MD Anderson, Under 65 Medicare Starts 6/1

[SirLurkAlot]

I have a client who has been undergoing cancer treatments for several years at MD Anderson and is expected to continue for quite some time. He has enjoyed the luxury of a subsidized BCBS individual PPO plan that has worked great. Due to the substantial cost of care, he meets his OOP maximum by the end of January and the rest of the year he basically pays very little in medical costs.

He just received his Medicare card effective June 1 as he has been on disability for two years now. He doesn't want to leave his BCBS plan but I assume he is forced to now that he is Medicare eligible- correct?

MD Anderson told him they do not accept any medicare advantage plans so I assume his best bet is Medicare plus Plan A supplement (since he is not 65)?

A few things about him:
- 60 years old
- Lives in Bowie county (near Texarkana)
- Income is too high for QMB\QI1 but right on border for possibly some Rx help through social security
- His costs are tremendous considering the extensive treatments and travel
- He is getting treatment both locally and at MD Anderson
- He is part of a experimental trial and I am unsure how Medicare looks at that- anyone have knowledge on this?
- Positive Note: When I met him two years ago, they gave him 4 months to live. He was 1 of 35 chosen for an experimental trial at MD Anderson and he is now in the best condition he has been in for several years.

I would appreciate anyone's advice as how you suggest going about helping him. He relies on family to assist with expenses when they can. I am hoping to find him the best financial option for him to continue receiving the treatment he needs.

Thanks in advance for your advice!

 

[rousemark]

Don't know if available in TX but Bankers Fidelity also offers Plans F, G and High DDied F for under 65. Either would be better for the money than a plan A. I am not a Med Sup agent but I assume he is eligible for Open Enrollment?

 

[SirLurkAlot]

Thanks rousemark! I am not aware of any companies offering GI for under 65's in Texas other than Plan A. Hopefully, if someone reading this knows of one, they can share.

 

[kgmom219]

I'm doing the same thing, for a TX client, except she is at UT Southwestern.

I THINK Kemper might offer F and/or G, but I am waiting on confirmation. PM me with your contact info and I will keep you updated.

Kemper is showing on CSG.

New Era is showing on Ritter, but I think its an error.

 

[yogooglethis]

I have a client who has been undergoing cancer treatments for several years at MD Anderson and is expected to continue for quite some time. He has enjoyed the luxury of a subsidized BCBS individual PPO plan that has worked great. Due to the substantial cost of care, he meets his OOP maximum by the end of January and the rest of the year he basically pays very little in medical costs.

He just received his Medicare card effective June 1 as he has been on disability for two years now. He doesn't want to leave his BCBS plan but I assume he is forced to now that he is Medicare eligible- correct?

MD Anderson told him they do not accept any medicare advantage plans so I assume his best bet is Medicare plus Plan A supplement (since he is not 65)?

A few things about him:
- 60 years old
- Lives in Bowie county (near Texarkana)
- Income is too high for QMBQI1 but right on border for possibly some Rx help through social security
- His costs are tremendous considering the extensive treatments and travel
- He is getting treatment both locally and at MD Anderson
- He is part of a experimental trial and I am unsure how Medicare looks at that- anyone have knowledge on this?
- Positive Note: When I met him two years ago, they gave him 4 months to live. He was 1 of 35 chosen for an experimental trial at MD Anderson and he is now in the best condition he has been in for several years.

I would appreciate anyone's advice as how you suggest going about helping him. He relies on family to assist with expenses when they can. I am hoping to find him the best financial option for him to continue receiving the treatment he needs.

Thanks in advance for your advice!

First call MD Anderson and determine if clinical trials extends to medicare eligibles and if he would have any share of cost with just medicare alone.That would prolly be best option because under age 65 med supps premiums are usually very high if they are even available at all in your state .If med supps are available for GI and also very high in premium you may want to recommend plans from BCBS or AARP/UHC that may GI the plan F or N then switch down to a more affordable plan K,L or Hi F if available to give MOOP protection

 

[SirLurkAlot]

Thanks yogooglethis! Client is doing the legwork with MD Anderson and seeing about their assistance programs, as well.

KGMom219- pm sent. Would love to find a Plan F for him!

 

[wehotex]

I'm doing the same thing, for a TX client, except she is at UT Southwestern. I THINK Kemper might offer F and/or G, but I am waiting on confirmation. PM me with your contact info and I will keep you updated. Kemper is showing on CSG. New Era is showing on Ritter, but I think its an error.

Yes. By all means, please let us know. If not, there's always good ol Secure Horizons Plan A with its low premium.

