Supplemental Insurance whats best??

Hello all! I am going to b eligible for Medicare on the 1st of June and I'm needing some good advice on what supplemental insurance to get?? Some1 I knew suggested to get Humana, but when I called to get info from them it was if they didn't know what I was talking abt. They told me that unless medically necessary they wouldn't cover the gastric bypass, well hello nowadays everyone getting approved for surgery, or having surgery due to their weight issue is medically necessary right? I guess I'm just wanting some advice from u or any1 who may have had supplemental insurance and can guide me in the right direction?? Hope to hear from u soon. Until the God Bless n b safe all...

Rachel

This list may help - as long as they see some comorbidites you should not have a problem getting improved.

Comorbidities are medical conditions that exist in addition to obesity and are often a result of being overweight. Comorbidities are a factor in determining a patient's eligibility for bariatric surgery. 

• Type 2 diabetes mellitus - metabolic disorder resulting from the body's inability to produce enough, or to properly use, insulin
  
   
• Obstructive sleep apnea - when a child stops breathing during periods of sleep
  
   
• Pseudotumor cerebri - increased pressure in the brain which causes chronic headaches and eye problems
  
   
• Hypertension - higher than normal pressure inside the arteries
  
   
• Dyslipidemias - abnormal concentrations of lipids in the blood
  
   
• Non-alcoholic steatohepatitis - fatty inflammation of the liver that is not caused by alcohol damage
  
   
• Venous stasis disease - faulty veins that allow blood to collect in the lower legs
  
   
• Significant impairment in activities of daily living 
  
   
• Intertriginous soft tissue infections - infections in excess folds of skin that are caused by obesity
  
   
• Stress urinary incontinence - involuntary leakage of urine caused by increased abdominal pressure from excessive body fat
  
   
• Gastroesophageal reflux disease - a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus
  
   
• Weight-related arthropathies (joint diseases) which impair physical activity
  
   
• Obesity-related psychosocial stress

I have Medicare and a Medigap/ supplemental plan F with BC/BS of KS.  To make it easier to compare plans, the govt. made the supplemental companies offer plans with a letter, hence, all plans A had to offer the same benefits, all plans B had to offer a certain set of benefits (different than A and the other letters), and so on.  I think it goes all the way to K or L (I am not sure).  For the most part, I think the letter of the plan counts more than the company that you choose (such as Humana, Cigna, Aetna, BC/BS of __, etc.), because they all are supposed to cover the same things within the same letter (such as all plan Fs).

At least in KS, you can get a hard copy or online version of handbooks explaining how these work, and what options to consider when making this choice, and a phone number you can call to get a volunteer counselor to help you make a good supplemental plan choice.  I think all states have such numbers.  Here, at least, the guidebook is available from the state's dept. of insurance/insurance commissioner's office, and the Dept. of Aging (can get even if you are under 65).

As to WLS, I think the supplemental plan has to go by what Medicare covered, then the policies of that letter (my plan F does not make me pay a deductible at the hospital, for example, but some letters make you pay that).  For example, if Medicare covers your band, RNY, or DS, Medicare pays first, then your supplemental pays the deductible and 20% copay.  If you get a VSG, I think Medicare would deny the whole claim, and then your supplemental would also deny it altogether.  You would be responsible for the whole bill.

BC/BS of KS hates WLS and totally excludes it from all plans they offer, as far as I know (unless they have changed recently), but that is when they are the primary insurance.  It is my understanding that the Medicare supplemental plans they offer have to cover what Medicare does, so they can't weasel out of their portion of my WLS bill (I hope, at least!!! I am still pre-op, so take that with a grain of salt).

It depends on your state law on whether or not they have to let a person who has Medicare based on disability (not age) become a customer of theirs.  I am lucky in that KS makes them accept me as a customer even though I am disabled, if I enroll within a certain time (6 months, I think) of first getting Medicare.  So don't delay.  If I would have waited too long, then they could have denied me based on their underwriting (knowing I use services more than the average person does).

Having this supplemental plan has been a huge blessing to me!!!  Before I had Medicare, I had BC/BS of KS from my former employer, and the copay for each mental health therapy appt. was $25 last year (before that was only $15).  I know that is much lower than some people's, yet it was a real burden to me, at my income.  With Medicare, therapy was until recently only covered at 50%.  (It is transitioning over the next few years to be 80% like other medical things; right now it's at 55%.)  There is no way I could pay half or 45% of my therapy bills.  I would have had to switch providers to the low-quality community mental health facility in my county that gets tax money and only charges a little bit to poor people.  Luckily, I did not have to change therapists, because I had supplemental plan F, and it pays all the rest of my therapy bill!  My therapist (who is also my psychiatrist/meds prescriber) accepts Medicare, and my current copay and deductible, after the supplemental insurance, is zero, zip, nada, so I can go weekly. 

Medicare supplemental plans work different.  BC/BS works as a secondary plan and whatever Medicare pays 80%, BC/BS automatically pays the remainding 20%.  That is how supplemental plans work.  I have it in NY and everything was paid for 100%.  They dont' preauthorize though.

If you are under 65, you must be Social Security disability for 2 years and then you automatically get medicare.

I�have Empire BC/BS -that is the NY�version of BC/BS.� The way the supplemental plans work, if medicare pays the 80%, then the supplemental plan will pay for the remaining 20%.� Medicare doesn't preauthorize. �You must go to a center of excellence and have a BMI�of 40 or over.� You must have certain co-morbities - I�think atleast 1 - diabetes, heart disease, sleep apnea, high blood pressure, arthritis, GERD, asthma, not sure of the rest of the list.� If your BMI�is 35-40, there are more requirements.� You must have a Nutritional consult and psych consult but you do not have to do a 6 month preop diet.� The rest is up to your surgeon, whatever he or she requires.

Each state has a different BC/BS, AARP�is very good but you have to be 50 or over, I�don't know if Humana has a medicare supplemental plan (they have an HMO�plan), I think GHI�might have one.� You can go to Medicare.gov and they probably have more info or call medicare and they can send you info.� I�know in the state of NY, since I was under 50 - Empire was my only choice.� No one else would accept me.� I�am also on plan B - the only thing I�have to pay out of pocket is a $135 deductible for the doctors each year.� My surgery cost me nothing except for the nutritionists - they dont' take insurance (atleast at my surgeons office)

Thax so much for ur responses.. I do have Medicare as of 06/01 of this yr. I can't wait to get the process started as far as blood tests, sleep study, etc... I tried calling for Humana Supplemental & they told me that it wouldn't cover unless medically necessary plus the rep didn't sound like she new what she was talking abt. Told me to call back in 2 weeks cuz they were still enrolling or in the process of enrolling.. Very weird. Anyway I said that I would call back but in the meantime I'm gonna go ahead & look into the Medigap as well to see what the state of Texas has to cover this procedure. Anybody have Medicare plus Medigap for RNY procedure?? Hit me up if u can I would really appreciate it. I will do more research on my end as well. Hope to hear from u soon & again want to thank u all for ur help...

Rachel

I don't think Texas has anything to do with it.  Medicare covers it but they dont' preauthorize it. If you meet there qualifications, you have to have the surgery and hope they cover it after the fact.  Whatever Medicare covers, the medigap will pay the extra 20%.  The medigap won't preauthorize either.  They have to cover it if medicare covers it, they have no choice - that is how medicare and medigaps work. 

I would get a list of all medigaps in the state of texas, get the prices and see what works for you.  They have different plans - B, F, H, J,K - not sure if that is all the letters.  If you are under 50, then you can only get plan B - atleast that is how it is in NY.