Author Topic: Medicare Supplement question  (Read 773 times)

Kathy57

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Medicare Supplement question
« on: June 24, 2019, 10:16:30 PM »
Sjoggie Friends,

Is anyone familiar with Medicare Supplements?  We have scheduled an appointment with an Insurance professional to try and find the best one for my husband, but I?m sure there is a wealth of information here. 🤗

I?m not old enough for Medicare yet but my husband will be this September.  We have excellent insurance right now but it is very expensive, but so worth it since my husband developed Cancer.  We have needed it and certainly have used it!

My husband is looking forward to lower premiums with Medicare but I am anxious about prescription coverage.  I know we have to get Medicare part D and a good Supplemental insurance.  My concern is that one of my husband?s chemo meds was $10,000 per month, but we only paid $20 for it. 

Right now he is off all meds for cancer but he still has cancer and the doctor gave him ?5 to 10 years? when she first saw him over 3 1/2 years ago.  I know he will eventually need more meds.😢.

My question is:  is there a supplement out there that has decent prescription coverage?  Any experience that you?ve had that might point us in the right direction?  To be perfectly honest, I would rather keep our insurance now with the high premiums but we can?t once he is Medicare eligible.

We do get a sum of money monthly to put towards a supplemental.  I believe it is like $165 per month, but we get to pick our insurance supplement.  I would pay a higher premium for better coverage.  I just need more info on what to do.  I hear horror stories about people unable to afford their meds😱

Thank you for any advice you could give.

Kathy
Diagnosed Sjogrens Aug. 1st 2014.  Plaqinil, Evoxac, Prevacid, Lexapro, Hypothyroid, Esophagel Reflux, Gastritis, Barretts Esophagus, failed sinus surgery with 3 nasal septal perforations.  (Can't see it from the outside)  Asthma, albuterol, Dulera, Nebulizer, Osteoporosis.

irish

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Re: Medicare Supplement question
« Reply #1 on: June 25, 2019, 09:34:41 PM »
This is such a thing to deal with isn't it. I went on my supplement in 2005 and I have BCBS Senior Gold. They are more expensive but little did I know back then that I would be such an expensive high maintenance person.

They have paid out so much money on me for surgeries, tons of doctors visits and IVIG monthly going on 13 years.  I don't remember if they still have this policy but it is worth your while to check with them cause they have a few other good plans. Every state is different also.

I have Medicare Blue Rx for my medications which is a separate policy. Good luck. Irish


Kathy57

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Re: Medicare Supplement question
« Reply #2 on: June 25, 2019, 11:54:52 PM »
Thanks Irish!

I?m sure this Insurance guy can answer our questions.  He used to play softball with my husband and told him he could help us find the right coverage for him.  Even if it is more expensive, I believe it will be well worth it.

I?m so glad that you have good insurance coverage because I have read so many of your postings and am aware of your serious health problems.  And yet you find the time to help the rest of us.  Thank you.

I?ve seen that a couple of people on this thread take IVIG and I know it is expensive.  I?d hate to have to pay for that out of pocket😱

It?s awful to be sick or have family members who are sick and have to worry about fickle insurance.  I know that you lost your good husband and have had family members who have been very ill.  My concerns are so small compared to many others here. 

My husband and I had the privilege to babysit our youngest daughter?s two boys while they vacationed over in Japan.  We had them for 16 days and one is four and the other is sixteen months.  Boy are we tired after that!  We love them dearly but my husband has a tendency to become fatigued from his cancer and I swear I am ALWAYS fatigued!  The 16 month old is so darn cute and sweet but he is a major handful!

We found out that he was just tall enough and curious enough to be able to turn on our gas stove😱. He is very good at crawling upstairs but doesn?t know how to safely come down.  We had to childproof our house very fast!  We enjoyed it but health wise I can say that it was too much for me.  My husband did well.

We do love them and enjoy them so much.  In the future we will continue to babysit but for not that long of a time.  We raised three kids ourselves with boundless energy, but we are missing the boundless energy part now

Not only do I feel much more fatigue but my brain fog has really increased.  I know it was from being so busy with the little ones.  I hope I can eventually get back to my normal level of fatigue soon.  I?ve been trying to rest up and take it easy since their parents picked them back up.  I do feel very good about the job that we did and the kids really seemed to enjoy themselves.

