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Medicare and Private Insurance
Jun 8, 2012

For last 18 months I have been on both private and SS Disability after heart attack/HIV. I will be eligible for Medicare in 6 months. I currently am covered by my emplolyer insurance, which will convert to either COBRA or Private Retiree Insurance in 30 days. My question is...Once I am eligible for Medicare, is there any reason for me to also keep my private Retiree Insurance. It is a great plan, but is approx $600 a month and the lifetime cap is $500k. Should I keep it as "back-up", or will medicare cover all i need as far as care and prescriptions.

It is all a little confusing. Your advise is appreciated.

Response from Mr. Chambers

Medicare is good coverage but there are gaps. The ideal would be to take Medicare Parts A & B, add a Part D prescription drug benefit AND buy a privately insured Medicare Supplement (Medigap) Policy.

However, there may be an issue with getting a Medigap policy. Federal law requires that someone getting Medicare due to turning 65 MUST be allowed to purchase a Medigap policy regardless of their medical condition.

However, there is no such matching federal law for people getting Medicare due to being on SSDI for 24 months. And, since Medigap policies are sold by insurance companies, they may require proof of good health to people applying outside the open enrollment period. Given your history of heart attack, you would not qualify that way.

Many states have passed their own laws that add an open enrollment period to people under age 65 getting Medicare due to disability. You need to check with your state's Department of Insurance to see if there is such a law in your state. If so, take advantage of it.

The federal government sets the benefits for those Medigap plans, and I recommend that, if it is available to you, purchase F. It is the broadest. Although not terribly cheap it should be much less than your retiree coverage.

An alternative would be to keep your retiree coverage, although expensive. Once you turn 65, you will have the federal open enrollment to buy a Medigap. If you are on COBRA when Medicare starts, COBRA coverage automatically stops.

Another alternative would be to see if there is a satisfactory Medicare Advantage Plan availoable. In most jurisdictions, almost all of the Medicare Advantage Plans are HMOs, and that type of coverage may not be satisfactory to you, but you might want to explore it in your state to be sure. You may find an HMO you like and some areas offer a few PPO plans. You can see what plans are available in your area by clicking here. clicking here. Click on Compare Drug and Health Plans.

Remember, you can change from Medicare Advantage back to Medicare during each annual enrollment period which begins October 15 and runs through December 7 each year for a January 1 effective date.

Good luck, Jacques



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