Social Security Medicare

My understaning is that once you are approved for SSD you are automatically enrolled in Medicare which starts 24 months later. I would make the necessary inquiries about Oamacare ASAP.

Icemantoo

It's very true that medicare health coverage (and Part D for drugs) can be both confusing and intimidating.  The medicare coverage for health care (excluding medications) is reasonable and might come in at a savings to the cost of adding your husband and kids to your employer's plan.  However, the cost of medications under medicare/Part D is pretty steep for cancer patients. 

To sort this out, my suggestion is that you find a medicare health insurance specialist.  Larger insurance brokers often have someone on staff who can navigate this for you.  I have medicare, a supplemental policy and a Part D policy.  Together, they cost me $350 to $400 a month.  For a cancer patient on medicare, the Part D deductibles could be $6,000 or $8,000 a year.  Again, see the insurance professional. 

All said, you may be totally fine going the route of bringing your family onto your policy at work.

One last thing to consider.   To offset the high cost of chemotherapy, some drug companies have programs which reimburse their patients for their out-of-pocket costs.  There are also some foundations out there that do the same thing.  Some of the programs have minor restrictions.  Some are more of a problem.  Income may be a disqualifier and being a participant in medicare may also be a disqualifier.

I hope that you find some financial answers for your situation.  Find that insurance salesperson who can sort this all out for you.

Dutch

foxhd said:

SS

I walked in to our local SS office and told the woman behind the desk that I had stage 4 kidney cancer. She set up a telephone interview for a couple days later. They called and were very understanding and compassionate. (I was fully expecting a motor vehicle department treatment). She told me that I would hear back in a couple weeks. In 2  weeks they dumped a bunch of money into my bank account, sent me a letter of eligibility, and that was all there was to it. I took a nasty hit to my income but I no longer have to go places, buy cars, clothes, etc. So, I could not be happier. And very thankful.

I will be eligible for medicare later this year so I have been doing a lot of research.  Humana was the only provider with a plan I would qualify for and they have 4 plans.  The cheapest one they had was $546 a month with a $6,850 deductible and $6,580 OOP.  I think your location can affect what plans are available.  The advantage to it is that, once you reach the OOP, your drugs are covered 100%.

I called an insurance broker who suggested some options but they weren't any better than what I found on my own.

For Medicare, you have the choice of getting a Supplement or Medicare Advantage.  Each has pros and cons. The killer is the Medicare Part D for drugs.  Axitinib costs $12,000 per month.  Even though Medicare covers most of it, I'm still left with $11,000 for the year.  Pfizer has a plan to help cover the cost, but my income is over the limit.  The PAN foundation helps people cover cancer drug costs, but my income is $2,000 over their limit.

One important thing to know is that you only have guaranteed issue rights for a Medicare Supplement for the first 12 months. If you get a plan in the marketplace or get a Medicare Advantage plan and want to switch to a Supplement after that 12 month period, you will have a waiting period where any pre-existing conditions are not covered.

How long has he been on SSDI?  Is he 65 or older?

If you want details on the plans that I found, send me a PM.

Kathy

MattInVa said:

A bit rambling but maybe this helps

I am by no means a expert but I spent an enormous amount of time learningthe ins and outs of the insurance programs and doing research, crunching #'s,making calls etc. I Had always just had insurance, never gave it much though because I never used or needed it. Then Whammy I get the big C. Even before the doctor finished telling me my thoughts where to cost management. Luckily my out of pocket expenses so far have been only around 8k including surgery, 3 hospital stays, slews of CT, MRI's,surgeons, GP and so on and so on. I knew this year would mainly be monitoring for progression and I could rely on my local facilities and providers, thus maximizing my benefits, when it comes time to re-up and will re-evaluate my situation again looking to my future needs.

I have the Obama care after my private insurance ended in Feb. 

I forget if its 2 years from date of disability or from date when benefits start for Medicare. I wont be eligible until after 2017 but you can be sure I will be investigating long before then.

A lot depends on your income levels and state of residence I believe. I have a PPO Aetna plan through the exchange, right now my income is limited to my SSD benefit so I qualify for nearly the maximum supplement. My Monthly premium is $13 and max deduct and OP yearly is $680.00. So I paid that towards my last cat scan and now they pay everything at 100% as long as I stay in network, all my providers are in my current excahnge plan and my previous private plan except for the specialists at Johns Hopkins. So I didn't have to go and look for new providers.

Votrient is covered at 100% after my deductible, my previous plan had no drug coverage and Novartis picked up 100% through their patient foundation

 

The biggest thing is to try to forcast your needs for care and treatment, so many plans only pay in network now, or a greatly reduced portion. So choose acording to who the your majority of health care expenses will be paid too. Specialized treatment and out of network or  region can end up costing you up to 50% or not covered at all, and there is usually no cap for out of pocket out of network. So if you plan to go to a specialty treatment center or doctor try to get a plan where they are in network or at worst where the plan covers the largest %

I think I would keep the OC plan if I can, a lot will depend on how I progress in treatments.  I also have my VA plan for backup and I recieve priority care for being a combat vet.

So much depends on your income levels. At this point I have little income, but large assets, so SSDI and Vet pensions are out unless I disperse my assets to family, which I know you can do for SSDI and then you are also eligible for Medicaid.

Social Security is pretty good to deal with I found, I suggest paying a visit to your local office, here in VA they where excellent to work with.

Matt

Hi!

When I had to leave my job due to disability, I got COBRA from work, but then had to go 5 months without any insurance till my SSDI was approved and Medicare started.

For medicare they take $100 out of your monthly check toward Medicare insurance.

BUT I took the AARP Medicare complete which now gets that $100 from my check directly from Government. I dont have to pay AARP. I am VERY pleased with AARP Complete as it has United Healthcare. The co pay is$45 a visit compared to my previous plan with $60 a visit. NO PREMIUMS outside of them getting that $`100 a monthfrom your Social Security check.

OBAMACARE is the ACA act which is a LAW not INSURANCE. It means you cannot be denied due to an illness, nor cut off plus other things. States have their own exhanges so it depends on where you live to see what insurances are offered. That is why I life AARP as they have so many subscribers.

You can apply for both online. Or call them and they'll walk you through it.

Good luck! Its really not that hard. I just made sure AARP covered all my providers and they did.

Jan