We took them swimming, to the zoo, the city park, and the Children?s museum.  We bought the 4 year old his first training wheel bike and we taught him to ride it🤗. Yes, I think we did a good job babysitting.  We are both so glad that we can still do it, but it is so fatiguing.

Next month we are babysitting our oldest daughters three kids for less than a week.  Their parents are going to Chicago for a conference.  The good news is they are a bit older and I won?t have to change diapers or child proof the house.  We will just have to keep them entertained.

My job at the hospital was eliminated this past February.   (They eliminated our entire small department and I didn?t see that coming.). None of us did. 
I thought long and hard about applying for another position but have drug my feet.  I?m lucky in that I don?t really have to work but I?ve just always felt that I would be at this time in my life.

I feel so fatigued and uncomfortable sometimes that I believe I won?t miss the stress of work.  I was an RN Admissions Coordinator and I worked for Case Management.  I?m trying to adjust to this sudden life change.  I only worked part time but it gave me another purpose and I loved my paycheck and my co-workers.

I?ve come to the hard realization that I may not feel like working anymore.  I need my smarts to do the job but I run into brain fog and feel like my brain is thinking and moving much too slow sometimes.  I?m relieved that financially I don?t have to work but am very sad at the way it all ended.  Everyone in my department was surprised and right before the Holidays they told us.

I look on line for per diem nursing jobs but haven?t found anything that makes me want to seriously apply.  I do miss my paycheck but am collecting a pension now from two of my previous places of employment, and I?m going to file for Social Security this year.  I?m taking it early but I don?t care.

I?m starting to think my job is to spend more time visiting and seeing loved ones right now rather than going to work.  Right now my husband feels pretty good considering all the chemo and radiation he was put through.  We have three trips planned this year to look forward to.

Just taking it one day at a time, and rolling with the good and the bad.  Sorry for unloading but I?ve been meaning to get back on here more and give updates like I used to. I think my job right now is to love and enjoy my husband and family, and to the best of my ability.


Kathy
Have a good week🤗
Diagnosed Sjogrens Aug. 1st 2014.  Plaqinil, Evoxac, Prevacid, Lexapro, Hypothyroid, Esophagel Reflux, Gastritis, Barretts Esophagus, failed sinus surgery with 3 nasal septal perforations.  (Can't see it from the outside)  Asthma, albuterol, Dulera, Nebulizer, Osteoporosis.

irish

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Re: Medicare Supplement question
« Reply #3 on: June 26, 2019, 12:48:01 AM »
Thanks for filling me in on all that is going on since the chemo is over. I took my sic sec early too and am glad I did. The doctor told me to apply for disability and I couldn't believe it. This was in 2005. Yes IVIG is 6000$ per time and between medicare and insurance it is covered.

I don't know how you did all that stuff with your grandkids. Better rest up good before the next round. My hubby and I babysat ouor 5 grandkids a lot. The youngest was 4 when hubby passed away so he remembers
a lot.

We never regretted taking out this health insurance and we just figured it into our budget. We didn't have a lot of other money to spend on extras but we didn't lose our home because of medical bills.Back in 2003 my hubby had 2 back surgeries 2 weeks apart plus he was in the hospital for 75 days. He had scans of spine every 2 weeks or more for over 6 months plus lots of antibiotics. He was very ill. We had 1000$ that we had to pay that insurance didn't and we were thrilled.

People that don't have health issues don't realize what the expense can do to them until it happens. Nurses keep up on this stuff!!!  Hubby was in many times and 8 hospitalizations that last year before Hospice. I hope you have good luck finding some insurance Also, I don't blame you for not going back to work. You have the right idea cause time is short and family is important. Take care and get some rest. 8) Irish

Carolina

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Re: Medicare Supplement question
« Reply #4 on: June 26, 2019, 01:14:34 AM »
 If you take any of the supplements when your husband is eligible there are no pre-existing condition  clause. If you do not take a supplement when he first is eligible and he decides he wants a supplement he will have to calculate in his pre-existing conditions. The supplement that I have is Medicare F and it pays for everything that Medicare doesn’t cover. So there are no co-pays with the doctor there are no percentages when I’m in the hospital. I never get a bill nor do I have to pay.  the supplement costs me about $250 a month. And since I have IV I G every four weeks and my co-pay with it Was $500 a month it pays for itself.

