No announcement yet.

Medicare Confusion at Age 57

  • Filter
  • Time
  • Show
Clear All
new posts

    Medicare Confusion at Age 57

    I am disabled at age 57. I will be eligible for Medicare effective Oct 1 2019 and I am so confused. I saw a SHIIP advisor on Monday and thought I understood until I started contacting insurance companies. It seems no company offers plan G under Medicare Part C if you're under 65. And then because of my MS the cost for Rx is crazy. That's another whole subject because I can't get assistance until I find an Rx plan. Those plans are off the chain expensive because of my Gilenya and a couple of other high tier meds.

    Can anyone offer some form of direction on how this works. Regular medicare vs Medicare Advantage Plans. I have been paying COBRA for the past two years and I just don't understand which would be an advantage for me since I am dealing with not only MS but other health issues as well. As most of us know, MS brings on a host of other complications. I don't really want a high deductible since I have so many doctors as well as a couple of necessary in office procedures a year.

    I am under stress from this ordeal of trying to figure out supplemental or Advantage coverage. Any direction or input would be appreciated. My brain is spinning.

    Medicare is complicated and confusing.

    My doctors do not accept Medicare Advantage plans so I ruled those out.

    When looking at the different plans, look at total out of pocket expenses.
    My high deductible plan F has a low premium so my total cost is about the same as low deductible plans with high premiums.

    I wish you well with your decision. It shouldn’t be so hard.


      You may want to look into taking an infusion MS drug as that falls under a different part of Medicare - part B and not the part D. I think, am not 100% sure, that it can make a huge monetary difference and that is part of the reason I am on an infusion so that when I lose my ins. I can continue meds.


        This might help - explains Medicare parts A B D It´s a pdf document.


          Originally posted by livinms View Post
          I am disabled at age 57. I will be eligible for Medicare effective Oct 1 2019 and I am so confused. ...

          Can anyone offer some form of direction on how this works.
          I hope you get things figured out.

          I often follow these threads to try to help educate myself. I am also 57 and disabled and may have some of the same questions that you do down the road. The difference for me, currently, is that my husband has employer coverage and I have chosen to remain on that, rather than begin to explore the whole Medicare maze.
          My advice:

          * I would have suggested seeing a SHIIP advisor, but you've already done that.

          * Kmallory suggested looking at total out of pocket expenses. That's good advice. Yet, if total expenses are high regardless of what option you choose, … then what?

          * Temagami suggested considering an infusion drug. It might not be ideal to switch meds, but that's one option. You could talk with your neuro about it.

          * Other things you could talk with your neuro about:
          - He or she may have other patients who have MS and are under age 65 who have had to work through this maze and have figured out the best way to navigate it. You may be able to get advice there.
          - What stage is your MS in -- RRMS? SPMS? Some neuros consider taking patients off of meds when they reach SPMS because they may no longer be effective. Other patients have symptoms that may "burn out" (my neuro doesn't like that term) as patients age and may also take them off meds for that reason.

          * Advice that I often give --
          - Take good care of yourself. Changes in diet (no gluten, no dairy, no refined sugar) and lifestyle (get rid of toxins in your environment, kitchen, personal care products, etc) can go a long ways towards improving health outcomes. Consider reading Terry Wahls Protocol.
          - Exercise moderately, drink enough water, get enough sleep, manage or prevent stress, consider meditation, yoga, deep breathing, going to your "happy place" in your mind, nurturing positive relationships, etc.
          ~ Faith
          MSWorld Volunteer -- Moderator since JUN2012
          (now a Mimibug)

          Symptoms began in JAN02
          - Dx with RRMS in OCT03, following 21 months of limbo, ruling out lots of other dx, and some "probable stroke" and "probable CNS" dx for awhile.
          - In 2008, I was back in limbo briefly, then re-dx w/ MS: JUL08

          - Betaseron NOV03-AUG08; Copaxone20 SEPT08-APR15; Copaxone40 APR15-present
          - Began receiving SSDI / LTD NOV08. Not employed. I volunteer in my church and community.



            I understand how confusing and freighting this must be for you.

            I would like to suggest you choose straight Medicare and whatever supplement that is available for Medicare folk under 65. Whichever supplement plan you choose you will be welcomed with open arms by any and all doctors that accept Medicare, the same with hospitals. There are no in network doctors or hospitals you have to worry about, you can go to any doctor of your choosing without checking with Medicare or your insurance company. Ninety plus percent of physicians accept Medicare, same with hospitals.

            Make a quick decision on whether you are going to managed care or straight Medicare & supplement as you have only three months from when you were eligible (not from when you signed up) for Medicare to get a supplement. After this period it will be impossible for you to find a supplement until you turn 65.

            Don’t worry if you have to take plan C instead of G. You will be fine with whatever plan is available to you.

            When you say plan D for prescription drugs is prohibitively expensive are you talking about monthly premiums or copays? You can receive limited help for the copays from foundations that help people on Medicare afford the medications they need.

            Please don’t be afraid, you are going to be ok with this.

            If you have any questions please feel free to ask them.

            I do not have MS, my wife has been living with it for twenty years.