Meds, Mind, Body & Benefits > Insurance, Benefits Programs & HIV

Private insurance Medicare suppliment question

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Oceanbeach:
Hey Forum Friends,

I just love being a 50's TV housewife.  June Cleaver with AIDS and has Medicare, Medi-Cal and ADAP assistance.  Mr. Ward Cleaver does not have HIV, is self employed and has private insurance.  The Cleavers are not legally married.

Mr. Ward Cleavers BCBS policy has a $1400.00 per month premium which was increased by 100% this year, 50% last year, is "grandfathered in" so Obamacare rules re: any rate increase over 10% do not apply.  BCBS has the right to charge any rate increase they choose.  Mr. Ward Cleaver has to pay $7500.00 out of pocket, share of cost, each year before receiving any benefits from this policy.

Mrs. Ward Cleaver has been living with AIDS for 17 years, goes to the same medical facility and the same pharmacy as Mr. Ward Cleaver but gets better care which is paid for by Medicare Parts A, B, & D.  The annual costs for Medical and Pharmacy are over $100,000.00 per year w/ no share of cost.  Mrs. Cleaver's meds cost $3600.00 per month and beginning in 2014 there will be a share of cost which escalates each year until 2020 when Medicare Part D is eliminated from the Medicare roster of services.

I am thinking...  If Ward and June cancel his private policy with BCBS policy in October 2013 and open a new policy with a different insurer, so this policy will not be "grandfathered in" and the insurer will be required to get govt approval for rate increases greater than 10%.  This will be a big savings.

The pre-existing conditions clause goes into effect in October 2013 as does the Pharmacy policy offers and pricing for 2014.  October 2013 is the time to shop.

Mrs. Cleavers medical costs, paid by Medicare Parts A & B is greater than Mr. Cleaver's annual out of pocket, share of cost.  My question is:  If Mr. & Mrs. Cleaver were on a joint policy with Mrs. Cleaver getting Medicare and Medi-Cal and using Mr. Cleavers policy as a supplement, would Mrs. Cleavers Medicare and Medi-Cal paid  medical costs apply to Mr. Cleavers share of cost?  If there is enough savings, I can justify pharmacy insurance for both of the Cleavers.   8)  Have the best day
Michael

JR Gabbard:
Hello Oceanbeach,
You would have to look at Ward's policy to see how they apply their pharmacy share of costs.  If they combine costs from different beneficiaries (if June and Ward aren't the same beneficiary), and if they allow SOC to be met by payments made on behalf of a secondary beneficiary (aka June), then maybe.
But in practical terms, I doubt it.
MediCal specifically, and Medicare in practice, consider themselves to be the payer of last resort.  That means if you have other insurance (if June is put on Ward's policy), Medi/Medi may expect that carrier to pick up the bulk of the payments, if not all.  So June would have to get her meds through Ward's pharmacy carrier, with Medi/Medi picking up the slack.
IOW, tread lightly June ol' gal!

mitch777:
Yikes June!

Just wondered how old Ward is these days.
Has he shopped around?
$17,000. per year with a $7500. deductible!!!

I thought my costs were high at $13,000. per year, no deductible, but I do have copays for almost everything which will add another $3,000. or so this year.
(I am self employed and also have BCBS)

Also, this is the second time I've heard about Medicare Part D fading away by 2020.
I hope to be on disability by this time next year (ALJ hearing) and know it will take a couple more years to get on Medicare.
What are June and I expected to do about our high cost of meds???
Does the current government drug coverage (I forget what it's called) for the elderly also apply to the disabled or will ADAP have to cover the full price of our meds?

I hope June and Ward (and I) are able to find a solution other than bankruptcy.
It wouldn't take long.

Oceanbeach:
Of all the TV moms, most people would see June Cleaver as a twit of a housewife who flounces around in a billowy apron while Ward Cleaver makes all the family decisions.  June called the insurance provider United Healthcare, the company has stated they and the other pharmacy providers will know in October, what they will charge during 2014.  There is nothing that can be done re: pharmacy until then.

Ward Cleaver doesn't shop...  His BCBS policy predates Aristotle and he bought online, has a printout.  June has shopped online but did not want the phone number of an agent in L.A..  A live independent agent, sitting at a desk in San Francisco who can be reached with a double latte.  That which JR said about MediMedi being the payer of last resort makes a lot of sense.  As I said earlier June Cleavers medical and pharmacy bills exceed $100,000.00 every year and June is never charged any share of cost.  Since her disability is AIDS, she will never be expected to work again, will always get SSDI and Medicare

Mitch, I have no idea why Wards BCBS policy is priced so much higher than yours.  He is in his mid fiftys, is a health single male living in San Francisco, never meets his deductible.  BCBS did increase his premium amount by 100% this year and 50% last year, because they can.  I read in another thread where Cigna was saddling their policy holders with unfair premium increases.   I am looking at AARP affiliated brokerage firms and will find something for Ward.

This leaves us all back at square 1, Who is going to pay the pharmacy when Medicare Part D is eliminated from the roster in 2020?  I speak with the Pharmacy Manager every month, they say they will call if there is a problem with any of the insurers while, the Pharmacy Provider won't know anything until October.  We are living with HIV, are we expected to live in blind trust the government will take care of it?  June Cleaver will probably ask Ward Cleaver to pay for pharmacy insurance   8)  Have the best day
Michael

   

mitch777:
Is June eligible for ADAP?
Wouldn't it solve the pharmacy dilemma ?

Sounds like Ward needs to get out more and learn the art of shopping.
My BCBS had a huge (30%) increase this year so I called the agent to find out what other plans were available.
We switched to a different BCBS plan with higher copays.
I think we will be saving a little but not much.
The insurance companies have us by our balls and the pain is turning me blue.

Guess I will check in October what is available at what cost.

You have a nice day too. :)
m.

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