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  • mediGAP plans

    looking to get 1 any ideas. who do you use. pro and cons

    thanks in advance

    I Just called a couple of co. they won/t insure me as i am to young 57

    what do the rest of you guys do idea? please
    Last edited by vjls; 07-31-2008, 03:51 PM. Reason: SPELLING

  • #2
    If you have Medicare it is illegal for Medigap companies to deny you coverage because you are "too young." You are elligible because of disability, the same way that you are eligible for Social Security (Disability) at any age because of the disability, not because you have reached 65.

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    • #3
      thank you i really did know what to do but i fiqured someone on this boad would know.

      thank you

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      • #4
        Eileen, I am not sure that's true. We ran into the same thing - many policies are for over 65 only, and I did a lot of research. (It does vary by state, as well.) My boyfriend ended up with a Medicare replacement plan, which is a PFFS (private fee for service) plan. It also covers his Medicare Part D, but you don't have to have them packaged together. It is through Unicare, and it has been wonderful so far - they copays are $10, even for specialists, and they have not balked at any testing ordered, and he's had a lot.

        However, I must add that we've only been using it for five months, he just got his disability and was on Medicaid before, so I can't give you info based on an extended time of coverage.

        Lastly, of the Medigap policies that he could have signed up for, the premium was so ridiculously high that it made much more sense to do the replacement plan. (Gap insurance covers everything that Medicare doesn't, but was going to cost around $250 a month. The replacement plan has very low co-pays, covers Medicare Part D, and is $64 a month.)

        Good luck! The medicare website is actually a very good source of information.

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        • #5
          Gigi,
          I didn't know it differed by state, assuming that because Medicare is a federal program they would have the same contract with Medigap providers no matter where they are. I live in Massachusetts, and have a medigap policy through Blue Cross/Blue Shield. It is great as I never have to pay a co-pay for anything. I pay for my part D seperately though AARP, who also don't care that you are a member or that you are past the age of 50. They both cover anyone who applies if they have already been approved for Medicare. You're are right that the Medigap policy is not inexpensive. I pay just short of $500 a quarter, but I have so many medical appointments that I still come out ahead of having to pay the co-payments.

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          • #6
            i called several back no go you have to be 65 . anyway i called david at pharmcy he gave me a number to call

            we shall see

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            • #7
              FYI to all, from the Medicare website:

              If you are under age 65 and disabled or have ESRD, you may not be able to buy the Medigap policy you want until you turn 65. Federal law doesn't require insurance companies to sell Medigap policies to people under age 65. However, some states require insurance companies to sell you a policy, at certain times, even if you are under age 65.

              Several states require Medigap insurance companies to offer a limited Medigap open enrollment period for people with Medicare Part B who are under age 65. The following states require insurance companies to offer at least one kind of Medigap policy during a special open enrollment period to people with Medicare under age 65:

              California, Connecticut, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Texas, Washington, Wisconsin

              Also, some insurance companies will sell Medigap policies to people with Medicare under age 65. However, these policies may cost you more. Remember, if you live in a state that has a Medigap open enrollment period for people under age 65, you will still get another Medigap open enrollment period when you turn age 65.

              If you live in a state that doesn't offer MediGap, there are some very good Medicare replacement plans, it is just a headache to figure it all out!

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              • #8
                vjls, check out this site: Medicare Plans

                Bottom left of webpage is a drop down menu to choose your state to see what's available. There are Medicare Advantage Plans nowadays, and they cover much more than original Medicare for a small $20 monthly premium. I've been reading up on them, getting prepared. Check out Humana, they seem to be the most popular.

                Good luck friend.
                Please donate a dollar a day at http://justadollarplease.org.
                Copy and paste this message to the bottom of your signature.

                Thanks!

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                • #9
                  I live in Virginia and have Medicare [Part A & B] with a "medigap" plan from Anthem BCBS. However, it's many years that I've had it, so the premium is now $278.00 per month ($3,336. per year) now. I'm 57 also, so Anthem tells me that I only have it because they can't cancel me. However, if I un-enroll or switch out plans, I can never get it back again (at least until I'm 65).

                  I'm very healthy for a C-6, 30 yrs. post injury and only see a primary doc and a urologist. Only a little spasm medication. There is the SP Foley and the legbags and a few other things that Medicare/Anthem pays for, but they don't add up to $3K+ per year.

                  So, I've been considering switching to a Medicare Advantage plan, but I keep reading articles by different groups that say that is a bad idea... Reasons: Doctors don't like the PFFS plans and many don't want to participate; it's private companies that "take over your Medicare for you, so if the government changes (reduces) what they pay the private companies, then the private companies can change (raise) your premiums...[with Medicare they can't change]; the private companies can always revise what they want to cover and for how much.

                  I wish there was someone out there who really knew about this stuff for SCI folks on SSDI under 65. The Medicare "advisors" are all volunteers and if you call four people, you get four different answers. Anthem advises me against changing...but I'm sure they like my $278 per month versus a less expensive Advantage plan.

                  Anyone have any ideas or recommendations?
                  A servant of The Weel who lives and rolls in the world of shadow...not alive, yet not quite dead.

                  "I'm just a dreamer, I dream my life away;
                  I'm just a dreamer, Who dreams of better days." -- Ozzy

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                  • #10
                    I have a Medicare Advantage Plan through BCBS of GA, and for $35 a month I am covered on pretty much everything plus I have an individual BCBS dental plan for as well.

