Medicare questions/decisions

[redbird]

I just had a phone appointment with someone, funded by the state of Massachusetts, to help decide between basic Medicare plus a Medigap plan, or a Medicare Advantage plan. I have gotten some useful information, but am going to double-check everything, because in at least one case what she told me contradicts what the official Medicare.gov site says. It's a relatively minor point--the existence of a roommate discount for some Medigap plans--but I asked about which plans it applied to, and she said it doesn't exist.

The new and interesting information is that apparently, because I am under 65 and disabled, I'm eligible for a Medicaid plan, without an income limit. It's called CommonHealth, and seems to be part of the state's "Commonwealth Care." If I understand correctly, after Medicare paid 80% of a bill, it would cover the rest, but only at providers that take MassHealth.

If I got basic Medicare (parts A and B), a part D drug plan, and a Medigap plan, I could see any provider that takes Medicare, without worrying about what's in-network. However, a Medigap plan would cost significantly more than this CommonHealth thing.

Or, I could sign up for another Medicare Advantage plan. The advantage there is there are some that would cost no more than the Medicare Part B premium. The disadvantage is being limited to in-network providers unless I'm willing to pay significantly more for that service.

I thought the question was, is it worth $250-$300/month (Medigap + prescription coverage) more to not have to worry about being in-network and prior authorization. It sounds like this CommonHealth plan would cost significantly less per month, but if the provider doesn't take MassHealth, I'd be paying 20%. Which gets back to the larger problem that there's no way to find out what number that will be 20% until after the visit.

If I understood correctly, all these options have copays for some things, and CommonHealth may require prior authorization for some things.

Comments

[snippy]

There is a subreddit, unsurprisingly called r/medicare, that has good advice mixed in with agents trying to sell people specific plans.

[calimac]

John Oliver had a recent segment on Medicare Advantage. He finds it problematic for reasons I'll not get into here, except to say that I have Medicare Advantage with an all-encompassing provider, Kaiser, which means there is no insurance denial problem. Kaiser's policy is if their house doctors order something, it's legitimate.

Another thing Oliver mentions is that it's tricky to switch back to regular Medicare after being on Medicare Advantage, because the Medigap plans will no longer cover pre-existing conditions, which they do if you sign up for regular Medicare immediately. However, that seems to apply to people becoming eligible at 65. I'm not sure how your being under 65 and eligible for Medicaid would figure into this. Good luck.

thanks

[redbird]

This is useful, thanks. It also leaves me with more questions, in part because I’m under 65 and I live in Massachusetts.

Thinking aloud, here: do I have another open enrollment option because they aren’t offering my current Medigap policy next year, or would that only apply if the company went out of business altogether?

What I’ve found so far says the general open enrollment is within 12 months after a person turns 65 and has Medicare part B. I’ve had it for more than 12 months (have I? they didn’t tell me, or cancel my Marketplace plan, until a few months in) but I’m under 65.

One thing I found when googling offered a short list of pre-existing conditions, and said Medigap might not cover visits for those things for the first six months. My own issues aren’t on the list, but is it complete?

Re: thanks

[adrian_turtle]

Massachusetts requires Medigap to provide benefits even if you have pre-existing conditions. Other states don't. It looks to me like the waiting period is for people who get Medigap outside the open enrollment period. (Either Nov-Dec, or their own personal open enrollment on turning 65 or becoming disabled.)
https://www.medicarefaq.com/faqs/medicare-supplement-plans-and-pre-existing-conditions/