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I have a friend who has original Medicare, but, is in desperate need of a Supplemental Health insurance to help pay the additional 20% of health care. She was told by a representative from Humana that due to her existing health condition it maybe hard for her to qualify for supplemental insurance. She has kidney disease (dialysis every 3 days of week), heart disease (bypass heart surgery), and diabetes.
My questions are: Does anyone know if there any hope of her getting Supplemental Health insurance with the existing health condition she has? If so, do you know the names of the Health agencies?


Any assistance you can provide me will be greatly appreciated.


Thanks.


Ann

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Have them contact the SHINE Program - There are people trained to help them fond the right plan for their needs. There may be a volunteer at their local COA or their local Elder Services. I found this information on the internet for Massachusetts:

The SHINE Program (Serving the Health Information Needs of Everyone) provides free health insurance information, counseling and assistance to all Massachusetts residents with Medicare. A counselor will review programs that help people with limited income to pay health care costs. You can reach a SHINE Counselor at (800) 243-4636, press 3 or press 5 if calling from cell phone. TTY (877) 610-024
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Thanks everyone for your input. Everyone has provided me with good advice and recommendation. I will pass along all of your advice to my friend.

Thank God for this message board, it is such a blessing to be in a support group online that will provide you with answers, advice and recommendations when you need it.

Ann
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Depending on your friend's income and other expenses she might qualify for state assisted insurance such as Medicaid to be used as a supplement to her Medicare. My other qualified after spending down and the expense of having 3 cancer surgeries. I think there's a limited amount a person can maintain in their bank accounts, savings though. It use to be $2500.00 maximum I think. She might be able to have more in her account now. I'm not sure.

I was told it's difficult to obtain supplemental insurance if the person doesn't apply for it within the first six months after turning 65.

I also agree with the others that an Advantage plan might work best for your friend. They may work different in different states. However, my own present Advantage plan has 0 copay for PCP doctor and 5 co-pay for specialist. Medication varies from 0 co-pay/ deductable to as much as over 100 depending on the tier level. 0 co-pay for routine dental exam. 0 co-pay for routine eye exam. 250 annually for glasses. 0 co-pay for routine hearing test, and even pays up to a certain amount for hearing-aides if needed.
With your friend being on dialysis I'm not sure how that will work in her best interest with an Advantage plan.
But some insurance companies will help the person sign up for additional help for state insurance if they qualify. My mother didn't even know she qualified for additional help from the state based on her income, expenses and size of her bank account savings until representative from Healthsprings helped her apply.
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worriedinCali Nov 25, 2019
Medicaid health Insurance is income based. $2500 is well above the income limit for Medicaid. In the OPs state the maximum gross income for Medicaid eligibility for a single person is $1438
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We used a pro bono insurance agent who came to the house who set us up for Medicare Supplemental - United Health Care through AARP - Plan letter F. You may want to try to go this route. Good luck.
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Blueberry is right, nothing wrong with the right advantage plan. United Healthcare's Advantage Plans have the highest rated by Medicare. My former husband has had one of their plans for years. He had a stroke and the medical bills he ended up paying was much less that my total yearly Medigap/supplement payments. I just signed up with United Healthcare advantage plan because every year my Medigap payments increased. The average senior can't afford them. And nearly every senior I know has an Advantage Plan. An agent that strictly sell Medigap policy will try to discourage you from an advantage plan because they want a commission. Sure Medigap policy will pay everything once you pay that deductible but if you're nearing 80 you'll pay big time. It's all a gamble and depends on each individuals age, health, and budget.
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She needs to call an agent. I was told by Medicare that the best way to get Supplemental Insurance is through an Agent - and my agent has found me insurance and even suggested me changing to another company for a better rate.

There are plenty of companies that will take her with existing health conditions. She also might be eligible for Medicaid as well as Medicare.
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Llamalover47 Nov 24, 2019
RayLin: Yes, that is the route to take for sure.
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Get thee to a medicare insurance expert.
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Go to the medicare website for answers:
https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
These are plans which are defined by Medicare, not the insurers. If a person wants everything covered with no deductible and no co-pay, choose a plan F supplement. Mine is through BCBS and have used it through 2 knee replacements and a couple of smaller issues without paying an additional penny. There were no health questions and no medical exams to get the coverage.

My husband and I pay about $300 per month for this coverage, another plan for drug coverage, and his Medicare part B (my Medicare part B comes from my SS check). This is less than the deductible that my sister has on her advantage plan. I figure that I would rather pay on a regular basis and not worry when I get sick. She likes to think that if she manages to get through the year without having to pay the whole deductible she saves money. It is a matter of preference.

As to pre-existing conditions, that was not an issue in the past for the medi-gap plans, but I haven't read all the information on the new rules for 2020.

