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n

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Silver Conversationalist

Ask your so called insurance experts to explain Wellcare and QMB (Qualified Medicare Beneficiary) to you.. Wellcare may not be available to you in your state but I don't understand why QMB wouldn't be.. Good luck.

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Honored Social Butterfly

  • You are in a pickle.  

 

What do you mean by "regular Medicare":

1.  At 65 did you enroll in Medicare Part A?     With good employer coverage that's what people do - since Part A is usually "premium free".

2.  When did you sign up for Part B?   Are you saying that you are including Medicare Parts A & B when you say you are signed up for "regular Medicare?   Have you been paying your Medicare Part B premiums?  Out of your Social Security benefit?

 

You can prove that you had this employer coverage by completing and having the employer complete CMS Form L564

 

CMS.gov Credible Coverage:  For the Prescription Drug Coverage, the employer should have been issuing you a Notice of Creditable Coverage each year.  That is your proof that you had Prescription Drug Credible Coverage.

 

Tell me what you have NOW:  

🔲   Medicare Part A  - approximate date of beginning 

🔲   Medicare Part B - approximate date of beginning

🔲   Medicare Part D - (prescription drug coverage)

🔲   When did you lose the employer coverage through your wife's employer?

 

Were you on Disability Insurance (SSDI) before you went on Social Security Retirement - You do have that right?

It's Always Something . . . . Roseanna Roseannadanna
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Honored Social Butterfly

@kb4949 

So what should have happened - 

When people are disabled and receive SSDI after (2) years of being on SSDI, the Medicare program is opened up to them BUT states can determine if and when they may be eligible for MediGAP  coverage for those being uinder 65 years old.

Some states don’t allow any MediGAP sign ups if the person is less than 65 OR some states will limit the MediGAP plan choices - usually it is only Plan A which those less than 65 csn get.

So you missed that sign up - it is over and gone.

 

However once a SSDI beneficiary has reached the age of 65 - there is a DO-OVER period when guaranteed issue (GI) rights come back into play for a MediGAP choice.  You seemed to hsve missed that too because GI rights for s MediGAP choice only last a few months.

 

Now what you can do now - Your choice is gonna be a Medicare Advantage plan - usually they are full service plans now - the prescription drug program is built in to the plan - MAPD means Medicare Advantage with Prescription drug coverage.  

 

For more details in the state where you are, contact your State Health Insurance Programs (SHIP) at the state government’s Dept of Insurance.  OR find yourself a local reputable Medicare Insurance agent or broker who writes for many different companies so you will have a choice of plans and a vast formulary for your meds.

 

IF your income is very low and you have very low assets, you might qualify for a Medicare Savings Program that will cover some of the Medicare premium cost for you.  

 

There are all kinds of Medicare Advantage plans - there are some that are special needs plans, there are HMO types and PPO types - 

The MEDIGAP ship has sailed for you from the info you have given here.  Even if you might get one, from what you have said about your health condition, with under writing for those conditions, your premiums could be astronomical.  

 

A good, local, Medicare agent or broker that represents a lot of different Medicare insurers can help you find a plan for your needs.

You do need something to protect you financially since MediGAP coverage isn’t there for you.

 

Plus you may have some other unique details  in health, money / finances, medicine, special needs that you haven’t mentioned here that would make the difference in plan MA selection  - 

 

It's Always Something . . . . Roseanna Roseannadanna
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