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Medicare / disability coverage with gap insurance
01-31-2012, 05:52 PM
Post: #1
Medicare / disability coverage with gap insurance
I am going to be eligible for Disability Medicare in next few months and am fairly confused over gap insurance vs Advantage plans. I currently live in NJ and this state has some wonderful rules that help folks with pre-existing conditions get insurance without any extra fees or being turned down. But I want to move out of state.....

I currently have an individual HMO plan that is getting very costly since I turned 50. I am anxious to get on Medicare but it seems getting a gap policy is not an automatic when you are under 65.

From what I can understand gap insurance still has pre-existing conditions when under 65. Advantage plans I am not sure what their rules are, they seem to vary state to state.

Are you guaranteed coverage to an Advantage Plan in any state? I don't exactly know what state I am moving to but it most likely will be NC, SC, NV or AZ. Is there any chart that shows state by state what the rules are for gap insurance?

Also do Advantage plans have limits on procedures? For example my current plan has a total of 60 days of physical therapy for lifetime per condition.
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02-01-2012, 01:39 PM
Post: #2
RE: Medicare / disability coverage with gap insurance
Hi flyfoam, welcome to our medicare forum!

I am not sure I can answer your question but wanted to let you know you weren't being ignored.

I do know that the Medicare Advantage plans just cover certain geographic areas and have their own network of doctors and hospitals. If you do not use their network your coverage is reduced, sometimes severely. So if you are not sure where you are moving and you go on Medicare before you move it would be best to get original Medicare and a supplement. Once you move you can change to a Medicare Advantage plan during the annual open enrollment period if you find one that you like better than original Medicare. Also during the open enrollment you can change from a Medicare Advantage plan back to original medicare as well as change to another prescription drug program. (part d)

The other part of your question I am just nor sure. I did not know that anyone eligible for Medicare could be excluded from a Medicare advantage program, but again I am just a layperson on Medicare and not an expert.

Maybe someone in the industry can answer your question.

My posts are for general discussions only and are not to be taken as professional advice. You should consult with your medical, physician, insurance or other professionals as appropriate.
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04-07-2012, 10:17 PM
Post: #3
RE: Medicare / disability coverage with gap insurance
My reply is quite late, and I hope you already found the answers to your questions.

If you are eligible for Medicare, you are eligible for the Medicare Advantage plan of your choice. As long as that plan is offered in your area, and they are accepting new members. There in an exception. If you have or had ESRD (End-Stage Renal Disease) the plan can choose not to accept you.

Medigap plans are controlled by the state. Each state has their own rules whether to allow those under 65 policies and under what conditions. To the best of my knowledge there is no one compiling a list of the rules for each state. It is just best to call the State Department of Insurance for the state you are thinking on moving to.

Most MA plans do have limits for most procedures. These limits will be stated on the plan materials. They will also be listed on the Medicare.gov website if you are using that to shop around new plans.
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04-07-2012, 10:53 PM
Post: #4
RE: Medicare / disability coverage with gap insurance
United Health Care held a Medicare meeting at a local iHop by me. I attended and it was very helpful. I was able to get gap/supplement insurance since I am over 50. If you are under 50 it's not offered.

I prefer GAP insurance because the Advantage plans are all network Dr's and I get frustrated not being to select the specialist I want. The advantage plans do offer out of network options with 70% coverage. I was very surprised to find out that United's Advantage plan does not have Sloan Kettering as an in network choice. Paying 30% of a hospital bill would get way too pricey.

Overall I am happy with the coverage United offered. The supplement and prescription plan came to about $190 a month plus the $99 for Part B medicare. That's way better than the $900+ I am paying now for a HMO plan with United.
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04-09-2012, 02:40 PM
Post: #5
RE: Medicare / disability coverage with gap insurance
(04-07-2012 10:53 PM)flyfoam Wrote:  United Health Care held a Medicare meeting at a local iHop by me. I attended and it was very helpful. I was able to get gap/supplement insurance since I am over 50. If you are under 50 it's not offered.

I prefer GAP insurance because the Advantage plans are all network Dr's and I get frustrated not being to select the specialist I want. The advantage plans do offer out of network options with 70% coverage. I was very surprised to find out that United's Advantage plan does not have Sloan Kettering as an in network choice. Paying 30% of a hospital bill would get way too pricey.

Overall I am happy with the coverage United offered. The supplement and prescription plan came to about $190 a month plus the $99 for Part B medicare. That's way better than the $900+ I am paying now for a HMO plan with United.

Wow. $900 a month hurts just to think about. How long have you had the HMO plan with United? Surely there's a better option until you hit the age minimum.

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04-09-2012, 03:11 PM
Post: #6
RE: Medicare / disability coverage with gap insurance
$900 sounds quite excessive. It is a little high if your HMO was an employer plan or COBRA. It sounds very much like highway robbery if it was a Medicare Advantage plan.
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04-09-2012, 03:23 PM
Post: #7
RE: Medicare / disability coverage with gap insurance
(04-09-2012 03:11 PM)Vaughn Kruger Wrote:  $900 sounds quite excessive. It is a little high if your HMO was an employer plan or COBRA. It sounds very much like highway robbery if it was a Medicare Advantage plan.

Yes, I've heard of Cobra plans in excess of $650 to $750 per month, but $900 is a first. So sorry!

