MD Anderson, Under 65 Medicare Starts 6/1

[kgmom219]

Yes, I know that. In our state (Texas), the only type of med Supp avbl for U65 is Plan A, and usually only at the 6 month window Open Enrollment that you alluded to. The other poster (kings mom) says that kemper may offer a richer med Supp, but that would be way beyond what is required by State of Texas and def some kinda crazy adverse selection.

Finally got Kemper on the phone...its an issue with CSG. They only offer A.

Yuk.

However, for both my client and probably Lurk's, its better than an MAPD. For my client, it would require switching docs. She's on year 10 of brain cancer. She won't be changing docs. And with an MRI every 30 days, I can't see an MA plan approving those. The only plus is that she doesn't get PET scans, which Medicare is now limiting to 3 in a lifetime.

Weho...I appreciate the phone number on the previous post for the Secure Horizons Plan A.

 

[wehotex]

Finally got Kemper on the phone...its an issue with CSG. They only offer A.

Yuk.

However, for both my client and probably Lurk's, its better than an MAPD. For my client, it would require switching docs. She's on year 10 of brain cancer. She won't be changing docs. And with an MRI every 30 days, I can't see an MA plan approving those. The only plus is that she doesn't get PET scans, which Medicare is now limiting to 3 in a lifetime.

Weho...I appreciate the phone number on the previous post for the Secure Horizons Plan A.

Wow. On a lark, I thought about this prospect moving to the Ark side of Texarkana. For those of you who don't know, part of Texarkana is in Texas and the other part in Ark. But, Ark U65 law is even WORSE than Texas!!! There is NO open enrollment situation for them when their Medicare starts.

The following came off an Ark government website:

In Arkansas, there is no open enrollment period for individuals who are not yet 65. However, they are entitled to a six-month open enrollment period when they reach age 65.

At least we do have the opportunity in Texas, although the premiums are very high with most Plan As. Maybe that's why the Secure Horizons Med Supp inside "consultants" kept arguing with me that they didn't have to accept my kidney dialysis patient who just received Medicare. If Ark is not accepting U65 without underwriting, I'll bet that some of the other states are doing the same.

 

[WCMason]

I had a similar case just today. 51-year-old female becoming eligible for Medicare 6/1 due to disability, receiving cancer treatment. Lives in Texas. We went over a number of MA plans. The ones that covered most of her doctors had horrible drug coverage. The one that had great drug coverage didn't cover her doctors. We ended up deciding that it would be best for her to go with the Medigap plan (Medigap plans offer plan A only in Texas). AARP Plan A at $329 per month. But the standalone drug plan was going to save her more than $1000 for the remainder of the year over the drug coverage of any of the MA plans, so that offsets part of that Medigap premium.

Because AARP does not compensate agents for under 65 Medigap plans, and because the drug plan that came up lowest for her is with Cigna HealthSpring, which also does not cover pay commission to agents, this was a pro bono case. I helped her enroll in the drug plan on the medicare.gov website, and showed her how to call to get her supplement lined up.

Turns out her husband, who was at the meeting, is a CPA who meets monthly with a group of 80 other CPAs. They hold seminars and get guest speakers at them. After what we did, he assured me he was going to put me in front of all of them. Sometimes things can work out even when you don't get the deal.

 

[yogooglethis]

I had a similar case just today. 51-year-old female becoming eligible for Medicare 6/1 due to disability, receiving cancer treatment. Lives in Texas. We went over a number of MA plans. The ones that covered most of her doctors had horrible drug coverage. The one that had great drug coverage didn't cover her doctors. We ended up deciding that it would be best for her to go with the Medigap plan (Medigap plans offer plan A only in Texas). AARP Plan A at $329 per month. But the standalone drug plan was going to save her more than $1000 for the remainder of the year over the drug coverage of any of the MA plans, so that offsets part of that Medigap premium.

Because AARP does not compensate agents for under 65 Medigap plans, and because the drug plan that came up lowest for her is with Cigna HealthSpring, which also does not cover pay commission to agents, this was a pro bono case. I helped her enroll in the drug plan on the medicare.gov website, and showed her how to call to get her supplement lined up.

