[ivanm]

Re: Medicare, SSDI, and 2-year gap (and clinical trials)

by ivanm on Fri Mar 21, 2014 11:47 am

Thanks again to everyone. So, I think that originally I misunderstood ACA exchange coverage. Indeed, apparently I can enroll in a plan. I will just have to pay full premium without pre-existing condition increase. In NY, for a platinum plan, the premium comes up to around $24k annually (for me and my family). Interestingly, there are issues with some of these plans. The following was recently in the news discussing that major cancer centers are not covered in the plans offered on the exchanges.

http://www.wjla.com/articles/2014/03/obamacare-many-top-cancer-hospitals-off-limits-for-newly-insured--101300.html

In any event, things do not appear to be as bleak as I thought. Two plans in NY cover Sloan Kettering for example, which is pretty much all I would need. So, in a situation where I may have to leave my job for disability reasons, I'd go COBRA and then hopefully convert the COBRA plan to an individual plan (currently vetting with our human resource person whether there is an increase in premium). This basically should give me the same coverage I have now. Alternatively, I can go through the ACA exchange. If I do that, I have to be extremely careful that the plan I choose covers the major cancer centers in my area. From what I understand, that may not be that easy, but apparently it is doable.

This covers me until I can go on Medicare or my wife finds a job. When I become eligible for Medicare, question is whether to enroll into Medicare. If I've done an allo transplant by then, I would probably do it (assuming I am still around and kicking ) If I have not, I'd stick with the ACA plan. One question here is whether my long term disability would require me to go on Medicare or whether I can opt out from the automatic Medicare enrollment. I know LTD policies require you to go on SSDI which then automatically enrolls you into Medicare. Then the issue goes to what Multibility was saying. If you can't have both an ACA and Medicare, then you better be done with your allo transplant prior to that because the transplant would not be covered under Medicare.

Anyways, I am getting ahead of myself here and I am somewhat obsessive compulsive about this, but talking through all of this on this great message board may be helpful to other young myeloma patients.

[Christa's Mom]

Re: Medicare, SSDI, and 2-year gap (and clinical trials)

by Christa's Mom on Fri Mar 21, 2014 3:02 pm

Hey Multibilly,

I never said you could have Medicare and get insurance through the exchange! I was reading through the posts, and there was a sense that you had to qualify for a subsidy to buy insurance off the exchange. That is all I was trying to clear up.

Medicare and Medicaid questions are definitely above my pay grade, but this discussion does raise a few questions -- My mother (80 yo, no multiple myeloma) is on Medicare and has to have a secondary insurance to cover what Medicare doesn't. Is this true if you are young like Ivan and can no longer work? Do you have to have a secondary insurance? I was also under the impression that you could not qualify for Medicare until you were at least 62 yo. If you were younger and disabled I thought that Medicaid was the safety net, although as others have said you need to burn through your assets first.

Just curious ... as I said ... above my pay grade.

Lyn

[ivanm]

Re: Medicare, SSDI, and 2-year gap (and clinical trials)

by ivanm on Fri Mar 21, 2014 3:21 pm

To answer the question about the secondary insurance, I just hung up with the right person in Sloan Kettering, and the answer is yes. If you end up on Medicare, allo transplants are not covered. You also do not qualify under the ACA state exchange because you already have Medicare. You have to obtain a supplemental secondary insurance from a third party on your own.

The person at Sloan was suggesting that the insurer cannot overcharge you for a pre-existing condition. If you cannot obtain such insurance basically you go to the hospital and they evaluate your case whether you can get charity from somewhere to cover your transplant. She also confirmed that, within ACA exchange, there are only a few approved plans with that cancer center. You have to call your hospital and find out what those are. In my case there were plans by MagnaCare (someone I'd never heard of). Aetna does not cover Sloan?! Unbelievable.

Anyways ... hope this is helpful to other folks here.

Best,

Ivan

[Multibilly]

Re: Medicare, SSDI, and 2-year gap (and clinical trials)

by Multibilly on Fri Mar 21, 2014 7:33 pm

Lyn, my apologies for misinterpreting your post. I believe when you say "secondary insurance" for your mother, you are actually referring to a Medigap policy, right? When one is on SSDI, one qualifies for Medicare at any age. To answer your question about supplementing Medicare coverage with Medigap coverage for a young (under the age of 65) SSDI patient see:

http://www.caring.com/questions/medigap-disability-insurance-eligibility

A word of caution on the above link. I'm not 100% certain that the info in this link is still accurate under the new ACA laws, so one should check this out.

Ivan, that's good news about the cost of secondary non-exchange insurance in conjunction with Medicare not being inflated due to a pre-existing condition. (I am assuming that "secondary insurance" in your most recent reply does not refer to a Medigap policy, but is instead refers to a completely different insurance policy, right?) .

To be clear, I am interested in being able to obtain a completely different insurance policy than Medicare/Medigap when I turn 65. But as Nancy said in one of my other posts on this subject, who knows what new rules will be in place by the time that happens...so I shouldn't worry too much about it....which is sage advice.

Sheesh, this medical insurance mess in the USA seems about as complicated as multiple myeloma.

[Wayne K]

Re: Medicare, SSDI, and 2-year gap (and clinical trials)

by Wayne K on Sat Mar 22, 2014 11:10 am

Age is not a factor as far as getting Medicare if you are on SSDI, but everyone has to wait 2 years. The only exception I know of is if you are 62 or older and take SSDI to bring your SS to 65 levels you can qualify for Medicare I believe.