                    The advantage plan works great as it covers quite a few things Medicare normally wouldn't. Supplies and prescriptions are covered as well. It operates basically as an HMO which I've used all my life anyway. I just had to select my physician (the same one I've always had) and that was it. The $35 is deducted automatically from my checking account.

                    For the under 65 crowd, this is probably the best route to take.

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                    • #11
                      I had to recently do quite a bit of homework on this subject. I just qualified for medicare, beginning this month.

                      I gave up on Medigap until I'm sixty-five. If you can find a company that offers it, the cost is ugly. I decided on BCBS diamond plan for Tennessee. In my area, doctors and hospitals don't want to take the PFFS plans, I had to go with a PPO and make a lot of phone calls to make sure I was choosing one my current doctor uses. No problem with the hospital in Knoxville, they take them all, the smaller one in Sevierville only used a few different ones, and my neurosurgeon in Knoxville only used a few. I don't have a primary yet, so I can choose one taking new patients. I was more concerned with my surgeon, I don't want to change, after more phone calls to his office and insurance people, they'll take me out of network since I'm an established patient. My co pay to him will be 25 dollars instead of the normal 10, I can live with that.

                      One thing I found out, it not only differs by state, but can also be different by county. I live in about a five county area preferring PPO's to PFFS. The billing office people were telling me it is harder to get paid by PFFS plans.

                      Make sure you go into the sites of insurance you are considering. Not all policies are created equal. Some have larger deductables, co pays, and some don't have part d included if you need it. Some cover more than others etc.

                      Good luck!

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                      • #12
                        [quote=smokymtn memories;961173]One thing I found out, it not only differs by state, but can also be different by county.[/qoute]

                        You're right about state by state and county by county...
                        In my state of Virginia and my county Anthem BCBS offers a PFFS Advantage plan called SmartValue which seems to have a good rating as well as two Humana Gold PFFS plans. There is no BCBS Diamond plan mentioned. PPO type plans are only a couple and are very low rated. Every doctor office I call seem to say that Humana Gold is what everyonne in the are are switching to.

                        Originally posted by smokymtn memories View Post
                        Make sure you go into the sites of insurance you are considering. Not all policies are created equal. Some have larger deductables, co pays, and some don't have part d included if you need it. Some cover more than others etc.
                        That is the hard part: the fine print. It's really hard to find someone that will navigate you through the plans without an objective to sell you a certain plan (the companies) or the best company that offers good service and good value (agents) without their bias and who will get them the most fee for selling you one company over another.

                        Fine print sorting also is like calling the IRS or reading the tax code. It's all Greek or Latin to me.
                        A servant of The Weel who lives and rolls in the world of shadow...not alive, yet not quite dead.

                        "I'm just a dreamer, I dream my life away;
                        I'm just a dreamer, Who dreams of better days." -- Ozzy

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                        • #13
                          I can understand why the elderly or someone totally new to insurance shopping could/would have a hard time choosing and searching.

                          One of the responsibilites of my old job was choosing the best insurance policies for the company. It was much easier and straight forward to choose the commercial insurance than the health insurance.

                          I worked on choosing mine for more than a week, reading policies and talking to people. You have to make the phone calls to find out the policies used in your area. One may sound good on the internet (or salesman), but you have to make sure it's used in your area, by your providers.

                          In Weelwraith's area Humana Gold PFFS has a good rating, in my area, no one will take it. Anyone choosing a policy needs to do their homework or at the very least, make sure you ask your salesman the right questions. By the time I finally talked to my salesman, I already knew which policy I would go with.
                          Last edited by smokymtn memories; 12-05-2008, 05:49 PM.

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                          • #14
                            Originally posted by Wheelieboy View Post
                            I have a Medicare Advantage Plan through BCBS of GA, and for $35 a month I am covered on pretty much everything plus I have an individual BCBS dental plan for as well.

                            The advantage plan works great as it covers quite a few things Medicare normally wouldn't. Supplies and prescriptions are covered as well. It operates basically as an HMO which I've used all my life anyway. I just had to select my physician (the same one I've always had) and that was it. The $35 is deducted automatically from my checking account.

                            For the under 65 crowd, this is probably the best route to take.
                            i just talked to david he is with lol i forgot state agency you call for help on this ins.
                            anyway he talked and told me as in ga they don/t have to sell me a policy till i am 65
                            the plan your on was what i was looking atbut he suggest since my drug plan 18 month
                            and it was adqueate for me don/t switch

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                            • #15
                              Originally posted by vjls View Post
                              i just talked to david he is with lol i forgot state agency you call for help on this ins.
                              anyway he talked and told me as in ga they don/t have to sell me a policy till i am 65
                              the plan your on was what i was looking atbut he suggest since my drug plan 18 month
                              and it was adqueate for me don/t switch
                              Customer service reps are pretty much the last people one can rely on for accurate information sometimes. I am in the metro area so the advantage plan applies for my county. If you are in middle Ga, then you can get on the BCBS advantage PFFS plan, I do believe:

                              http://www.bcbsga.com/wps/portal/chp...ervice%20(PFFS)

                              Someone else mentioned a PFFS plan in this thread, and I think it's worth checking out if you want to save money and have flexibility. Enter your zip and check the coverage in your area. If prescription coverage is an issue, then you probably don't need to switch, but that coverage is based on your zip code.

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