 

[retread]

He just received his Medicare card effective June 1 as he has been on disability for two years now. He doesn't want to leave his BCBS plan but I assume he is forced to now that he is Medicare eligible- correct?

MD Anderson told him they do not accept any medicare advantage plans so I assume his best bet is Medicare plus Plan A supplement (since he is not 65)?

A few things about him:
- 60 years old
- Lives in Bowie county (near Texarkana)
- Income is too high for QMBQI1 but right on border for possibly some Rx help through social security
- His costs are tremendous considering the extensive treatments and travel
- He is getting treatment both locally and at MD Anderson
- He is part of a experimental trial and I am unsure how Medicare looks at that- anyone have knowledge on this?
- Positive Note: When I met him two years ago, they gave him 4 months to live. He was 1 of 35 chosen for an experimental trial at MD Anderson and he is now in the best condition he has been in for several years.

I can address the issue of Medicare Supplement qualification. If his Part B effective date is 6/1, he has a 6 month guarantee issue (open enrollment) to get a med sup, just like any other Medicare beneficiary. Being under 65, Texas is one of the states that require issuance of at least one policy by each carrier for him. Have him contact a Texas licensed agent for more information. If he misses the 6 month open enrollment, he won't get another chance for guaranteed issue until he turns 65. I don't know any carrier that will take disabled under 65 unless they are made to by regulations, so he is in a good position at the moment. Hope he doesn't fail to take advantage of it.

And as to the plan, he should shop around for a carrier that provides an under 65 plan that he wants and can afford... and I do not recommend Plan A, either. The lowest cost med sup is still better than nothing (or a Medicare Advantage plan). If he screws up and goes beyond open enrollment for a med sup, or can't afford one, he can always get an MA. Initial enrollment for an MA is 3 mos, and in his situation would be from now until Sept 30th, and if he misses that, Oct 15th- Dec 7th for 1/1/2016.

Being disabled, he might qualify for financial aid through the Medicare Savings Program, but if he goes on Medicaid, he won't be able to use a Med Sup. However, if he has a med sup, he can get it suspended until he gets off Medicaid and then have it resume coverage.

Hope this helps.

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Yes. By all means, please let us know. If not, there's always good ol Secure Horizons Plan A with its low premium.

You do realize that Plan A does not cover Part A deductible, Part B deductible, Part B excess charges, or SNF, don't you? Plan A is not worth the money. No insurance plan is worth having if it doesn't cover your needs.

 

[GreenSky]

You do realize that Plan A does not cover Part A deductible, Part B deductible, Part B excess charges, or SNF, don't you? Plan A is not worth the money. No insurance plan is worth having if it doesn't cover your needs.

Would covering the 20% for chemo, radiation, surgery, etc. be worthwhile?

Not a big fan of Plan A but it's certainly better than going without any supplement.

Rick

 

[wehotex]

I can address the issue of Medicare Supplement qualification. If his Part B effective date is 6/1, he has a 6 month guarantee issue (open enrollment) to get a med sup, just like any other Medicare beneficiary. Being under 65, Texas is one of the states that require issuance of at least one policy by each carrier for him. Have him contact a Texas licensed agent for more information. If he misses the 6 month open enrollment, he won't get another chance for guaranteed issue until he turns 65. I don't know any carrier that will take disabled under 65 unless they are made to by regulations, so he is in a good position at the moment. Hope he doesn't fail to take advantage of it.

And as to the plan, he should shop around for a carrier that provides an under 65 plan that he wants and can afford... and I do not recommend Plan A, either. The lowest cost med sup is still better than nothing (or a Medicare Advantage plan). If he screws up and goes beyond open enrollment for a med sup, or can't afford one, he can always get an MA. Initial enrollment for an MA is 3 mos, and in his situation would be from now until Sept 30th, and if he misses that, Oct 15th- Dec 7th for 1/1/2016.

Being disabled, he might qualify for financial aid through the Medicare Savings Program, but if he goes on Medicaid, he won't be able to use a Med Sup. However, if he has a med sup, he can get it suspended until he gets off Medicaid and then have it resume coverage.

Hope this helps.

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You do realize that Plan A does not cover Part A deductible, Part B deductible, Part B excess charges, or SNF, don't you? Plan A is not worth the money. No insurance plan is worth having if it doesn't cover your needs.

Yes, I know that. In our state (Texas), the only type of med Supp avbl for U65 is Plan A, and usually only at the 6 month window Open Enrollment that you alluded to. The other poster (kings mom) says that kemper may offer a richer med Supp, but that would be way beyond what is required by State of Texas and def some kinda crazy adverse selection.