I wanted to rip my hair out searching. It can be a lot of work, especially if you have meds they do not cover.
Good Rx was mentioned, which is not "insurance" it is a discount company that covers under their free option or they have a "gold" plan which is $10 per month. If you've never used Good Rx, you may not know the rules. For my friend, Good Rx price was cheaper then the plan by a few hundred per month. Her pharmacy, a Rite Aid, told her she could not use Good Rx because they had a medicare drug plan which is not true. You can use it if you do not use your medicare plan to first cover it. You have to use either the medicare plan or the good Rx plan. Her Rite aid refused to allow her to use it, so she would have to find another company. She would call me to do the search because she did not have internet on her cell. I have one med that my silver script does not cover, (no medicare drug company covers it, I have to use Good Rx. I went to pick up my med in March, they told me it cost over a hundred, Good Rx stopped covering it for $25 at my CVS. It turns out that I had to sign up for Good Rx gold in order to get the discount which was now $21.
I now have to check every month what "insurance" to use, my silver script, Good Rx or Good Rx gold because all of my meds are cheaper not using the medicare plan. Some use Good Rx regular, some use gold at CVS. To add to the confusion, only CVS went to Good Rx gold to cover my non covered med, it was still available at all other pharmacies using Good Rx regular. I had to fill it at CVS because there are 10 generics, the one CVS uses is the only one that works like the brand.
As was mentioned, if she finally qualifies for medicaid, that would be the main coverage you used. My daughter has a medicaid plan with Horizon BCBS, one of her doctors told her they won't be accepting it starting next month, so she had to call all of her doctors to see if they also accept the plan she is changing to, so keep this in mind. If you have questions, it's easy to make a new thread here to get feedback.
For Good RX, you can either use your web browser, or you can install the app which you should install so you have it for when you do need to use it. Try it out if you're not familiar with it. If using Good Rx gold on the app, your gold plan information is listed in the app. For some reason, mine was coming up with my daughters name and info when I first joined Good Rx gold. I believe I changed it on the web site. You should install the Good Rx cell app so you're familiar with it.
Both medicare and medicaid had drugs they do not cover at all. This is true of medicare with my one sleeping pill but medicaid does cover it in full for my daughter.
As was mentioned, you may want to sign up for a medigap plan in the beginning because if you go with an advantage plan, she may not pass underwriting to switch to a medigap. To confuse it more, some states may not have an underwriting clause, so it is more you will have to know, every state is different.
Also keep in mind that if you did do an advantage plan that there could be a yearly deductible which could end up draining your bank account, especially if your mom gets hospitalized in December, where she is there still in January or back in in January, could end up costing $10k with both deductibles.
My opinion which I'm doing for my hub, he had stage 4 tonsil cancer in 2009 that usually comes back as/in a lung or brain cancer. He is going to be getting a medigap G plan because of his cancer history plus his spine is going. He also has knee issues from running track in high school and shoulder issues from tightening cars on his car carrier. I don't want him to have to depend on an advantage plan because they may not cover something, or they do cover it but we can't find a local provider, we'd have to travel over an hour like I've seen happen to a woman here who had stage 4 breast cancer. By the time she found a facility for treatment, it was too late. She posted to let us know it got worst, her kids were on their way to visit before she passed away.
By law, if medicare covers something, the advantage plan has to cover it too except there is nothing to say they have to have providers that will accept their insurance.
With your mother already having a bad stroke in her early 60's, being left without the full use of her left side (IIRC), who knows what her health issues will be like as she ages. This is another reason I'm not supportive of you taking on her care, especially if you move to another country like you'd like to. You're much better off leaving her here, admitted to one of our nursing homes. It's very hard to find a nursing home these days. Once she gets removed, she may not find another to take her.
I'll stop here, I've given you enough info for right now, don't want your head to explode lol
South Carolina medicaid providers
Healthy Connections: The SC Medicaid Program
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On a National level, the Medicaid program covers more people than you may realize. While the program is federally regulated, states have the power to add additional benefits and create their own state-wide version of the Medicaid system. In South Carolina, this is called “Healthy Connections.â€
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Good Rx gold
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