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Lino M. Family Member

Medicare Advantage vs Medigap/Supplemental

Hello everyone, my father received his LVAD approx 2 years ago. He qualified for SSI Disability and will finally be covered by Medicare next month. He is still under 65, so the prices for Supplemental and Medigap coverage are unregulated and ridiculously expensive. We don't qualify for a plan under AARP/United because he is under age. Between the Medicare Premium and Supplemental the cost is more than we were paying for insurance coverage through the ACA State Health Exchange. What plans do you find best to cover all of your needs? Plan C & D? I've seen a couple people mention Plan F? The language is very confusing to me.

Our next option is to get Medicare Advantage. What is everyone's experience with that? Are most of your routine care, labs, medical supplies, and prescriptions covered? How is your monthly premium and deductible. The SSDI is the only income he receives so we are on a fixed budget. Thank you all.

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Stan C.

I was in the same position as your father last year.  He will qualify for a Medicare Advantage program but not for stand alone Medicare & Medigap because he is under 65.  I found an insurance broker and he stepped me through the whole process.  For me the AARP Medicare Advantage program was the best deal and does include drug coverage.  You still have to pay for Part A Medicare but my monthly premium with AARP is only $23.00 plus my co-pay for medications.  Some people do qualify for $0 monthly premiums but like me he probably will not due to the LVAD.

There is 3 things which is a pain with them.  1, they do have a Rx "doughnut hole". 2, they do not cover OTC meds like 81mg aspirin or other required vitamins for me. 3, although they have a $50 allowance for OTC medications every 3 months it is through Wal-Mart and they are always out of what I need or very small sizes.  Best solution for the OTC meds is Amazon and they are cheaper anyways.

Income wise check with your State as there should be a Senior assistance program that might be able to help in many areas.

Finally, you can check for your own Medicare Supplement on the Medicare website but I wanted a more knowlegable person than myself helping with this.  I can do it now myself but not when I was trying to figure everything out.

Good luck!


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In reply to by Stan C.

Lino M.

Thank you for your knowledge on the subject, it is greatly appreciated. I've started research with the Medicare Advantage options as they are more affordable upfront. I'm hoping that not too much changes with his medical expenses as the doctors have been changing his medication a lot due to his IAD going off.

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Matthew B.

I would also recommend an insurance broker. Does not cost you anything and really helps. I am also on SSDI and have used broker for many years with myself and my wife. They will look at all the medications, type of Dr. you see and where you go for medical appointments then recommend the best fit for you to get best coverage. Again there should not be any cost to you for this service as the broker gets paid by the insurance contracts that they write. 

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kathy S.

My husband is 64. He is on disability and had the Lvad put in September 2018 got the heart transplant this past June.. Since he was in heart failure he qualified for the United Health Care Gold Medicare Advantage Plan.  The max you pay out of your pocket for covered services per year is $6700. That was for medical expenses, not drugs. Through Optumrx mail order most of his drugs were 0 copay. With the heart transplant we have gone into the donut hole. We never qualified for any extra assistance.  We never came near the $6700 medical amount until he got the Lvad. His Part B premium is automatically drafted out of his disability check before he receives it. He paid $13 a month premium to United Health Care, but will go up to $19 a month next year. This plan also covers dental, drugs and vision.  When he got his Lvad in 2018 we only paid the $6700 for the year.  I expect the same with the transplant. Have not received any bill yet. They also have Optum that kicks in automatically when you get transplant and you have a case manager. You receive up to $125 per day for mileage and lodging with this plan if you receive a transplant and that is for up to a year after the transplant.  I keep a record of miles to and from doctor visits after transplant.  We had to stay in Charleston and I was reimbursed for my hotel room and then rented a patio home while there because he could not leave Charleston right after transplant. I have been reimbursed for the rent in the patio home.  Been with this plan for 10 years and glad we chose it.  We knew eventually he would have to get the transplant.