Need To Drop Medigap. Really Scared.

I've been on disability for A Very Long Time. I've had BC/BS since I was a child. After my last attempt to return to work failed, I switched my coverage to a Medigap policy (still thru Anthem/BCBS). At first it was fine, but once Anthem took over, the premiums more than doubled. Because I am under 65, they're allowed to do this. I now pay $370/month for that secondary policy. Now that I pay all the bills, that amount is killing me. I'm less than $2k/year over the federal poverty level. I've been told that I shouldn't drop this policy b/c I will never be able to replace it. It seems like a luxury at this point.

My big worry about dropping the policy is that I'll need more healthcare than I do now. I'm eligible for partial Medicaid (SLMB) and on a huge spend down for full Medicaid. I plan on saving some of the premium in a bank account, but can only have a certain amount in my bank account.. I know that my copay will be 20% of what Medicare approves. (Except for outpatient mental health, which is higher.) I know that what Medicare approves is usually much less than the billed amount, so my copays won't be as high.

I've been freaking out about this for quite a while now. I have schizoaffective disorder and, until they died, lived with my parents pretty much all my life. I'm scared all the time trying to figure things out.

Does anyone have any input, pro or con, as to what I should do and/or potential issues that could arise?

I would talk to my doctors' office(s) and see what they take and how it would affect your current care. It is probable that you will need more care the older you get and having/not having the plan will affect the quality of that care. I think of it more as an investment and a "given" like rent, than negotiable. Many doctors will not take you if you do not have that Medigap policy so finding a doctor, never mind a specialist, could be very hard, especially when you are sick and having to figure things out on your own? What is covered by Medicare/Medicaid is also more limited and the Medigap policy helps there too, covering things that are not covered.

Perna, Thanx for your reply! Much appreciated. I wanted to clarify a couple of things. Not sure how it affects your feelings on this.

Like many Medigap policies, my policy only pays on what is covered by Medicare. It pays deductibles and copays, nothing else.

My doctors just require that, if there's no secondary policy, you pay the copay at time of service. I've never heard of a doctor's office refusing care if someone doesn't have secondary insurance, though there are some specialists I haven't seen. Probably would need the money up front for non-emergency surgery. I have done insurance billing (years ago), but it was at pediatric clinics, where there tends to be less restrictions on seeing patients who owe money. For outpatient services, the local healthcare conglomerate asks for a partial payment up front. I asked about an MRI and was told that I would need to pay $50. They have on their website the income levels that they use to determine how much of your bill will be written off. I would not have to pay much, if any at all. In the past, I've had hospital bills written off. Not sure how the ACA affects this, but in the past, hospitals that received federal funds were required to provide a certain amount of charity care. The woman who does the Medicare insurance counseling said that this hospital wouldn't write off the bill from her husband's final admission. They have worked with her and she pays $5/month.

Sorry this is so long.

After you "spend down", will you be eligible for Medicaid to pay the premium for your Medicare Part B policy? I don't know a lot about this situation - I have a couple of acquaintances who have been on disability since their teens. The have both Medicare and Medicaid, and Medicaid pays their Medicare Part B premiums.

It may vary from state to state whether Medicaid will do that. Also, I think their income is just below the poverty line, not just above it.

Jo, thanx for your reply! I do have the SLMB which is where Medicaid pays my Medicare premium. I'm on a spend down for full coverage. Once my medical bills reach a certain level, I can get full Medicaid. I haven't reached that in years. The insurance does go towards the spend down, but dropping it won't have much affect. If I drop my insurance, I'll have money for dental work, which I can submit towards the spenddown. And the deductibles and copays will also go towards the spenddown. As will my counselor's fee, since Medicare doesn't cover LPCs unless there's a doctor on premises. He has a private practice, so no physicians.

Sorry I've been kind of dribbling out info. A big part of my problem has been not being able to think this thru. I blame the schizoaffective d/o. Putting it here and getting feedback is helping with the whole thing. It's one of the things I love about this site: That the people here understand the thought d/o issues and I don't feel judged if I can't get it all out at once in a coherent manner.