I would recommend that you or your friend start with the Medicare site and get some solid information before talking to insurance companies. Remember who pays the insurance company "assistant" who you might talk to on an insurance site. I have been lied to or misled more than once by what are really just sales people.
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BettyMG Nov 25, 2019
Littleorchid, I've had Medgap/supplement insurance for 14 years and I changed companies several times when they increased my rates and NO insurance company will accept anyone without going thru underwriting. The ONLY exemption is first time when you turn 65. No insurer will insure just anyone with certain medical conditions. This is not so with advantage plans. It's misleading to suggest to people on this site that anyone can get a Medigap policy. It's just not so.
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The Affordable Care Act (Obamacare) made it unlawful to discriminate against people with pre-existing illnesses.

I hope Trump hasn't totally wrecked the Act -- as he has removed the mantatory insurance coverage which made this possible.

Are you near a Kaiser Permanente?

Or, call AARP. You must've gotten many ads in the mail these past weeks.
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worriedinCali Nov 24, 2019
Its a supplemental insurance he’s looking for though so the ACA doesn’t apply and he can be denied because if his pre-existing conditions.
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I did not think heath issues prohibited Supplemental Insurance except if her kidney stage is "end stage renal disease.". Maybe she is at that stage.

T th AARP United Health Care but stick with original Medicare and supplement. Don't be lured into an advantage plan.
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blueberrybelle Nov 24, 2019
There's nothing wrong with an Advantage Plan - I have it with my Kaiser Permanente insurance. I am well covered and feel very secure. There are co-pays and a monthly premium (I pay $47 monthly -- but it may vary from state to state).
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AARP has some insurance plans but you should be able to find providers - especially during open season for Medicare. They'll be knocking down your doors for your business.
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Try AARP. They are actually managed by united healthcare. Are they within their window of opportunity? Just retired or started medicare? There are special rules about acceptance into supplemental insurance policies. Check out your local senior services center asap since election coverage deadlines are fast approaching. Many of the centers have the ability to compare plans and sign them up for their best fit. Don't forget perscription drug coverage too.
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Try to get it thru AARP
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Even with supplemental, she will still have expenses. She needs to talk to the social worker if she goes to a dialysis center. Peritoneal dialysis is the cheapest option.
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I must add just about anyone can get an advantage plan but it's nearly impossible to get a supplement plan when you already have health issues. You have to gualify and there are a ton of questions they ask. When I had one I changed companies every time they increased. It finally got too expensive, the reason I enrolled in an advantage plan.
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Kidney dialysis should qualify a person for automatic disability and Medicaid (once financial criteria is met).
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anonymous972110 Nov 24, 2019
I am on dialysis and I do not qualify for disability or Medicaid. I still work and pay my own expenses.
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Call or visit your local DHS and find out about Medicare Savings Programs your State has available. It is not Medicaid. It can help your patient now. In Illinois you can even apply online.
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Every dialysis center certified by Medicare is required to have a licensed clinical social worker (LCSW) on staff. Ask them for ideas. Some states (like mine, Maryland) have a Kidney Commission (MKF) that can assist with co-pays for secondary coverage. One must apply and meet eligibility requirements as well.
The LCSW knows the dialysis center wants to bill that 20% for payment to the dialysis company thus have a vested interest in helping patients find secondary coverage to help the dialysis company get paid additionally because the Medicare reimbursement rate for dialysis treatments is close to nothing (in 2010 it was $131 a treatment). I’ve been out of that field since then.
I think no matter who you find to cover her, the premiums, deductibles and co-pays will be high due to her pre-existing conditions but not insurmountable if mom can pay.
Good luck!
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When is she wanting this to pay out?
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Don’t know but I wish you the best of luck with finding a solution to this trying situation.
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My mom is 85 and her Medi gap premium was up to $300 a month. I go to a broker every year. He is not a fan of Advantage plans but this year since her premium has increased so high he suggested she go with an Advantage plan. Medi gap plans are more limiting. I asked him if there were any pre_existing conditions with Advantage plans and he told me kidney failure. I would see a broker. Good luck!
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blueberrybelle Nov 24, 2019
Humana is the most expensive and hardest to find a doctor. That's why I got my Mom off it in her 90s and onto Kaiser Permanente. I hope there's one near you. It's efficient, cost-effective, and has plenty of doctors.
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Find a medicare specialist BROKER.

Humana is trash and they want everyone in an advantage plan because they are getting rich off of them.

A broker will be able to look at all companies and tell your friend what the options are. She may have to go through underwriting and then she may or may not be accepted, do the math and see what makes better sense.

If she doesn't qualify can she put a set amount aside monthly to cover her copays until the deductibles are met? I would encourage her to do that.
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Does she qualify for Medicaid health insurance? I would call ur local Office of Aging and see if they can help find something. Medigaps don't include prescriptions so that has to be purchased separately. My Mom had a state prescription plan called PADD. Your friend may qualify for that.
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Try finding an agent working for an independent insurance firm. They handle policies from several different companies and have a better chance finding an acceptable policy.
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Well....I don’t think we can give a yes or no answer to this question. If your friend is in VA then unfortunately they can be denied a supplemental policy because of their pre-existing conditions. Only 4 states require medigap policies to give policies to people with pre-existing conditions. So in a yes the Humana person is right, she may be denied coverage because of her pre-existing conditions.
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