GIST Support Wiki

 
Medicare, Supplements and Prescription Coverage

I am happy to share that information with this disclaimer: Medicare regulations varies from state to state, so while Medicare is a federal program, the specifics vary in different states. I have edited that information to better suit a Wiki type of post.

Original Medicare (part A & B) and a Medicare Supplement generally provides better coverage than most group insurance. There should be considerable concern about any Part C or Medicare Advantage plan for a several reasons: 1) Reduced funding as a result of the recent health care reform legislation will lead to higher costs in the future. 2) They are not guaranteed renewable from year to year. 3) They have a significant gap in chemo treatment. There are other concerns as well such as excessive out of pocket expenses, and poorly rated companies. Generally MA plans do provide as good coverage as original Medicare alone. Also, enrollment in a Part C plan dis-enrolls a person from Part A & Part B.

Conversely, a good Medicare Supplement plan such as a Plan F, or a Plan G will eliminate, or reduce potential out of pocket expense ($0 or $155.00/Yr). That being said, a major consideration on a Supplement plan is whether it is based upon 'attained age' or 'issued age': attained age plans increase in cost as a person grows older, and an issued age plan will be the most stable in cost increases.

If a person is leaving a group insurance plan they would have a Medicare Guaranteed Issue Right, and can join a Medicare Supplement plan at any time. Also if they are within the first 12 months of joining an Medicare Advantage Plan they can switch to Medicare Supplement plan. But the big gift from Medicare is a 6 month window called 'Open Enrollment', which is the first 6 months after a person takes Part B of Medicare. In that 6 months, there is no consideration of past or present health. They can take any supplement plan they wish.

Medicare's rules vary from state to state, but because it is a federal program, generally the coverage will be consistent regardless of which part of the country a person is located in.

Regarding the Part D plans or drug coverage; likely most of the GIST type of medication will put a person in the donut hole each year. In Oklahoma that would be approximately $4,500/year; likely it will be similar in each state. However some good news is that in the recent health care reform, some of the reduced from the Part C plans will be reallocated to the Part D plans. In 2010 a person who hits the donut hole should have a rebate of $250.00, and beginning 2011 name brand prescriptions should be reduced by 50%.

There are many Medicare approved Prescription Drug Plans (PDP) so there are options. A person can call Medicare, tell them what prescriptions they take, and over the phone Medicare will give a list with details on which plans will best accommodate your prescriptions. The same process can take place on Medicare's web site.

Supplements:

All of the Supplement plans are regulated in coverage by Medicare, so coverage from one company to another will be consistent. Depending on how long you have had a plan, it may or may not be "attained age". It could be a third option of 'community age' which means everyone from 65 - 100 pays the same rate. Issued Age plans will always be preferred as the cost will be most stable in the years going forward.

The primary distinctions between 'attained age' vs 'issued age' is, with attained age you get at least one rate increase every year as you have a birthday. As a person ages, their risk increases for health problems, and that additional risk is passed on in a rate increase. Additionally you can anticipate one, and sometimes more, rate increases due to medical inflation, or medical trend. Some companies have 2-3 medical trend increases in a year.

"Issued age" will only have medical trend increases, and I know with one company there is never more than one per year & it never exceeds 5-7%. Also with medical trend, everybody in the state on the same plan takes the rate increase together. As an individual, you can never be singled out for a rate increase.

Without knowing details about a specific plan, I am reluctant to make any comment on it. If you are not in any of Medicare's 'open enrollment' or 'guaranteed issue' scenarios, I strongly recommend you check if any supplement plan you consider has underwriting disqualifications because of an existing cancer diagnosis.

Should a person be within 6 months of taking out Part B Medicare they have an open enrollment period, where there is no consideration of heath issues, and you can switch supplement plans at will. I hope this information will be helpful to you.