Tough Position

sjac

Expert
31
I just met with a couple a few days ago who were in a tough position. The wife is 68 years old and on dialysis. The husband is a retired postal worker and been on Aetna PPO Medicare plan since retiring. As of the new year their premium is increasing $300-$1200 a month, their total monthly income is approximately $4000 a month. The monthly premiums and other ancillary expenses are getting to the point where they fear they will not be able to meet their monthly obligations in the near future. They're looking for a way to reduce their monthly premiums but due to their income and her health condition I couldn't come up with an idea. I know this isn't a moneymaker but I'd like to do the right thing. If anybody has an idea on how I could help please let me know.
 
I just met with a couple a few days ago who were in a tough position. The wife is 68 years old and on dialysis. The husband is a retired postal worker and been on Aetna PPO Medicare plan since retiring. As of the new year their premium is increasing $300-$1200 a month, their total monthly income is approximately $4000 a month. The monthly premiums and other ancillary expenses are getting to the point where they fear they will not be able to meet their monthly obligations in the near future. They're looking for a way to reduce their monthly premiums but due to their income and her health condition I couldn't come up with an idea. I know this isn't a moneymaker but I'd like to do the right thing. If anybody has an idea on how I could help please let me know.


If they're on the Federal insurance available to retired Postal Workers, they should have been given other options to choose from...that's a huge increase!

What about them getting on Medicare Part B and going with an individual MAPD?
 
I suggest you contact an Elder Care/Special Needs Attorney in your area, and work with them on what options are available to them, aside from just insurance. You might actually get some business out of it.

Thanks for doing the right thing by the client.
 
I just met with a couple a few days ago who were in a tough position. The wife is 68 years old and on dialysis. The husband is a retired postal worker and been on Aetna PPO Medicare plan since retiring. As of the new year their premium is increasing $300-$1200 a month, their total monthly income is approximately $4000 a month. The monthly premiums and other ancillary expenses are getting to the point where they fear they will not be able to meet their monthly obligations in the near future. They're looking for a way to reduce their monthly premiums but due to their income and her health condition I couldn't come up with an idea. I know this isn't a moneymaker but I'd like to do the right thing. If anybody has an idea on how I could help please let me know.



Are you sure they are giving you correct information about their premiums because that sounds extremely high for the a Medicare eligible postal retiree health insurance.

I went on an appointment to a postal retiree home last year who was interested in MA plan and although I don't remember all the details the upshot is that after calling the insurance carrier and his health administrator I recommended that he keep his retiree plan.

I believe he had a couple of options but the one he was set to default in to was about 200.00 monthly premium for an individual. I believe it had either a 1000 or 2000 deductible then it paid 100% after that. 2000.00 a year was deposited in to a FSA by the postal service that could be rolled over in to the next year if not used.

The plan administrator said the plan would be primary payer if he didn't take part B and it wasn't required to take part B to stay on plan even though he wasn't working. That's a good thing if you are going to stay on the plan for the rest of your life

If these people have the same postal retiree program and didn't take out part B yet wouldn't she get a GI for Med sup when she does enroll in part B?


Another possibility is if he cancels the insurance and that is still viewed as involuntary loss of EGHP for her then she would have GI for involuntary loss of EGHP. I am just throwing that out there but I don't know if that would fly but maybe someone else in the audience can give their input.


Also check to see if it's possible that Mr. drops off retiree plan and she stays on it. Some , but not many , EGHP allow that
 
its a $300 dollar increase, from 900 to 1200 My original post was a little misleading, sorry
They showed me the increase letter
 
put them on med supps, they are guarantee issue coming off group no matter dialysis or not.
 
They aren't guarantee issue coming off group in all states if they just decide to leave their plan. If they lose it involuntarily then they would be GI to Med Sup.
 
They aren't guarantee issue coming off group in all states if they just decide to leave their plan. If they lose it involuntarily then they would be GI to Med Sup.
My bad, just speaking of where of from, I forget that sometimes.
 
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