It's complicated!

There are so many questions.

The SAA SpA community has answers to help you navigate.

Check out these recent questions answered by our SpA advocates and community.

We invite you to add your  Medicare questions or advice by emailing advocacy@spondylitis.org, subject line “My experiences & advice for Medicare & SpA.”  

(For more information and assistance, check the Medicare Rights Center here.)

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Question:

Hello!   I am a 64-year-old male with AS.  Wondering if Spondylitis.org has advice on the best Medicare plan(s) I might choose in six months when I turn 65.   

Thanks,
AS Warrior in New Hampshire
 

Answer #1:

The best advice is to create a personal login page on the Medicare website.  Medicare will show you all the plans available in your area and the benefits of each plan, with a simple comparison chart for each plan. 

You have the option, with original Medicare, to have “Medigap” supplemental plans. Medigap plans pick up where Medicare leaves off. Some Medigap plans pay your deductible. Original Medicare has many different supplemental plans, with many different options. 

Supplemental “advantage plans” are like group health insurance. These plans have networks, and you pay for medical services as you go along. Private insurance companies sell and administer the plans.  Many supplemental “advantage plans” are advertised on television. 

Another resource is AARP, which offers United Healthcare Advantage Plan. The AARP individuals are very knowledgeable and helpful. You must be a member of AARP to use the United Healthcare plan. 

Some states have “free-standing” stores, like Blue Cross/Blue Shield, where you can make an appointment for an explanation of the plans offered. 

Every state and county has a Department of Aging which will answer your questions and explain the supplemental plans. Usually, volunteers have extensive knowledge about Medicare. 

Once you have the comparisons and plan information details, speaking with a broker may be helpful. However, a broker works on commission, so unless you understand exactly what you need and want for supplemental insurance, it can become confusing. 

I hope this is helpful!

Victoria

P.S

United Health Care Advantage Plan through AARP provided complete coverage for my brother’s Remicade treatments. 

The plan put the Remicade coverage and administration under the prescription plan. However, the monthly Remicade infusions had to be administered in a hospital setting, not a doctor’s office or at home. 

Answer #2:

Medicare is a very personal choice for everyone.   I've been on Disability Medicare Insurance for the last 2 years. My disability dates back 5 years ago.  And April 2023 will be the 66-year 4-month time to toggle over to Full Retirement Medicare.  Where I can work and get paid over $877 per month and not lose Medicare Insurance or Disability payments. 

It really depends on the person's situation, whether he is on disability presently with higher payouts monthly, or lesser payments monthly based on time in working class and income presented to Social Security.   

Also, it depends on TNF Blockers or high-cost treatments that may not be fully covered under the medicine portion of Medicare; hence, they will be administered by a provider.   It is also different, whereas under public insurance you can get a visa copay card directly from the drug company which can be assigned to the provider to help pay copays for, say, Remicaid Infusions. Once on Medicare, whether from a disability or turning 65, Medicare will not allow drug companies to help pay for copays, so now you’re stuck getting up to a $650 bill from your provider because Medicare does not show these types of administered specialty drugs within the comparison Medicines covered, because those Medicare Advantage plans won't usually show these types of "Administer Infusion drugs" as like a drug you would get at your local pharmacist. 

If you’re not taking any specialty drugs, the Silver Plans are the best "in my opinion" for a Medicare recipient. 

It's very tricky. Be very thorough while comparing the state you are comparing with. 

People don't need to get caught up with agents trying to sell them a certain plan...   You can do it all online at Medicare/gov, which gives you a listing of carriers for their state, plus every Insurance Carrier will have more than one plan of coverage... That's where it becomes tricky. They can call the Insurance Carriers on their own and ask them questions about their various Medicare Advantage Plans. 

Also, you can call their local Social Security Office/branch and ask for an appointment to speak with one of their "Retirement Specialists". They will be able to show you firsthand how much you will get, and ...what will be deducted from the Social Security check for the base coverage.  They will be able to see firsthand whether their income can afford the Xtra coverage plans.  Affordability can be a factor, why I said it is an individual choice.   Btw, these S.S. Retirement Specialists are a 100% Free Service!   They will be able to refer to other free services that will help if you have not earned enough income over your working history. 

Dan

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We invite you to add your questions or advice by emailing advocacy@spondylitis.org, subject line “My experiences & advice for Medicare & SpA.”  

For more information and assistance, check the Medicare Rights Center here.