I'm 37, disabled and I will soon be getting Medicare, Part D and a Medigap plan. If I have all these, will I be well covered? Or should I hold onto the very expensive individual insurance I have (I'd then have medicare plus indiv insurance) I'd really like to drop it because in 2006 it will be about $8K. Everyone I've talked to loves Medicare but I'm still extremely nervous. Does anyone have anything reassuring to say on the subject? Thanks.

I am a senior on Medicare. It is the best thing that governemnt has done other then social security. However, your situation is different and requires expert advice, much more then you could get on the internet. Call your state insurance department, a local welfare agency, or local senior citizens agency. Get expert advise, not just one opinion, but 2 or 3 opinions. The good news is that there are well trained employees and volunteers who can help you. Good lick.

Jayess, Thanks for your reply. I've already done what you advised. Just wondering if you've had hundreds or thousands of dollars in unexpected out-of-pocket costs each year? I'm prepared for some o.o.p., but hoping it won't be in the thousands. Also, have you found that your insurance covers everything that it said it would?

Dolly, you did not state the type of individual plan you have and for how long. As a ex-health insurance agent I know the difficulty in obtaining medicare for ages under 65. And, I am not knowlegdable enough on what medigap plans are available for under 65 and the cost of medigap and what insurance company issues these plans. My experience is 65+ and I know that medicare A&B cover evertything at age 65, and medigap taken on open enrollment covers pre-existing. However, medigap plans after open enrollment have pre-ex clauses. My only o-o-p has been for meds, and I buy what I can in Canada. Hope this helps, but still get local expert advise.

Medicare offers the same exact benefits as those 65+. It's the same insurance. Medigap plans I will be offered are plans A-C. Cheapest plan A would be $1400 a year. Gap plans in my state do not pre-x unless you are in one of their plans which offers drugs. By the way, do you plan to sign up for Part D in case Canada thing falls through one of these years? It would be a shame to sign up for it later and pay high penalties.

I'm 37, disabled and I will soon be getting Medicare, Part D and a Medigap plan. If I have all these, will I be well covered? Or should I hold onto the very expensive individual insurance I have (I'd then have medicare plus indiv insurance) I'd really like to drop it because in 2006 it will be about $8K. Everyone I've talked to loves Medicare but I'm still extremely nervous. Does anyone have anything reassuring to say on the subject? Thanks.


Hi,

Just weighing in here as I've been so upset with the ripoff the government is putting off on seniors as a health benefit Medicare part D. No, I'm not an insurance agent or I'd say it was good, but am a retired Federal analyst and have spent hundreds of hours studying the plan for my mother.

Okay, she has AARP plan C, which is cheaper than any other company we could find and I must admit that without it, she would be hurting. It does pay what Medicare does not pay for everything from doctor's visits and hospital care. It even pays her Medicare deductible, so insurance premiums are all that she is out of pocket here. But, early last summer, we attempted to switch her from Plan C to one with medicine coverage, realizing that the big jump in premiums versus her meds, we would not gain anything, but maybe just break even once you count the increased premium which is more than the Medicare plan D's that she could get. Add to that the first $500 out of pocket cost and that they would pay about 1/2 of the meds after that up to the max, then she would be paying out of pocket again. The reason we would pay the higher premium is that she would have her choice of buying brand versus taking generic.

Yes, of course they advertise on TV that with the Medicare plan D you can do that, but it is mis-leading. When you read the particular plans, you may get brand name once you have tried generic and they don't work or you have a reaction plus the doc has to do more to get it justified, then if you get to buy the brand, her particular brand meds were either such a high tier or class rated that the insurance payed maybe 25% to 1/2 of the costs, and the prices they are listing online through the Medicare formulary are way, way higher than we are paying out of pocket using the AARP discount card.

Finally, I called the pharmacy and asked about which of the discount cards might be best,as most don't seem to offer much more than 10% discount, so why pay for that? The pharmacy we use (at a discount chain store) agreed that most such discount cards are essentially worthless, but that pushed to say, then the best one for a senior was the one we had.

So, as AARP would not let her switch plans some 7-8 months ago when we tried (they say it is based on the cost of her meds during the past 12 months, in other words they would make more $$ on her taking one of the Medicare plan D policies they offer) then she will be doing without any coverage on her meds, just as the other people we have talked with. It will be hard to continue paying total costs out of pocket, but easier than paying any company for a premium while they have a deal with the pharmacy to charge even more for the medicines so that we can't afford them at all. Hard to believe that our government has workedk such a deal at the cost to the seniors, but just go online to the formularies. They are at the Medicare web site where you can access all the plan's formularies and type in what medicines you take and the doseage per month. They will show you what the cost will be through their plans and you can figure the percentage you pay, plus don't forget the premium you pay out through Medicare, and certainly don't forget the deductibles and the caps. Compare it to what you pay using a discount card and see where you stand. For some it will work as a benefit, but it does not seem that it is the case for huge numbers.