Turns out her husband, who was at the meeting, is a CPA who meets monthly with a group of 80 other CPAs. They hold seminars and get guest speakers at them. After what we did, he assured me he was going to put me in front of all of them. Sometimes things can work out even when you don't get the deal.

was she losing group coverage ? from what i read AARP/UHC only offers the plan A ( 388 monthly) for under 65 if it's a GI from loss of coverage.In the OP posters case i don't think they would qualify since by default everybody loses individual coverage when they start medicare because it becomes useless but who knows maybe the rules have changed under ACA

https://www.aarpsupplementalhealth....rGuide/StateVariations/GU25003TXWB (8-12).pdf

 

[SirLurkAlot]

Thanks everyone! It is what I suspected but just wanted to make sure I wasn't missing anything. Client is looking into MD Anderson's charity program as a possibility to cover whatever Medicare doesn't. This is a good guy who has been through more than anyone deserves to and it's sad he has to give up his individual plan. Just wish there was more I could do for him. Thanks again to all who replied!

 

[Millwood]

Check United American. I believe they may offer a disability High F. Price comparable to A.

 

[DS4]

He doesn't want to leave his BCBS plan but I assume he is forced to now that he is Medicare eligible- correct?

"In the state of Texas, if you are under the age of 65, and are eligible, you are entitled to purchase only a Medicare Supplement Plan A"

Your client can probably keep BCBS, with Medicare paying primary, and, BCBS paying secondary.
W/o access to Med Supp Plans N, F or G, I like this as the better option.
More costly but better coverage.
Just my 3 cents.

 

[kgmom219]

"In the state of Texas, if you are under the age of 65, and are eligible, you are entitled to purchase only a Medicare Supplement Plan A"

Your client can probably keep BCBS, with Medicare paying primary, and, BCBS paying secondary.
W/o access to Med Supp Plans N, F or G, I like this as the better option.
More costly but better coverage.
Just my 3 cents.

That's what I am trying to figure out now.

https://www.healthcare.gov/people-with-disabilities/marketplace-application/

If you say you're disabled, but your state determines you either don't qualify for Medicaid based on your income or determines that you don't have a qualifying disability, you can still buy health coverage through the Marketplace. Plans can't deny you coverage or charge you more because of your disability.

I'm trying to get clarification. She definitely doesn't qualify for Medicaid in TX. If I can keep her on a Marketplace plan that's a MUCH better idea than putting her on an Advantage POS. Then I need to determine if she has to add Part B.

Any thoughts?

 

[yogooglethis]

That's what I am trying to figure out now.

https://www.healthcare.gov/people-with-disabilities/marketplace-application/

If you say you're disabled, but your state determines you either don't qualify for Medicaid based on your income or determines that you don't have a qualifying disability, you can still buy health coverage through the Marketplace. Plans can't deny you coverage or charge you more because of your disability.

I'm trying to get clarification. She definitely doesn't qualify for Medicaid in TX. If I can keep her on a Marketplace plan that's a MUCH better idea than putting her on an Advantage POS. Then I need to determine if she has to add Part B.

Any thoughts?

They are referring to people in that 24 month waiting period between the award date of SSDI and the start date of Medicare.If she has medicare already this won't help her.

 

[WCMason]

"In the state of Texas, if you are under the age of 65, and are eligible, you are entitled to purchase only a Medicare Supplement Plan A" Your client can probably keep BCBS, with Medicare paying primary, and, BCBS paying secondary. W/o access to Med Supp Plans N, F or G, I like this as the better option. More costly but better coverage. Just my 3 cents.

I'm not so sure about that. Medicare eligibility means no subsidy (APTC) for an ACA-compliant individual plan. A Plan A supplement covers 100% except for the deductible for Parts A and B, the skilled nursing copayment after 20 days, and Part B excess. Given the monthly premium of an ACA-compliant individual plan without a subsidy, it would seem that a Plan A med supp (at $300+ monthly) would be a much better alternative to an individual ACA-compliant plan.