Medigap

[palmtree]

Finally! I'm turning 65 and can get a Medicare supplement. Even though the premium is another chunk of money, I feel like I had better jump at the opportunity. There is only a 6 month open enrollment without any medical questions asked. It occurs only once in a lifetime.

But now the questions: Does anyone here have experience with Medicare supplements?

Some of our medications are covered under Medicare Part B instead of D. Is the co payment for medications covered under Part B covered by a supplement? Do they distinguish between medications administered in a doctors office or hospital vs medications you take at home?

I hope I'm asking the right questions. Any information would be greatly appreciated.

[kmallory1]

The only medications that I have had covered under Medicare part B are delivered in the doctor’s office or infusion center. ( Ocrevus and my baclofen pump refill.) Anything that I’ve taken at home fell under Part D.

My supplement covers the 20% that is the Part B Co-pay once I’ve met the deductible. I chose a high deductible plan with really low premiums of about $50 per month. My husband’s plan has $200 monthly premiums with no deductible.

At the time it made sense for me to go with a high-deductible plan since I was on Tecfidera. My out of pocket Part B expenses were really low. Now I’m on Ocrevus so that $2,000 deductible will come into play.

I had my first Ocrevus infusions in June and Medicare still has not paid the infusion center, so I don’t know what my supplement will pay. My second infusion is coming up and I’m a little nervous about another $30,000 treatment when the first is still outstanding.

[Mamabug]

I'm currently on hubby insurance and he is still 10 years away from retirement. But I worry about the future.

I wonder if your doctor or local nmss office would be able to advise you.

[palmtree]

The only medications that I have had covered under Medicare part B are delivered in the doctor’s office or infusion center. ( Ocrevus and my baclofen pump refill.) Anything that I’ve taken at home fell under Part D.

My supplement covers the 20% that is the Part B Co-pay once I’ve met the deductible. I chose a high deductible plan with really low premiums of about $50 per month. My husband’s plan has $200 monthly premiums with no deductible.

At the time it made sense for me to go with a high-deductible plan since I was on Tecfidera. My out of pocket Part B expenses were really low. Now I’m on Ocrevus so that $2,000 deductible will come into play.

I had my first Ocrevus infusions in June and Medicare still has not paid the infusion center, so I don’t know what my supplement will pay. My second infusion is coming up and I’m a little nervous about another $30,000 treatment when the first is still outstanding.

You said everything that is not administered in a doctors office is covered under Medicare Part D. But I have some medications that are covered under Part B that I use at home (they are not MS medications so maybe my question is mute) Just thought someone here might know.

I guess I will contact the senior center in my town. They know stuff like this.

[palmtree]

KMallory1,

What company offers you insurance for $50/month? That is a very good price.

[kmallory1]

It’s Cigna, and it’s going up to $67 next year. There is a $2,000 annual deductible, so it pays nothing until you reach that. Insurance companies price plans by state so you might not see the same price depending on where you live.

[ru4cats]

You said everything that is not administered in a doctors office is covered under Medicare Part D. But I have some medications that are covered under Part B that I use at home (they are not MS medications so maybe my question is mute) Just thought someone here might know.

I guess I will contact the senior center in my town. They know stuff like this.

I would really check to make sure that Medicare will cover those medications you use at home under Part B. I agree with KMallory1 that the only meds covered by Part B are administered in a hospital, i.e. infusions. (I'm not aware of the doctor's office one.) To my knowledge, all other MS medications are part of Medicare Part D with a max cost of almost $5000 a year this year.

I've been on Medicare for almost a year, and I chose traditional Medicare with Plan F that has no deductible. My monthly payments for Part B, Supplemental, and Part D come to $275 a month. My prior cost was close to $12,000 a year! I have NO out of pocket expense, other than a few generic drugs.

Medicare gives you a one time get-out-of-jail-free card as far as supplemental coverage is concerned. Entry age Medicare (purchasing at your first opportunity) provides you with a sign-up without them being able to ask any questions related to your health issues other than do you smoke. You can change plans yearly, but you could pay more related to your MS. Medicare is paying not quite $6000 for my Tysabri infusions, with my supplemental paying 20% of that cost. After much checking, I've come to realize that if you pay less monthly for your supplemental, you will pay more when it comes to any medical costs. I would NEVER purchase a Medicare Advantage plan with a diagnosis of MS.

I've found a great website called ehealthmedicareplans.com that allows you to check plans offered in your area and compare their prices to see which ones will work for you. One thing to remember is that Plan C and Plan F (the only plans that cover the deductible) will disappear in 2020. If you get one of those before that date, you will be grandfathered in.

Good luck!

[palmtree]

There is no question these meds are covered by Medicare, Part B. They are respiratory medications like oxygen. I’ve been getting them for years with co payment assistance programs.

I sure agree that Medicare Advantage, Part C is a rip off. It’s essentially surrendering your Medicare to an HMO. I really hate it that it is called “Advantage”. So many seniors are tricked into these plans and end up seeing 2nd rate doctors and having surgeries with doctors they don’t feel comfortable with.

@kmallory1, I want to get Cigna, too. Still trying to find out if it’s available in my area. Everyone I call gives me different information.

[kmallory1]

Palmtree,
Medicare.gov has a Medigap policy finder. You put in your zip code so it only shows companies that operate in your area. I have plan F High Deductible. It’s offered by 4 companies here.

[palmtree]

Thank you for the information. I spoke with an agent who gave me a quote for Plan G $114.91/mo.

I was a little confused about your plan. Plan F has no deductible. You must have a different plan.

[Mamabug]

I just attended a retirement seminar at held by my financial investment guy this week. One piece of information that might be useful is that the "product" (ie: Plan F, Plan G or whatever plan you choose) is the same no matter which company you purchase it from. Cigna or whoever else is available where you are.

The difference is only in the price. All Plan F's are the same. All Plan G's are the same. Etc.

[ru4cats]

Mamabug,

You are mostly correct. The similarities between the plans are generally the same; however there can be minor differences. My husband’s plan F has a small deductible. Mine doesn’t. The website I listed above makes it really easy to compare plans. The individual I worked with said to go with the cheapest plan once you have made a comparison.

[palmtree]

It’s done! I’m excited. No more co payment hassles. I got the Cigna, Plan G for $114.91. They also answered my question that precipitated this thread. Anything that is covered by Plan B is covered by the insurance.

They have no idea what they are getting themselves into. I am going to break the company.