Something New to Me, That I Need Your Help On:

[Jessica Durphy]

I have a gentleman that T65 in June.... He called me because he was referred to me. I met with him, and found that he has a lot of health issues that would keep him from getting into a supplement (if not GI)... I suggested that he get on a Plan C (in our area it's the best around for a really cheap price of $97.67)... He was very happy with that, then he questioned me about Drug plans that he had looked up on Medicare.gov, I told him of my suggestions and we did the pricing tools online (together)...and he found that with the drugs he's going to be taking, he'll be in the donut hole part way through the year.... So this gentleman (A RETIRED SCHOOL TEACHER) told me that he's going to have to think about it and let me know what he would do... he had a "seminar" that he had been scheduled to go to after our meeting, so he didn't want to decide before attending that seminar!

This gentleman called me a couple days after that seminar, and told me that he decided to go with Pennsylvania Public School Employees' Retirement System~(PSERS) They use Freedom Blue PPO... copays are $15.00 for Dr's and Specialists... Therapy visits (per visit/per day/ per provider), Diabetic Testing Supplies... covered 85%, he pays 15% $500.00 max out of pocket.... etc. (just to list a few)

This guy has really bad diabetes, just had a knee replacement, and has heart issues! He's already had to have therapy, and surgery, etc.... diabetic supplies... He's NOT happy at all with this coverage!

PSERS and everyone else he has talked to swore up and down that he would be a fool if he opted not to take that coverage! I tend to disagree... He does get a $100.00 benefit towards his coverage monthly... the premium for his MAPD plan is $125.00.. normally would be $225.00.... I feel he should have gone with the supplement and forgotten the $100.00, but I just am curious as to what you guys think?

His wife is turning 65 in Nov., we just wrote her with a Plan C, she's tickled pink and he's upset that he didn't go that route... Would he perhaps have the option to change and go to the Med Supp, even if his health would not allow it?

(I know that I could do a MoO Plan N) but I'm asking about a C, Just in case?!?!

Sorry so long, I just needed to give you the history.

 

[G.Gordon]

If he T65'd in June 2010 then he's still in his open enrollment so health does not come into play. He can do what the hell he wants to.

 

[Jessica Durphy]

That's awesome! Thanks so much! I told him today, I thought he could, but I wanted to be sure of my answer, do a little research, and ask some other agents what they thought as well.

 

[G.Gordon]

Until the last day of November he can dance from plan to plan.

 

[Jessica Durphy]

Yea, I was just reading Medicare.gov, and I was trying to find out for sure about a Drug plan... the same rules apply correct?!

His biggest concern, isn't so much the monthly premium, it's the cost of his drugs (TROOP)! He takes so many different ones that are EXPENSIVE!! And he's inevitable to hit the donut hole by mid year....He wants to know exactly what's coming out of his pocket!!!

I can get him into a plan that works great for him NOW, the next few months, but what about next year?! He's going to have to fuss with it again!

How would you handle that G.Gordon?! Suggest a PDP for him for the remainder of this year, and go ahead and suggest a PDP for next year beginning Jan 1, 2011, all at the same time??? I don't write PDP's, I more or less just "assist" a senior by helping them with the drug tools online! I don't know all the details of the different plans for next year yet... some but not most...

 

[G.Gordon]

What is the drug benefit like on the retirees plan he is in? If it is unlimited then that fact alone might make it worth you walking away and telling him he needs to stay put.

He has a 100% chance of spending a bunch of money on drugs.

He does not have a 100% chance of spending money on other medical expenses. He'd only spend $$ on medical expenses if/when they come up.

Understand?

I've walked from retirees spending $400-500/mo on retirement benefit plans because they have unlimited drug benefits. I exited the situation with the suggestion that IF they plan ever lowered the drug coverage or raised his cost sharing of them to a point that made him uncomfortable then he needed to re-contact me.

 

[ineedhelp]

If he T65'd in June 2010 then he's still in his open enrollment so health does not come into play. He can do what the hell he wants to.

If he T65 in June, isn't his GI option up the end of Sept ?

 

[bourbonlegend]

Sounds like he just has a blue cross MAPD and an overpriced one at that.

Even if his current part d coverage with the MAPD is the best available, you can probably get it as a stand alone plan.

Will the PSERS only apply the $100 towards that particular plan?

 

[G.Gordon]

ineedhelp,


Not if he is exiting retiree benefits. I've triggered this SEP for several this year alone. It is a call in to Medicare moment. I don't suggest you taking a part D application on him.
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Will the PSERS only apply the $100 towards that particular plan?

Good question. I have two retiree groups that get a payment monthly for having insurance or one sort or another.

 

[Frank Stastny]

If he T65 in June, isn't his GI option up the end of Sept ?

Medicare uses the term "Open Enrollment" not GI. His Open Enrollment period lasts for six months following the effective date of his Medicare Part B.

Actually, since he is T65 he can sign up for a Med Supp six months prior to the month he turns 65 and will have Open Enrollment for six months after his Part B effective date. That is a twelve month period.