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Questions regards Medicare and State High Risk pool=Indiana?
I live in the state of Indiana. My husband will be age 65, June 2010, so am looking at medicare policies and RX coverage. I understand Part A is Hospitals Part B is medical; ie doctor visits etc Part C is supplemental insurance Part D is RX My husband currently has a "gap policy" which are only 6 month policies that have major medical coverage, but can be renewed only 1 time for total of 1 year coverage. Each policy starts over as a new policy and if condition pre-existing will not cover. In the last couple of years have had to switch insurance companies due to the 1 year rule. He has Parkinson's disease, so unable to get individual policy since it is preexisting. I am unemployed, so no group policy and he is self-employed with 1 employee, no not eligible for group policy in his business. I checked today with the Indiana High Risk Pool and found that he could possibly be insured and that all preexisting conditions have a 3 month waiting period to be covered. Granted the premium is almost $1K per month, but it also has RX coverage of $300 deductible to meet and that is the average monthly cost for his drugs for his disease. On the brochure they also list rates for medicare which are almost the same as the high risk pool. My question is, why would someone get the high risk insurance if eligible for medicare? per medicare brochure, 2009 premium is $96. Would this apply to Supplemental insurance to Medicare Part A and B? Or even though he has pre-existing condition, would he still not be eligible for a regular supplemental policy when he turns age 65? Years ago, my own agent had told me that the high risk pool in Indiana had a $100K lifetime maximum and that was the reason for going with the gap policies so that we could get catastrophic coverage. But today, they told me there is no lifetime maximum except for mental illness, substance abuse and transplants that had cap of $250K; Can someone enlighten me and explain. Thanking everyone in advance.
5 months ago - 2 answers
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First off, Part C is the Medicare Advantage plans. Medicare Advantage plans and Medicare Supplements are two different products and they work differently. When he turns 65 he can get either a Medicare Advantage plan (most of which also include Part D coverage) or a Medicare Supplement with a stand-alone Part D plan. Both are guaranteed issue at age 65, meaning he cannot be turned down. The only reason I can see for being on the high risk pool and Medicare is if for some reason a person doesn't have Part B, or if they are under 65 with ESRD and cannot get a Medicare Advantage plan. With a Medicare Advantage plan he can change plans each year only during open enrollment from November 15 to December 31 and he cannot be turned down unless he has ESRD. Medicare Advantage plans generally have a lower premium but he will have a co-pay each time he uses medical services. With a Medicare Supplement he can possibly change plans at any time; but after the guaranteed issue period at age 65 he can be turned down or charged a higher premium. The Supplements generally have a higher premium but he will have no additional costs when using medical services in most cases. The premium of $96.40 is the Part B premium and must be paid no matter what additional coverage he'll have.
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Independent Agent Certified Senior Advisor®
by Zarnev
5 months ago
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Other Answers
Generally, they don't. High risk health pools are really for people who don't have Medicare access.
by mbrcatz- 5 months ago