What To Do With Patrick

Bob_The_Insurance_Guy

Guru
1000 Post Club
1,908
Decatur, Ga.
Got a lead from an associate of mine. The individual's employer emailed me the following information:

Patrick is 57 years old and has Type 2 diabetes and MS.

Metformin-1000 mg-2Xdaily
Glipizide-2.5 mg-1Xdaily
Trilipix-135 mg-1Xdaily
Provigil-200mg-1Xdaily
Lisinopril-10mg-1Xdaily
Pravastatin-40 mg-1Xdaily
Gabbapentin-300mg-4Xdaily
Carbatrol-300mg-4Xdaily
Capaxone-1Xdaily-injection

Here's what I know:
  • he is currently on their group plan
  • they are interested in finding out if he can be put on a Medicare Supplement
  • he is drawing Social Security
Here's what I don't know:
  • what the monthly premium is for him on the plan
  • if he is eligible for any Medicare-based coverage (under a Special Needs Plan)
Didn't know where this post had a home, so I put it here. The lady I need to talk to has left for the day, so I will call back tomorrow.
 
Seeing that he is 57, there isn't a Medicare Supplement available for him in Georgia (at one point, United American had a Plan B available to those under 65 but it was outrageously priced - not sure if that's still available in Georgia or not). If he loses his employer coverage and is on Medicare, he could get a Medicare Advantage plan.
 
Questions,
1) Does this person have Parts A & B of Medicare?
If "yes", is employer plan primary or MSP?
If "yes", what are eff dates of Parts A & B of Medicare?
 
So, just to clarify my thinking, even if he is receiving Medicare Parts A and B, he still does not qualify to enroll in a Medicare Supplement, due solely on his age.

However, he is eligible for a Medicare Advantage Plan, receiving Medicare Parts A and B, and being age 57.

Correct?
 
If he is "new" to Medicare, here in Cali, I would have many Medicare supplemental plans to offer a 57 yr old.
What state does this person live in?
 
Here's the rest of the story:


Yes, for A & B, and his monthly insurance cost through the group $575.22 which includes prescription coverage., Also in speaking with his wife I learned that they also signed him up for D and that the cost varies (she didn't give me cost) but increases every month, I guess due to his meds and that he did not want D due to the cost. The group insurance went up 29% at this renewal and is probably in danger of being cost maxed out at next renewal. We are trying to compare what is best for Patrick and the company cost wise since the company pays 50% of the premiums.

So, I assume it's Medicare Advantage to the rescue. Has to be a MA only plan, because I doubt every one of his meds will be covered.
 
Well, I think I am just going to have to turn this one away. Here's the deal breaker in all this:

I was going to put him on a CIP Gold Rx Chronic Illness Plan (having Diabetes makes him eligible). It was a zero premium plan, good coverage for hospital, doctors, and medicine. EXCEPT for one medicine he takes for his MS.

Capaxone is the name of the medicine, and it is not on the formulary at CIP. I spoke with his wife last night and asked her if there was a generic for it, or a substitute for it, and she said "no". Capaxone, without insurance, runs $4,000 per month. On the group plan, through BCBSGa, it costs him $600 per month.

There is no way I can say to them, "here, take the CIP Plan. It will cover most everything, except you will have to pay $4,000 per month for this one medication."

I double checked, and his age prevents him from getting a Med Supp until he is 65 in Georgia.

Any ideas?
:GEEK:
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Yeah, I've got one.

LEARN HOW TO SPELL, ***!

The correct spelling is COPAXONE. I have called CIP for you, and it is in their formulary. It will cost Patrick $1277 for the first three months. After that, he will pay 5% of retail price.

Jeez. How long have you been doing this? Who in the he** would have you for their agent.
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Do you ever get the feeling your talking to yourself?
 
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