MD Anderson, Under 65 Medicare Starts 6/1

[kgmom219]

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.

I'm going to have to do a spreadsheet on the costs, but if its close, I am guessing she will stay.

And over 65 means no subsidy. Not Medicare eligible. Based on the above link, I'm not sure she can't get a subsidy and/or remain on an ACA plan

----------

I'm going to have to do a spreadsheet on the costs, but if its close, I am guessing she will stay.

And over 65 means no subsidy. Not Medicare eligible. Based on the above link, I'm not sure she can't get a subsidy and/or remain on an ACA plan

For the next person who runs in to this.

1. If you are on a metallic plan prior to the 25th month of disability (at which time you become Medicare eligible) you may use your metallic plan for your supplement. You are not subsidy eligible.

2. You are "allowed" to decline Part B, but you will be subject to the late enrollment penalty when you enroll in B. Metallic coverage is not considered creditable coverage for purposes of the Part B enrollment period

3. Medicare is primary over metallic plans

 

[yogooglethis]

I'm going to have to do a spreadsheet on the costs, but if its close, I am guessing she will stay.

And over 65 means no subsidy. Not Medicare eligible. Based on the above link, I'm not sure she can't get a subsidy and/or remain on an ACA plan

----------



For the next person who runs in to this.

1. If you are on a metallic plan prior to the 25th month of disability (at which time you become Medicare eligible) you may use your metallic plan for your supplement. You are not subsidy eligible.

2. You are "allowed" to decline Part B, but you will be subject to the late enrollment penalty when you enroll in B. Metallic coverage is not considered creditable coverage for purposes of the Part B enrollment period

3. Medicare is primary over metallic plans

I don't see how this would ever be a good option for someone in this situation.For one in order for medicare as the primary insurer to mean anything they would have to have part B first .I would upgrade your E&O insurance before you advise anyone they don't really need part B in this case.If you have part A and B why would someone pay 400.00 a month for a " supplement plan " plan with 6000.00 deductible and go from Medicare's non managed care plan with complete provider flexibility to an ACA medicaid like HMO network that precludes MD Anderson Center and probably most of his doctors too..an further in order for the ACA HMO to pay anything even after the 6000 deducible they would require him to be established with a gatekeeper ACA HMO PCP and that would most likely disrupt his continuity of care.

Nation's elite cancer hospitals off-limits under Obamacare | New York Post



I ran a quote in 75504 zip for age 60 and lowest premium:


Blue Advantage Bronze HMO? 006 - HMO

Monthly Payment
$393

Deductible
$6,000
per person

DoctorNo charge after deductible
SpecialistNo charge after deductible
Generic RxNo charge after deductible

 

[kgmom219]

I don't see how this would ever be a good option for someone in this situation.For one in order for medicare as the primary insurer to mean anything they would have to have part B first .I would upgrade your E&O insurance before you advise anyone they don't really need part B in this case.If you have part A and B why would someone pay 400.00 a month for a " supplement plan " plan with 6000.00 deductible and go from Medicare's non managed care plan with complete provider flexibility to an ACA medicaid like HMO network that precludes MD Anderson Center and probably most of his doctors too..an further in order for the ACA HMO to pay anything even after the 6000 deducible they would require him to be established with a gatekeeper ACA HMO PCP and that would most likely disrupt his continuity of care.

Nation's elite cancer hospitals off-limits under Obamacare | New York Post

I ran a quote in 75504 zip for age 60 and lowest premium:

Blue Advantage Bronze HMO? 006 - HMO

Monthly Payment
$393

Deductible
$6,000
per person

DoctorNo charge after deductible
SpecialistNo charge after deductible
Generic RxNo charge after deductible

Assume much?

1. She isnt declining B, nor did I make that statement.
2. She's on the BCBSTX PPO $6K 100% plan. She met the deductible in January. She is receiving all treatments in network at UT Southwestern. And MD Anderson is also in this network. (The New York Post isnt an expert at TX ACA plans. Shocking)
3. If she moves to Part A and B without a supplement or Advantage plan the Part A deductible equals 2.5 months of her 4 premium payments (her Medicare eff date is 9/1).
4. Shes 45 and in zip 75080. We have significant price discrepancies between Houston and Dallas.
5. Under no circumstance can she change docs or facilities. None of them take an Advantage plan. They've kept her alive with a brain tumor for almost 10 years. And even if I get her Plan A at $300, I still have to deal with Part D. Her drugs cost $3K per month.

The 2015 answer is add Medicare A&B, keeping the current plan.

The 2016 answer is TBD, based on premiums. But I seriously doubt we will make changes.