So, if you have a plan which pays any part of your medicine, and you are doing okay on it, you are better off keeping that plan.

Medicare + Medigap (choose your level carefully...many people waste money covering cheap deductibles) is good coverage. The Medicare D coverage is horribly stupid and compicated and is a good deal only if you take a hideous amount of drugs. See what you can cobble together to get any specific expensive drugs you take on a regular basis.

Don;t do the private insurance, it's a needless expense that duplicates MANY of the Medicare benefits.

BEWARE any "medigap" type plans that gives you X dollars for every day in the hospital...useless plans.

And DON'T cover your deductibles (the $125 doctor and $800 or so hospital) once a year.

Medicare D WILL be changed once enough people start hitting their congressmen with flower pots and purses. It is an odious bit of work geared only to move money from the taxpayer to Big Pharma.
Maybe something DECENT will replace it after the 2006 elections if people start voting with their brains.

Medicare + Medigap (choose your level carefully...many people waste money covering cheap deductibles) is good coverage. The Medicare D coverage is horribly stupid and compicated and is a good deal only if you take a hideous amount of drugs. See what you can cobble together to get any specific expensive drugs you take on a regular basis.

Don;t do the private insurance, it's a needless expense that duplicates MANY of the Medicare benefits.

BEWARE any "medigap" type plans that gives you X dollars for every day in the hospital...useless plans.

And DON'T cover your deductibles (the $125 doctor and $800 or so hospital) once a year.

Medicare D WILL be changed once enough people start hitting their congressmen with flower pots and purses. It is an odious bit of work geared only to move money from the taxpayer to Big Pharma.
Maybe something DECENT will replace it after the 2006 elections if people start voting with their brains.


Lenin,

Can't agree with your appraisal on the various medigap plans. For instance, my mother has plan C, which you can get through various companies and it is the same options. However, in our particular state, AARP was less expensive, but it has been well worth the premiums. It not only covers the $100 Medicare deductible and pays everything (except meds) that medicare approves, so she does not pay a single penny for doctor visits, x-rays, labs, and most importantly she does not pay the $976 odd dollar deductible every time she goes into the hospital. Were she in perfect health she would be paying dearly for something not used, but then as we age, we all know at some point we are going to break down and start using doctors and hospitals more. Still, when we took that policy, she took only one med, but after having heart valves replaced, having heart failure, kidney failure, etc, she does take more medicine now. It runs several hundred a month for me, but with this she would be put a risk to abide by these new Medicare prescription plans. There are about 10-12 in our state that actually covers all of her meds, but they require that she be switched to generic before they agree to pay. Based on her reaction to them, then they can be moved to the next level of medication and if she still has a reaction, then she can go back to her brand name drugs. Naturally, the cardiologists do not want her to switch brands and actually they have told us that they do not like the generics. So, in order to get the brands, she first has to see if she dies by switching to something else. Fat chance, as long as I can care for her, and if it means I give up some of my medicines, then that's the way it will be.

It is such a fraud by the insurance companies and Medicare with the TV ads about you can get brand named drugs under these plans - such a farce!

I just wish that even though it would have been expensive at the time when she was not on meds, we had switched from Plan C to Plan J, because AARP won't let her switch now. She's not on a terrible amount of drugs, and even had she been switched, we would not have been any better off because the increased premium did not actually save us any money. It just would have saved me from the frustration and hundreds of hours of studying these plans being peddled as good coverage under the Medicare Prescription program.

As for the plans that pay you when you are in the hospital. We've had that for many years, and paid less than $8 per month. When we were working, it would have helped out if we had been hospitalized, especially since where she worked there was no sick leave, so no pay if a worker was hospitalized and had a recovery period. Well, it has never gone up, but they offered to double the coverage, for $5, so yes, we took it. Believe me, it has helped when four times in the last 2 years she has been in critical care for 2 or more weeks. There's no hassle to filing as you simply send in a copy of the itemized hospital bill and the EOB from Medicare or insurance if you have it. Believe me, you do incur a lot of other expenses when you have this kind of hospitalization, and for us, those $$$ which are doubled for critical care have saved the day.

I do agree with you though, that if people would pay more attention and start voting more with their brains instead of just a flip of the switch without ever paying attention throughout the campaigns, maybe we can see something far better in the future. Let's hope so, for the future seniors sake!!!

I am on disability and receive medicare as well. I also have insurance with Excellus bc/bs medicare plan. It pays for my doctor visits and i pay a $5 copayment. I was notified by medicare that my state (NY) will pay my medicare fee of $84 and all my drugs are now free effective 1/1/06.

The only thing i will pay in 2006 will be the copay of $5 or $20 for specialist.