Regards,  Elaine

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Kathy57

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Re: Medicare Supplement question
« Reply #5 on: June 26, 2019, 01:13:42 PM »
Thanks, Elaine and Irish,

You make me feel less anxious about Medicare.  It sounds like you?ve guys have great insurance.  I like the idea of no copays and no bills🤗. Sure sounds good to me.  We will find out soon what the options are.

Thanks for letting me tell some of my story.  It feels good to talk to people who can really understand.  I just want to really thank you for your advice and just for ?listening?.  Both of you have gone through so much!  I am very familiar with your stories because I try to keep up with everyone here even though I haven?t posted.

I feel better when I post on here cause this is a safe and understanding place, and there are such strong people who have been there way before me, and have surmounted much bigger odds than I probably will ever have to.

Since I have been diagnosed, I have received such sound advice and help here, and no topic is too icky.  We deal with an icky illness.  This site has really been a blessing in my life.  Even if I don?t post, I still read.

Kathy
Diagnosed Sjogrens Aug. 1st 2014.  Plaqinil, Evoxac, Prevacid, Lexapro, Hypothyroid, Esophagel Reflux, Gastritis, Barretts Esophagus, failed sinus surgery with 3 nasal septal perforations.  (Can't see it from the outside)  Asthma, albuterol, Dulera, Nebulizer, Osteoporosis.

Jasper

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Re: Medicare Supplement question
« Reply #6 on: July 08, 2019, 07:14:51 AM »
Hi Kathy,

The supplemental insurance that Irish talks about is excellent but  BCBS Senior Gold is a Minnesota BCBS plan. They also have a BCBS Platinum plan which my friends just got. If you live in Minnesota, one of those two plans is definitely the best. My friends had an insurance broker find the best plan for them  which is BCBS (Senior) Platinum. I have other relatives and friends on the BCBS Senior Gold plan and they never get bills or co-pays for medical services. They do have co-pays for medications but they are not bad. Sometimes there may be choices for medication plans, but always get the better plan even if it costs $10 or $20 more a month. It is worth it.

I am sure your insurance person can figure out the best plan for you by comparing them. Even if you live in another state, there should be some good plans available.

Wishing you the best in finding the best plan.
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irish

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Re: Medicare Supplement question
« Reply #7 on: July 08, 2019, 08:49:28 PM »
I think that every state has their own type of BCBS insurance. I know that MN has been inventing different policies the past few years and trying them out and making changes. The insurance industry is caught trying to take care of their patients with out charging them a bundle. The sad thing is if Medicare had never been invented we would not have this quandary.

I was in my first year as a new nurse when Medicare came out and it has been a downhill decline since it came. It encouraged the high prices over the years and it was like a downhill ski slope that no one has been able to corral. Of course  it is more complicated than that but it still ticks me off. My humble opinion and I really don't mean to start a discussion. If you are interest in the history of Medicare maybe do a search and see how the landscape changed.I think that comparing it in 5 year increments would show the changes better. Thanks Irish

Carolina

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Re: Medicare Supplement question
« Reply #8 on: July 09, 2019, 05:05:47 AM »
Interesting, Irish.  I'm sure you're right that Medicare isn't what is was when it started. 

Medicine has experience astounding changes in the past 54 years.  My grandmother had terrible knee problems. She would have benefited greatly from modern knee replacement surgery, which was first patented in 1974, the year my grandmother died.

I don't have any alternative to Medicare, which of course isn't perfect.  I was a Director of HR for several types of employers, both large and small, all private.  And I know first hand that health insurance is extraordinarily complicated, outrageously expensive, and every employer has shifted more and more costs of medical coverage to employees.

By the way, I had Medicare Advantage plans for many years.   I wasn't aware I needed a Supplemental Plan, instead of an Advantage plan.  Supplemental Plans are almost always more expensive than Advantage Plans, as well.

Medicare Advantage Plans are designed by Insurance companies, who contract with Medicare to manage medical care using the Medicare revenue transferred to the company from Medicare. Any given insurance company may offer a wide range of Advantage Plans and they differ from state to state.  The plans offered, and contributions required can change from year to year.

