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    Medicare/Medigap

    I'm going to be eligible for Medicare starting January. I am thinking of buying supplemental (Medigap) insurance as well. What would be a good policy and issuer (the insurance company), specially here in California? I'm hoping to find out about a good insurance company with no or little hassle in approving doctor's/therapist's visits, drug prescription, etc. Thanks.

    #2
    Keep in mind that most Medigap insurance does not cover what Medicare does not...it only helps to pay off the 20% co-payment. So most Medigap does not cover drugs (as Medicare does not cover drugs) and it will not generally pay for durable medical equipment not already paid for by Medicare.Here is a good resource within California for more individual information and assistance:

    The Health Insurance Counseling and Advocacy Program

    (KLD)
    The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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      #3
      Thanks, SCI-Nurse. The link appears really useful. I have to call them for details though. I was really wondering which one of A through J Medigap policies did SCI people find useful. Policies H through J have drug benefits but are probably going to be revised starting January 2006. Policies F or J appear to have good coverage. Has anybody had any experience with these? Also each policy has so many insurance companies selling it. Which insurance company is preferable? Thanks.

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        #4
        62:

        Examine the cost benefit ratio. Does it cover the initial yearly Medicare deductible, does the Medigap have a deductable. How much are your premiums and what is your frequency of doctor's visits?

        I don't remember but your deductible is only $100 if hospitalized. Some doctors will waive the co-payment if you ask them, but still do the math.

        For a $20 monthly insurance premium, will you see a doctor more than 12 times a year? How many times do you predict you will be hospitalized? How old are you and will you ever discontinue Medicare (return to work) or the Medigap.

        From what I hear, no personal experience r knowledge, it is usually not worth it.

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          #5
          Cris, I was hoping to hear from people in my situation. I guess it must be pretty unique. Thanks for your input.

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            #6
            I'm in NY and have Mutual of Omaha Medigap plan F. To see your options you need to determine which companies and plans are available in your state. Medigap plans are completely unrestrictive; Medicare managed care plans offer additional options but usually come with restrictions of varying degrees. For Medigap I would not use them for rx coverage unless you have massive rx expenses; the rx breakeven point is high and Mcare will have scrip coverage of sorts in '06 I believe. Until then, buy meds from discount suppliers direct, Canada or USA.

            To have SCI and not have Medigap or Mcare HMO etc coverage is not smart IMO. One hospitalization, surgery etc can leave you with 20% of bill in the tens of thousands. SCI is a serious disability with significant health care risks and costs. To go without additional financial protection is rolling a stacked set of dice which will eventually cost you.

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              #7
              quad62, I'm in Massachusetts, on Medicare and several years ago I bought a supplemental policy that will pay the 20% gap that Medicare wouldn't cover. It has prescription coverage and it's about $5000/year. Remember, a supplemental policy will only cover the 20% that Medicare won't pay...and only things that Medicare will agree to pay for at all. You have to sit down and figure out what your expenses are, how much the gap policy will cover etc. Crags is right though, a hospital stay can run up a colossal bill real quick.

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                #8
                I was covered by my company's policy I worked for under the Cobra plan and I wanted to buy a Medigap policy when Medicare kicked in, I'm on Medicare now, but was advised that in Arkansas I could not get any coverage. Because I was under 65 there were only about 5 companies that offered a policy but if you use a walker or wheelchair they will not cover you. This makes me so mad, it doesn't seem fair to me. So Medicare just went into effect for me this October & I'm scared without any additional coverage. The insurance I had was great & I miss it so bad.

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                  #9
                  Thanks crags, smokey, and Sandra. I think supplemental insurance is a good idea. crags, you're right. The managed-care options are very restrictive, and do not allow going to a specialist of your choice directly. Plan F sounds useful. The other good thing about Plan F is that it will cover excess charges for physicians who don't accept Medicare. Have you had any problems with Mutual Of Omaha? smokey, who is your insurer and have you had any problems with them? Sandra, I am really sorry to hear about Medigap policies in Arkansas. As I understand, there is a window of a few months to get a supplemental policy. Hope something can materialize for you.

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                    #10
                    quad62, my supplemental insurance company is Blue Cross/Blue Shield of Massachusetts. They have been excellent...no problems at all (except the rates go up every year!)

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                      #11
                      Thanks, smokey.

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                        #12
                        Crags (or anyone):

                        Perhaps my situation is abnormal. I have BCBS full coverage and Medicare is my primary provide except when I am working. Last time I was working I had three insurance plans, Medicare, BCBS and the employers HMO (the co pay for RX was worth the premium) and then BCBS was (I chose it to be) primary, the HMO secondary and then Medicare. Believe me, it is a unique situation.

                        I thought if admitted to a hospital under Medicare, after the $100 deductible, everything, except the charges from the Doctors themselves, was then covered 100%. This is why my urologists has me admitted to receive the expensive IV antibiotics, in the hospital they are covered 100% by Medicare, home health (outside the hospital) BCBS picks up 80% and I am liable for the rest, which can be a lot.

                        Smokey, what is the cost for your BCBS supplemental policy? I pay $50 for BCBS for Federal employees and will have the 'group plan' savings until 65. Then, as the law is now, I will lose BCBS and only have Medicare. Can I get medigap at age 65?

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                          #13
                          I'm in NY and have BC/BS has my supp. I pay @ 900 every quarter

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                            #14
                            Maybe this will be helpful, if and when it happens
                            http://story.news.yahoo.com/news?tmp...are_drug_plans

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                              #15
                              i'm in ny and use mutual of omaha with no complaints, 236/mo, 2832/yr, (plus jim will bring an alligator to your house to wrestle)

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