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Thread: mediGAP plans

  1. #1
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    mediGAP plans

    looking to get 1 any ideas. who do you use. pro and cons

    thanks in advance

    I Just called a couple of co. they won/t insure me as i am to young 57

    what do the rest of you guys do idea? please
    Last edited by vjls; 07-31-2008 at 03:51 PM. Reason: SPELLING

  2. #2
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    If you have Medicare it is illegal for Medigap companies to deny you coverage because you are "too young." You are elligible because of disability, the same way that you are eligible for Social Security (Disability) at any age because of the disability, not because you have reached 65.

  3. #3
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    thank you i really did know what to do but i fiqured someone on this boad would know.

    thank you

  4. #4
    Eileen, I am not sure that's true. We ran into the same thing - many policies are for over 65 only, and I did a lot of research. (It does vary by state, as well.) My boyfriend ended up with a Medicare replacement plan, which is a PFFS (private fee for service) plan. It also covers his Medicare Part D, but you don't have to have them packaged together. It is through Unicare, and it has been wonderful so far - they copays are $10, even for specialists, and they have not balked at any testing ordered, and he's had a lot.

    However, I must add that we've only been using it for five months, he just got his disability and was on Medicaid before, so I can't give you info based on an extended time of coverage.

    Lastly, of the Medigap policies that he could have signed up for, the premium was so ridiculously high that it made much more sense to do the replacement plan. (Gap insurance covers everything that Medicare doesn't, but was going to cost around $250 a month. The replacement plan has very low co-pays, covers Medicare Part D, and is $64 a month.)

    Good luck! The medicare website is actually a very good source of information.

  5. #5
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    Gigi,
    I didn't know it differed by state, assuming that because Medicare is a federal program they would have the same contract with Medigap providers no matter where they are. I live in Massachusetts, and have a medigap policy through Blue Cross/Blue Shield. It is great as I never have to pay a co-pay for anything. I pay for my part D seperately though AARP, who also don't care that you are a member or that you are past the age of 50. They both cover anyone who applies if they have already been approved for Medicare. You're are right that the Medigap policy is not inexpensive. I pay just short of $500 a quarter, but I have so many medical appointments that I still come out ahead of having to pay the co-payments.

  6. #6
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    i called several back no go you have to be 65 . anyway i called david at pharmcy he gave me a number to call

    we shall see

  7. #7
    FYI to all, from the Medicare website:

    If you are under age 65 and disabled or have ESRD, you may not be able to buy the Medigap policy you want until you turn 65. Federal law doesn't require insurance companies to sell Medigap policies to people under age 65. However, some states require insurance companies to sell you a policy, at certain times, even if you are under age 65.

    Several states require Medigap insurance companies to offer a limited Medigap open enrollment period for people with Medicare Part B who are under age 65. The following states require insurance companies to offer at least one kind of Medigap policy during a special open enrollment period to people with Medicare under age 65:

    California, Connecticut, Kansas, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Texas, Washington, Wisconsin

    Also, some insurance companies will sell Medigap policies to people with Medicare under age 65. However, these policies may cost you more. Remember, if you live in a state that has a Medigap open enrollment period for people under age 65, you will still get another Medigap open enrollment period when you turn age 65.

    If you live in a state that doesn't offer MediGap, there are some very good Medicare replacement plans, it is just a headache to figure it all out!

  8. #8
    Senior Member rdf's Avatar
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    vjls, check out this site: Medicare Plans

    Bottom left of webpage is a drop down menu to choose your state to see what's available. There are Medicare Advantage Plans nowadays, and they cover much more than original Medicare for a small $20 monthly premium. I've been reading up on them, getting prepared. Check out Humana, they seem to be the most popular.

    Good luck friend.
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    Thanks!

  9. #9
    Junior Member WeelWraith's Avatar
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    I live in Virginia and have Medicare [Part A & B] with a "medigap" plan from Anthem BCBS. However, it's many years that I've had it, so the premium is now $278.00 per month ($3,336. per year) now. I'm 57 also, so Anthem tells me that I only have it because they can't cancel me. However, if I un-enroll or switch out plans, I can never get it back again (at least until I'm 65).

    I'm very healthy for a C-6, 30 yrs. post injury and only see a primary doc and a urologist. Only a little spasm medication. There is the SP Foley and the legbags and a few other things that Medicare/Anthem pays for, but they don't add up to $3K+ per year.

    So, I've been considering switching to a Medicare Advantage plan, but I keep reading articles by different groups that say that is a bad idea... Reasons: Doctors don't like the PFFS plans and many don't want to participate; it's private companies that "take over your Medicare for you, so if the government changes (reduces) what they pay the private companies, then the private companies can change (raise) your premiums...[with Medicare they can't change]; the private companies can always revise what they want to cover and for how much.

    I wish there was someone out there who really knew about this stuff for SCI folks on SSDI under 65. The Medicare "advisors" are all volunteers and if you call four people, you get four different answers. Anthem advises me against changing...but I'm sure they like my $278 per month versus a less expensive Advantage plan.

    Anyone have any ideas or recommendations?

  10. #10
    I have a Medicare Advantage Plan through BCBS of GA, and for $35 a month I am covered on pretty much everything plus I have an individual BCBS dental plan for as well.

    The advantage plan works great as it covers quite a few things Medicare normally wouldn't. Supplies and prescriptions are covered as well. It operates basically as an HMO which I've used all my life anyway. I just had to select my physician (the same one I've always had) and that was it. The $35 is deducted automatically from my checking account.

    For the under 65 crowd, this is probably the best route to take.

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