So, this thread got me thinking about my insurance options when I turn 65 (I'm currently 57, but I'm mapping out my retirement plans)
https://myelomabeacon.org/forum/medicare-ssdi-2-year-gap-clinical-trials-t3039.html
I'm not too thrilled about the coverage one can get for treating multiple myeloma under medicare.
Also, one doesn't have the option to reject medicare coverage unless one wants to give up their social security payments.
Also, one cannot apparently enroll in an Obamacare exchange policy if one is on Medicare.
So, my question is whether you can still buy a new health insurance policy outside of the Obamacare exchange while on Medicare?
Will the policy rates purchased outside of the exchange be astronomical if you have a pre-existing condition like multiple myeloma?
Do these non-exchange policies even have to insure you if you have a pre-existing condition? Or, does the Obamacare pre-existing condition coverage guarantee apply to ALL policies, exchange-based or not)?
Forums
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Insurance coverage when you turn 65 in the USA
MultiBilly,
Don't worry about Medicare now if you are planning to start it when you are 65. Who knows if things will be the same then as they are now. But, I have found that my coverage under Medicare and a supplemental program are quite good. I have chosen the best coverage available in my area because I have no copays with it and it covers everything that a doctor might charge above what Medicare approves. So, I know what my monthly medical expenses will be and am able to budget better.
No medical insurance plan can deny coverage because of pre-existing conditions and they can't put a cap on your coverage. The trick is that you need to sign up for Medicare and a supplemental plan, or an Advantage plan, within a certain time period of when you turn 65 or when you retire from working with an employer insurance plan.
When you get close to 65 and are looking to decide on insurance, go to a seminar that is geared for people who have cancer. I went to one and it really helped me decide on what I was looking for and what questions to ask the different insurance reps.
Don't worry about Medicare now if you are planning to start it when you are 65. Who knows if things will be the same then as they are now. But, I have found that my coverage under Medicare and a supplemental program are quite good. I have chosen the best coverage available in my area because I have no copays with it and it covers everything that a doctor might charge above what Medicare approves. So, I know what my monthly medical expenses will be and am able to budget better.
No medical insurance plan can deny coverage because of pre-existing conditions and they can't put a cap on your coverage. The trick is that you need to sign up for Medicare and a supplemental plan, or an Advantage plan, within a certain time period of when you turn 65 or when you retire from working with an employer insurance plan.
When you get close to 65 and are looking to decide on insurance, go to a seminar that is geared for people who have cancer. I went to one and it really helped me decide on what I was looking for and what questions to ask the different insurance reps.
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NStewart - Name: Nancy Stewart
- Who do you know with myeloma?: self
- When were you/they diagnosed?: 3/08
- Age at diagnosis: 60
Re: Insurance coverage when you turn 65 in the USA
Thanks Nancy. Good advice.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Insurance coverage when you turn 65 in the USA
I agree with Nancy. I choose original Medicare (Part A and Part B) and in addition purchased a Medigap policy. I have had essentially no out of pocket expenses. However, if you go that route, you also need a Part D prescription drug plan, and that is where the costs of oral chemotherapies comes into play. From my research, Revlimid will cost you approx $10K per year regardless of what drug plan you choose. There are programs to assist in this cost if you qualify.
Knowing this, I still choose to go that route because it allows me to see any doctor. As you know, with multiple myeloma it is essential to have a myeloma specialist overseeing your plan of care, and the Advantage plans may not have a specialist you can see. If they do, you will be limited to see only that specialist. The pros of the Advantage plan are (1) monthly premiums are less, however you could have co pays, and (2) many have prescription drugs covered.
I don't believe Medicare will change significantly in the short term.
Knowing this, I still choose to go that route because it allows me to see any doctor. As you know, with multiple myeloma it is essential to have a myeloma specialist overseeing your plan of care, and the Advantage plans may not have a specialist you can see. If they do, you will be limited to see only that specialist. The pros of the Advantage plan are (1) monthly premiums are less, however you could have co pays, and (2) many have prescription drugs covered.
I don't believe Medicare will change significantly in the short term.
