Kidney Transplant

[cador]

I read the thread on CKD and had a question about Kidney X-plant-didn't want to thread jack though. I had CKD Stage 4, diagnosed Jan 2017 and was lucky enough to receive a live donor from my cousin last Dec, doing great now. I'm 50 yrs old.
The financial coordinator at the Hosp was real eager to get me on Medicare but after going over the situation with my health ins agent we figured I'd be better off staying on Ind Medical due to the ongoing costs of medicine. I'm with Molina.
I've been reading this forum this last cpl mths regularly trying to familiarize myself with MC as I'm seriously considering moving from Commercial Ins (20 yrs) to Medicare Advantage/Med Supp sales.
Thought I'd get some professional opinions as to the Advantage of Medicare over an Ind policy, and whether I made a mistake or not staying with Molina. I know I should of got a Medicare Agents opinion prior my surgery but had a ton going on and did not do that.
I appreciate any advice/input.

 

[somarco]

Molina is primarily a Medicaid insurer that expanded into the U65 health insurance market when Obamacare rolled out. Many of the Medicaid/Obamacare carriers have smaller networks which can be problematic when seeking health care.

Medicare is an individual policy, just like your Molina coverage. I would never recommend a Medicare Advantage plan for someone with CKD. If you decide to go on Medicare make sure there are supplement plans available for U65 in your area. If there are none the decision is easy. Stay with Obamacare as long as you can.

I gather you have been in P&C commercial lines sales for 20 years. That is a tough market to crack and is mostly relationship driven. Why do you want to move to individual Medicare sales? They are two completely different markets with nothing in common. You would be starting over from scratch. The learning curve for Medicare isn't as steep as commercial lines but don't expect many of your clients to follow you into the new market.

 

[Devin01]

If you decide to go the Medicare route I agree with above poster stay away from Medicare advantage. Once you get Part B you have a six month window to pick up a supplement , after you will most likely not be able to qualify. A plan F or Plan G will pick just about all of your costs associated with your ckd, not sure if you require dialysis but the supplement would be the way to go.

 

[TwoCents]

Another thing to consider is that currently, if a person only qualifies for Medicare based on ESRD, Medicare eligibility will end 3 yrs after a transplant then you're left scrambling to find other coverage.

 

[LostDollar]

Another thing to consider is that currently, if a person only qualifies for Medicare based on ESRD, Medicare eligibility will end 3 yrs after a transplant then you're left scrambling to find other coverage.

Wow! That's something I don't remember anyone pointing out before.

I found this Medicare booklet, posting the link in case it will help someone else in the future:
https://www.medicare.gov/Pubs/pdf/10128-Medicare-Coverage-ESRD.pdf

Your point is on page 13.

 

[WCMason]

Another thing to consider is that currently, if a person only qualifies for Medicare based on ESRD, Medicare eligibility will end 3 yrs after a transplant then you're left scrambling to find other coverage.

I don’t know that I would describe getting an SEP to return to a marketplace plan scrambling to find other coverage. Granted those plans are not that great but they are easy to get, and may be eligible for APTC once Medicare eligibility is taken away.

 

[LostDollar]

I don’t know that I would describe getting an SEP to return to a marketplace plan scrambling to find other coverage. Granted those plans are not that great but they are easy to get, and may be eligible for APTC once Medicare eligibility is taken away.

Given that op is 15 years away from age 65 and the relatively short term of an aca sep, scrambling could be precisely the word if he or she was unaware of the termination of under age 65 medicare as described earlier and did not plan properly.

 

[somarco]

Once you get Part B you have a six month window to pick up a supplement ,

There may be some states where the U65 rules are different from 65 and up. Until a few years ago (around 8) Georgia did not require Medigap carriers to off U65 plans. The legislature said if a carrier was going to offer plans for 65 and up they had to offer under 65 plans as well.

Carriers responded by offering plans that no one can afford.

I don't believe we were unique.

There may be other states where the Part B 6 month rule is not in play.

 

[kgmom219]

OP, Is your commercial ins a group plan through your employer or spouse? If so you'll probably want to keep it. If it is an individual ACA plan and you get Medicare, you'll have to drop the ACA plan.

If your planning on getting long term social security disability, they will automatically enroll you in medicare part A after 24 months of disability payments.

EXCEPT when you go on dialysis. Dialysis puts you on Medicare the first of the month when you receive treatment.

OP...another thing to consider. The American Kidney Foundation often pays the premium for your supplement. You might need to look into that option before making a decision.

And if you get a transplant and are removed from Medicare, then you go back to Molina. Its an SEP for the marketplace and not a big deal to get reinstated.

 

[cador]

Why do you want to move to individual Medicare sales? They are two completely different markets with nothing in common. You would be starting over from scratch.

Good question-I've lost 3 of my largest accounts (2 went out of biz-1 went with another agent) in 1 yr last yr that accounted for almost 1/2 my income (we write large accounts). Bad year/Bad timing (especially since I was sick and wasn't aggressively chasing new biz to replace) as I've only lost 1 other account in prolly 15 yrs, these all came at once.
Between that, and our agency reducing commissions/taking away commissions I'm thinking its would be a good time to focus on another line of biz. I'm going to continue to renew my commercial accounts so I have some income as I know MC can be tough to make a living in the first cpl yrs.
I like MC because of the prospecting (I spend 85% of my time currently on the phone prospecting for commercial accounts and getting more and more difficult to produce results from my efforts) and the fact I will own my book (do not currently own my book-can purchase it but it's not really a good deal for me).
MC is going to be a lot different-with commercial if I pop an acct or two (or even one good size one) a yr I can add I can add 30K or so to my already renewal income-I know with MC it will take 100 plus to do that-but I can talk to way more buyers.
I look forward to the challenge.