1)Medicare/Medigap supplement 2)Transition from Medicare to Group Insurance

geral Member Posts: 130
edited March 2014 in Breast Cancer #1
Hi Everyone!

I'm hoping those of you who are on Medicare or once were can help me. I have spoken with so many [Medicare, various State Ins. Depts. including VICAP (VA Ins. Counseling), Health Ins. Assoc. of America, ACS, Patient Advocate Foundation, CancerCare, etc. and still wasn't able to get the counseling I need. All referred me to others and most 'roads' led back to VICAP who said they weren't "equipped" to help me! Medicare/Medigap is confusing enough for those over 65, but my being under 65 AND having a pre-exist cond. has baffled them all!

I know insurance issues vary by state and age. I live in Virginia and am 46 yrs. old. Here, we only have the Original Medicare option.

12/02, I became eligible for Medicare and purchased Medigap. I have Medigap 'F' (NO prescription coverage)which is the only one I could purchase from the only ins. co. that would sell me Medigap due to my age (46) and pre-existing condition. Because of the high premium ($463/mo.), I would only be able to carry it for a year at the most due to my finances. So I don't know whether to continue with it or not.

Without Medigap, as you know, I would have to pay 20% copays plus deductibles [$100/Part B(medical); $840/Part A(hospital)] plus Part B excess charges. The way I figure it, in order for the Medigap to be a benefit to me, my monthly medical expenses under Medicare alone would have to be over $2315 (making my part, 20%, $463). 20% of my current medical expenses is less than $200/mo. I'm not including meds in my total expenses since either way I won't be covered for meds.

Fortunately, currently I'm not receiving any treatments and haven't for almost 2 yrs. I know this could change anytime. Unless I have to be admitted to a hospital this year, I won't have to pay the $840 Part A deductible. But did you know that this deductible is PER BENEFIT PERIOD?!? Benefit period starts when you enter the hospital and ends 60 days after discharge! Worse case scenario, you would have to pay the $840 more than once in one year!

Obviously, for all of us it's a gamble, and I've never been a gambler making this decision much harder for me than some. While keying this message, I'm leaning toward discontinuing Medigap, but my decision could change by the time I log off (it has so many times in the last couple of months).

I am not only concerned about how to handle my medical expenses now. I'm concerned about returning to the working world one day and obtaining group coverage. So I don't want to do anything now that could prevent me from getting coverage!

Am I missing something? Or am I spending MUCH NEEDED money on Medigap? At least I now have Medicare to help with expenses!

Hopefully, one day I will be well enough to work again. Do you know if Medicare will be considered as 'credible coverage' in the transition from Medicare to a company's Group Policy? As hard as it was financially to do, I maintained an individual health policy until I was eligible for Medicare so that I would not have a lapse in coverage.

Thank ya'll SO MUCH for listening!

I'm scheduled to have a bone scan this Tuesday. Would appreciate your kind thoughts.

Take care,

(Sorry, some of this I know I've repeated twice, but I don't feel like re-editing this. Thanx!)