Medigap or Medicare Supplement Plans were designed by Medicare and adopted by many Insurance Companies. There are 9 Plans, and the coverage under each plan is exactly the same from one insurance company to the next.  Only the cost differs.

The Supplement plans have alphabetical names A-L, and there are TWO F plans.  The F Plan I have covers everything with no deductible, the other is a high deductible plan.  Why they are both plan F designations escapes me!

A few years ago the Medicare Advantage Plan I had in NC, the specific plan, was CANCELLED.  And that event, which is called a 'qualifying event', made me and my husband eligible to choose ANY plan, including Medicare Supplement Plans.  The insurance company that cancelled my Advantage Plan, had many other Advantage Plans I could have chosen from, but I did my research and gratefully took Plan F, no deductible.

The past May I was hospitalized with what is called a pseudo intestinal blockage.

Last week I was evaluated in a Duke Urgent Care facility and then sent to Duke Raleigh Hospital, where I had a CT Scan and was diagnosed with pneumonia, a collapsed lung and bronchitis. In that time (end of May to July 2) I had TWO IVIG infusions, in my home, billed at $15,000 each.

Yesterday I saw my Primary Care Physician for my annual visit.

Each time, I showed my ID, my Medicare Care and my Supplement Card.  I paid nothing.  I will never see an itemized bill. 

With either an Advantage Plan or a Supplement you must be treated by doctors and institutions that accept Medicare.  Not everyone does.

Like any new product or service you purchase,Kathy, you will have lots to learn. 

Best wishes, and keep us posted!

Regards, Elaine


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Kathy57

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Re: Medicare Supplement question
« Reply #9 on: July 09, 2019, 11:33:25 PM »
Thank you so much, Jasper, Irish, and Elaine,

It?s nice to hear what insurance has worked well for you.  I read a Medicare book and we have met with the insurance professional and it is all as clear as mud,😂😂🤣.

Jasper, Minnesota seems like they are a progressive state.  We live in Illinois and I feel like our insurance professional explained everything to us as best as he could. I told him that I want the best supplement that money can buy.  My other concern was that with some of the plans that were presented, you could only go to a certain healthcare system and to a group of their physicians.  Of course their plans were much cheaper.  We need to be able to keep my husbands doctor at MD Anderson in Houston.

As far as I am concerned - she has saved his life.  For now.  She offered us treatment that we would have never received where we live now.  She gave us the most hope and the most help.  We were able to have his chemo and radiation at home but she ordered it all and they all followed her instructions to the T.

All our doctors at home are impressed with our doctor in Texas, but then she does so much research and they have all the newest meds and treatments.  So our insurance guy made sure that he chose a supplement that will let us go anywhere. 

He felt like our best deal was a CIGNA plan and it is a Medicare F.  So confusing, but he got us the best bang for our premium.  Blue cross had the same thing but they were more expensive.  He told us that CIGNA and Blue Cross are both good and reliable insurance companies so they essentially had the same plan but different prices.

One bad thing is that Medicare has like an approved drug list?  Anyway, I made him look up my husbands chemo med and it is not a med that Medicare would cover.  It is really new. However they had three other meds in the same general category that they would cover.

I told him I?m not too happy about that.  He was kind enough to look up the cost of this medication in Canada and it is so much cheaper there!  It is an option if our doctor really wants him on it.  My husband is off of everything now, but his PSA levels have been rising and so we go back to Houston for more tests and treatment this August.

His Medicare will start in September so we are under the gun.  Anyway, I am feeling better that this will all work out.  We do the best we can do.  Thanks so much.  I really appreciate the advice🤗

Kathy
« Last Edit: July 09, 2019, 11:35:05 PM by Kathy57 »
Diagnosed Sjogrens Aug. 1st 2014.  Plaqinil, Evoxac, Prevacid, Lexapro, Hypothyroid, Esophagel Reflux, Gastritis, Barretts Esophagus, failed sinus surgery with 3 nasal septal perforations.  (Can't see it from the outside)  Asthma, albuterol, Dulera, Nebulizer, Osteoporosis.

irish

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Re: Medicare Supplement question
« Reply #10 on: July 10, 2019, 06:08:39 PM »
So glad that your insurance agent was able to help you find good alternatives and get you set with insurance. Wishing your husband well as he gets ready to see his doctor. keep up updated when you have times. irish