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04-09-2012, 03:48 PM
Post: #8
RE: Medicare / disability coverage with gap insurance
(04-09-2012 03:11 PM)Vaughn Kruger Wrote:  $900 sounds quite excessive. It is a little high if your HMO was an employer plan or COBRA. It sounds very much like highway robbery if it was a Medicare Advantage plan.
It was an individual plan, not an employer plan. I shopped too Blue Cross Horizon was a few bucks more. My group policy was around $430 per month but they went out of business and cobra is not offered when an employer goes under.
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05-23-2012, 02:53 PM (This post was last modified: 05-23-2012 03:00 PM by jrm105.)
Post: #9
RE: Medicare / disability coverage with gap insurance
(01-31-2012 05:52 PM)flyfoam Wrote:  I am going to be eligible for Disability Medicare in next few months and am fairly confused over gap insurance vs Advantage plans. I currently live in NJ and this state has some wonderful rules that help folks with pre-existing conditions get insurance without any extra fees or being turned down. But I want to move out of state.....

I currently have an individual HMO plan that is getting very costly since I turned 50. I am anxious to get on Medicare but it seems getting a gap policy is not an automatic when you are under 65.

From what I can understand gap insurance still has pre-existing conditions when under 65. Advantage plans I am not sure what their rules are, they seem to vary state to state.

Are you guaranteed coverage to an Advantage Plan in any state? I don't exactly know what state I am moving to but it most likely will be NC, SC, NV or AZ. Is there any chart that shows state by state what the rules are for gap insurance?

Also do Advantage plans have limits on procedures? For example my current plan has a total of 60 days of physical therapy for lifetime per condition.

My reply is also very late and perhaps you have your answers. I hope my response will help you and others who might find themselves with the same questions.

If you are moving onto Medicare through Disability and moving to SC (pretty much any state actually) you will be given an opportunity by Medicare to enroll in any plan you want that is in the SERVICE AREA you move to. Generally service area means the county you live in. You can go to the official web site called: http://www.Medicare.gov and there you will find plenty of information including the ability to go to a particular zip code and see what Medicare Advantage Plans, Drug plans and Medicare supplements are available.

You indicated you are in your 50's. You will find in SC that your age will limit the Medicare supplement available to you. HOWEVER. the good news is that you will be allowed to enroll in ANY Medicare Advantage Plan in your service area, so long as you do not have End stage renal disease. In SC there are a number of good plans but not all are available in every county. (once you are enrolled it is good all over the United States) You simply have to live in a service county to enroll in it. An MAPD plan offers drug coverage inside the plan itself so that you don't have to spend extra money getting a drug plan and the really good news is that most MAPD plans are very reasonable, including some with a zero premium and yes, they are full plans offering everything the law requires them to do and more. Med supp plans when under 65 are not the best deal in town but a Medicare Advantage Plan has NO pre-existing conditions other than ERSD and that one will keep you off most plans. Once you enroll you have full coverage no pre-existing conditions allowed. As you may have surmised I am an insurance agent and so have a greater than average knowledge of these plans.

So, if you want to move to SC come on down! We will be glad to have you join us.
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05-23-2012, 04:24 PM
Post: #10
RE: Medicare / disability coverage with gap insurance
(05-23-2012 02:53 PM)jrm105 Wrote:  
(01-31-2012 05:52 PM)flyfoam Wrote:  I am going to be eligible for Disability Medicare in next few months and am fairly confused over gap insurance vs Advantage plans. I currently live in NJ and this state has some wonderful rules that help folks with pre-existing conditions get insurance without any extra fees or being turned down. But I want to move out of state.....

I currently have an individual HMO plan that is getting very costly since I turned 50. I am anxious to get on Medicare but it seems getting a gap policy is not an automatic when you are under 65.

From what I can understand gap insurance still has pre-existing conditions when under 65. Advantage plans I am not sure what their rules are, they seem to vary state to state.

Are you guaranteed coverage to an Advantage Plan in any state? I don't exactly know what state I am moving to but it most likely will be NC, SC, NV or AZ. Is there any chart that shows state by state what the rules are for gap insurance?

Also do Advantage plans have limits on procedures? For example my current plan has a total of 60 days of physical therapy for lifetime per condition.

My reply is also very late and perhaps you have your answers. I hope my response will help you and others who might find themselves with the same questions.

If you are moving onto Medicare through Disability and moving to SC (pretty much any state actually) you will be given an opportunity by Medicare to enroll in any plan you want that is in the SERVICE AREA you move to. Generally service area means the county you live in. You can go to the official web site called: http://www.Medicare.gov and there you will find plenty of information including the ability to go to a particular zip code and see what Medicare Advantage Plans, Drug plans and Medicare supplements are available.

You indicated you are in your 50's. You will find in SC that your age will limit the Medicare supplement available to you. HOWEVER. the good news is that you will be allowed to enroll in ANY Medicare Advantage Plan in your service area, so long as you do not have End stage renal disease. In SC there are a number of good plans but not all are available in every county. (once you are enrolled it is good all over the United States) You simply have to live in a service county to enroll in it. An MAPD plan offers drug coverage inside the plan itself so that you don't have to spend extra money getting a drug plan and the really good news is that most MAPD plans are very reasonable, including some with a zero premium and yes, they are full plans offering everything the law requires them to do and more. Med supp plans when under 65 are not the best deal in town but a Medicare Advantage Plan has NO pre-existing conditions other than ERSD and that one will keep you off most plans. Once you enroll you have full coverage no pre-existing conditions allowed. As you may have surmised I am an insurance agent and so have a greater than average knowledge of these plans.

So, if you want to move to SC come on down! We will be glad to have you join us.
I thought once you were enrolled in a Medicare Supplement plan it would carry forward to any state. It's the Medicare Advantage plans that I understood you need to reapply depending on where you move.
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