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torimooney - Name: tori
- Who do you know with myeloma?: myself
- When were you/they diagnosed?: apr 2012
- Age at diagnosis: 64
Re: Insurance coverage when you turn 65 in the USA
You should definitely explore Medigap policies. They can vary quite a bit in coverage and cost. You will receive Part A Medicare and, unless you buy a complete policy, you'll want Part B. The Part D will depend on what else you do, but most Medicare Advantage and Medigaps offer it as part of their plans. You won't want an Advantage plan even if it survives.
Given the roller coaster environment of health care at present that's probably as far as you can plan at present. I do believe this will be the scenario that you will face however. The Medigap providers were lobbying pretty heavy for the ACA and, even if something replaces the Act, it will still probably favor them for SS retirees.
Given the roller coaster environment of health care at present that's probably as far as you can plan at present. I do believe this will be the scenario that you will face however. The Medigap providers were lobbying pretty heavy for the ACA and, even if something replaces the Act, it will still probably favor them for SS retirees.
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Wayne K - Name: Wayne
- Who do you know with myeloma?: Myself, my sister who passed in '95
- When were you/they diagnosed?: 03/09
- Age at diagnosis: 70
Re: Insurance coverage when you turn 65 in the USA
I was told if you are on Medicare they will only pay for one stem cell transplant. Is that true? Jerry
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JBarnes - Name: Jerry Barnes
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: Aug 17, 2012
- Age at diagnosis: 54
Re: Insurance coverage when you turn 65 in the USA
Regarding "I was told if you are on Medicare they will only pay for one stem cell transplant. Is that true? Jerry".
This is true.
Effective
October 1, 2000
(ICD-9-CM 203.0 and 238.6) for beneficiaries less than age 78 who have Durie-Salmon stage II or III newly diagnosed or responsive multiple myeloma with adequate cardiac, renal, pulmonary and hepatic functioning. This includes those patients with previously untreated disease, those with at least a partial response to prior chemotherapy (partial response is defined as a 50% decrease either in measurable paraprotein [serum and/or urine] or in bone marrow infiltration, sustained for at least one month), and those in responsive relapse. Multiple rounds of autologous stem cell transplantation (known as tandem transplantation) will, however, remain non-covered
http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=45&ncdver=2&NCAId=159&NcaName=Stem+Cell+Transplantation&IsPopup=y&bc=AAAAAAAAAQAAAA%3D%3D&
http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R125CIM.pdf
This is true.
Effective
October 1, 2000
(ICD-9-CM 203.0 and 238.6) for beneficiaries less than age 78 who have Durie-Salmon stage II or III newly diagnosed or responsive multiple myeloma with adequate cardiac, renal, pulmonary and hepatic functioning. This includes those patients with previously untreated disease, those with at least a partial response to prior chemotherapy (partial response is defined as a 50% decrease either in measurable paraprotein [serum and/or urine] or in bone marrow infiltration, sustained for at least one month), and those in responsive relapse. Multiple rounds of autologous stem cell transplantation (known as tandem transplantation) will, however, remain non-covered
http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=45&ncdver=2&NCAId=159&NcaName=Stem+Cell+Transplantation&IsPopup=y&bc=AAAAAAAAAQAAAA%3D%3D&
http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R125CIM.pdf
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
Re: Insurance coverage when you turn 65 in the USA
MountainMan, you are walking DataBase of knowledge!
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JBarnes - Name: Jerry Barnes
- Who do you know with myeloma?: Self
- When were you/they diagnosed?: Aug 17, 2012
- Age at diagnosis: 54
Re: Insurance coverage when you turn 65 in the USA
Does anyone have any experiance with TRICARE? I am a retired military reservist and will be eligible for Tricare at age 60 and planned to use it when I turn 65.
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mobri65 - Name: Marty
- Who do you know with myeloma?: Myself
- When were you/they diagnosed?: October 2013
- Age at diagnosis: 56
Re: Insurance coverage when you turn 65 in the USA
Mobri, trying using the advanced search feature in this forum. Type in "tricare" in the keyword field and be sure to check "post subject and message text". You will get a couple of hits.
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Multibilly - Name: Multibilly
- Who do you know with myeloma?: Me
- When were you/they diagnosed?: Smoldering, Nov, 2012
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