OH P&C Agent Needs Help with Mom & Medicare

Oct 31, 2015

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  1. INSUREGEEK
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    INSUREGEEK Super Genius

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    My Mother turns 65 in December. We need help from someone fairly local.

    She still works FT, but could have easily qualified for SSDI due to emphysema 2 years ago.

    I struggle to get info on how her employer provided benefits change once she's eligible for Medicare. She is not married - lives alone.

    She got her Medicare A&B card as she was told she HAD to do this in order to investigate other supplements and advantage plans. It's costing her $105/month on top of her employer health plan with a bi-weekly payroll deduction.

    PM's welcome.......her friends are rattling in her ear at the same time she's asking me to figure it all out....but don't treat her like an invalid, because she's not an invalid.

    Help!
     
  2. Fisher
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    Fisher Guru

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    I'm not evenly remotely local but chances are high that your Mom would be better off going straight Medicare with a supplement or Advantage plan and dropping the employer coverage.
     
    Fisher, Oct 31, 2015
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  3. sshafran
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    sshafran Guru

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    Until you factor in Rx's.............

    In short, it depends on what her employer coverage costs and covers, and what county she is in.
     
    sshafran, Oct 31, 2015
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  4. Fisher
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    Fisher Guru

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    You've found that Rx coverage is usually better with group plans, Shafran? That hasn't been my reality.

    Not to mention that I've yet to see a group plan with zero deductible.

    Other than that I completely agree with your 'in short' breakdown. Too many unknowns in the OP's post.
     
    Fisher, Oct 31, 2015
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  5. Justin Bilyj
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    Justin Bilyj Guru

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    Im your Ohio agent if you need one!
     
  6. somarco
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    somarco GA Medicare Expert

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    Most of the group plans cap your combined out of pocket maximum for health care and Rx.

    Which drug plans, stand alone, or baked into MAPD cap your OOP for Rx?
     
    somarco, Nov 1, 2015
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  7. sshafran
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    sshafran Guru

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    Exactly..................

    Thanks, now I din't have to type it.

    Not saying it's never a good move, to be clear, but when someone has group I am slow to recommend leaving group...
     
  8. somarco
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    somarco GA Medicare Expert

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    Scott, I have a lady like that now that will lose big time $$ when she goes on Mcare. She has Crohn's and a heart condition. Mcare + gap is cheaper and better coverage than what she has now but her med's are through the roof.

    Making it worse, she is having complications now and her docs keep changing her med's to get her stable. Last time I ran an Rx report she was looking at $10k+ OOP for her med's.

    She has been trying to retire for 2 yrs and every time she calls I get an Rx update and it doesn't get any better.
     
    somarco, Nov 1, 2015
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  9. INSUREGEEK
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    INSUREGEEK Super Genius

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    Thanks for the input so far!

    It sounds like I will have to get my hands on her employer plan info - open enrollment is going on how. Her Mcare card says eff 12/1/15. She doesn't really want to keep working but she understands the reality of needing be able to afford to quit working - even with Medicare.

    A couple of you have reached out to me privately. I will be sure to update everyone with what decide and why in hopes that it helps someone else.
     
  10. INSUREGEEK
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    INSUREGEEK Super Genius

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    Thanks for all of the PM's!! Here's some new info to share:

    Mom takes a synthroid that is super cheap and a non-issue

    Mom recently switched to a Tudorza 2x daily inhaler that we're told could run $370 per month without a supp. She verified this with the pharmacy. So - we'll need a supp as she really likes this over the Spiriva.

    She carries a rescue inhaler that would cost retail about $45 when she refills it every 90 days - she usually tosses this without using it and it's money wasted, really, but she has to have it. It could probably be any albuterol based inhaler and she'd be OK.

    She has other "conditions" though. Not medical conditions, she has requirements for her supp plan - No AARP or MediGold. Must be Tri-Health facilities as her doc goes there (he recently left Mercy) and cost-effective because.....

    She can get (better?) employer provided coverage for a roughly $70 bi-weekly deduction as she's still working (and hating it) full time. MC is at $105 for A+B....plus we need a supp. But she really, really wants to go part time or retire in full.

    Ugh. We're in Cincinnati, and yes, her PCP is her pulmonary specialist. She's been seeing him since he was a GHP.

    I know a few of you ran numbers. Please PM if you have something that meets momma's needs.

    Happy Thanksgiving!!
     
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