Insuring the Disabled with Guaranteed Issue Pre-65 Medicare Supplements
Of all the people I help find health insurance, some of the most grateful are people under 65 who are
permanently disabled and have parts A and B of Medicare. Many disabled people believe that there is no way they’ll qualify for a health plan. A very important point I want to get across here is that there are guarantee issue health insurance plans for people who are under 65 and have parts A and B of Medicare. Both HMO and PPO, and some of the plans even include a prescription drug benefit.
When it comes to Medicare, it’s important that you know both sides of the story, and understand the advantages and disadvantages of relying solely on Medicare to provide for your health care needs. Though Medicare by itself covers many health care costs, there are many medical services that Medicare does not cover. This point is clearly made in the “Guide to Health Insurance for People with Medicare,” which is published yearly by the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services. As the guidebook suggests, there are health care costs that Medicare either does not pay in full or does not pay at all. If you need or want services not covered by Medicare, you must pay the bill. To help fill the gaps in your Medicare coverage, you have the option of buying supplemental insurance policies known as “Medigap” plans. Supplement plans help pay the bills Medicare does not, and provide you with protection from the ever-increasing gaps in Medicare.
For the pre-65 Medicare beneficiary there are certain guidelines and timeframes you need to follow in order the get a health insurance policy issued. For a Medicare Supplement plan acceptance of your application is guaranteed if you are under age 65 and apply within six (6) months of your initial enrollment in Part B of Medicare. You must already be enrolled in both Parts A and B of Medicare to apply for these plans. If you have missed the enrollment period you will have to wait until November 15th and apply for a Medicare Advantage Plan.
Medicare Advantage Plans are health plan options that are part of the Medicare program. If you join one of these plans, you generally get all your Medicare-covered health care through that plan. This coverage can include prescription drug coverage. Medicare Advantage Plans include:
• Medicare Health Maintenance Organization (HMOs)
• Preferred Provider Organizations (PPO)
• Private Fee-for-Service Plans
• Medicare Special Needs Plans
When you join a Medicare Advantage Plan, you use the health insurance card that you get from the plan for your health care. In most of these plans, generally there are extra benefits and lower copayments than in the Original Medicare Plan. However, you may have to see doctors that belong to the plan or go to certain hospitals to get services.
To join a Medicare Advantage Plan, you must have Medicare Part A and Part B. You will have to pay your monthly Medicare Part B premium to Medicare. In addition, you might have to pay a monthly premium to your Medicare Advantage Plan for the extra benefits that they offer.
So, if you are under 65 and have both parts A and B of Medicare, you can get good affordable California health insurance. We just need to follow a few rules and timelines.
December 23rd, 2008 at 12:58 pm
If there is any way that you can provide me with an answer to this question, I will appreciate your help greatly.
I am “uninsurable.” Because I had health insurance before a diagnosis, I have been able to remain insured through the many years since. I now have an Anthem Blue Cross Pre-65 plan in California.
If my parents’ health requires me to care for them in Pennsylvania, will I be able to buy a Pre-65 plan as a resident of Pennsylvania or will I find myself tossed into the “uninsurable” category?
December 31st, 2008 at 1:53 pm
I talked to an internal Anthem Blue Cross rep today and asked about your situation. If you move to Pennsylvania you can keep your pre-65 Anthem Blue Cross F plan. I would double check that answer by calling Senior Support at 800-928-6201. You also can coincide your move to Pennsylvania with your birth-day month and qualify under the Medicare Supplement Guaranteed Issue Guideline #8 which states:
“Birthday Rule: You are entitled to acceptance into equal or lesser value plans for 30 days beginning on your birthday. You must have a Medicare Supplement Plan and you must provide proof of prior coverage with your application.”
Whatever you do, do not cancel any coverage you have in force now until you have a new policy accepted and issued.
You do have a fairly unique situation and I hope I was able to help.