I sooo don't know anything about this.... but is there a social worker through the hospital that can help with possible resources or ideas? Here they help for free. What about disability coverage?

thinking of you

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Thanx for the suggestion, JD. I haven't tried that b/c I kept telling myself that they won't help me and then put the whole thing out of my mind. There is a "Contact Us" option, so I'll give that a try. Thanx again!

Hi jayne. Your income is just a little more than mine. I would agree that $370/month for Medigap is a luxury that you can't afford. That's a huge chunk of your annual income. (over $4000/year.)

Look into Medicare Advantage Plans. My boyfriend has an income silmilar to yours and mine. That is what he has. Advantage Plans tend to be the best bet for low income people. These plans are provided by private insurers, like Humana. They will happily send someone to explain the options to you. They have (usually) an option particularly for low income folks. Often there is no premium for you to pay. The "Advantage" Plan puts you into an HMO or PPO. The HMO is usually cheaper than the PPO. Sometimes the plan has nice extras, like free membership in a fitness center.

Now, being in an HMO, whuch is what an Advantage plan is, does limit what doctors you can go to. But your co-pay, if any, will be very low. I took my boyfriend to an excellent Urgent Care center, and his co-pay was $10 (for a cut foot.) He was seen by an actual doctor, rather than a Nurse Practitioner.

Make appointments to speak to a few representatives from different Advantage plans. Then when each one comes, say you are seeing others and will not make a decision until you have interviewed all of them. They will give you nice brochers and good explanations of how their plans work.

Get the Medicaid coverage to pay your Part B premium. I get that. Think about this: if the government feels you need help paying the Part B premium, then they sure don't expect that you should be spending hundreds of dollars per month on Medigap. Medigap is for people with more income and wealth than what you have. It gives them broader options, but you can still get decent healthcare in plans with fewer options.

The Advantage plan that you select will get something like $10,000 per year from the federal government for their agreement to take care of you. Out of that pile of money, whatever they don't spend on you is what they keep as profit. Google: "Advantage plans" for the state you live in. In my state we have ones that don't require any monthly premium at all. Then don't fret too much about which one to pick. You can switch to a different one, after a year. That's their incentive to keep you happy. Co-pays for the no, or low premium plans will not be very much, like I said above.

Definitely go after that full Medicaid, if you can get it. I was denied that, even though my income is slightly lower than yours. Medicaid takes care of dental and vision, which is a big deal. But some Advantage plans will give you a little dental and vision coverage, even if you don't have Medicaid. The only reason I am not on an Advantage plan myself, is because, back when I was close to indigent, I got taken into a special plan in my county that lets me access all my care through the local state university hospital, which also happens to have a full-service psychiatric facility. I've had the option to stay with that. Otherwise, I definitely would have got into a no-premium advantage plan.

I turn 65 in October and am going from my Blue Cross/Blue Shield plan ($405/month) to an Advantage plan, same as my husband has, "F"; done deliberately because I know my doctor is in the plan, also Blue Cross/Blue Shield, for like $64/month. I have to get separate pharmacy coverage but it, too, is not too bad, my total health insurance bill (including what is deducted from my Social Security for "B") should be only a little over half of what it is now.

Thanx for your reply, Rose!

Humana is the only one that offers Advantage plans in my area and not all of my docs were included. Not sure if any were. I will definitely recheck that, though. Thanx for explaining how it works.

I have the SLMB Medicaid that pays for my Medicare premiums. If I have medical and dental bills higher than a certain amount (I think about 70% of my disability check), full Medicaid will kick in. My state Medicaid doesn't cover dental or vision. It sounds like your state has better services.

Thanx again for all the info. It sounds like you've had to deal with a lot of this stuff, too.

So it kinda sounds like you would only get Medicaid, if something fairly catastrophic happened to you. They did give me partial Medicaid to cover the cost of getting contraceptives, which is pointless, since I'm past menopause. (For some reason, they don't bother filtering out older women.) Reading more about Medicaid, I see that the dental and vision tends to be only for children in a lot of states. (My state does cover adults, so wish I could have gotten it.)

There is also a federal program called "Extra Help," which covers a lot of the co-pays for prescription drugs. In my case, the government notified me that I was eligible for it. I'ld be surprised if you weren't eligible for it too. Here's a link:

Save on drug costs | Medicare.gov. (It looks to me like you would definitely qualify for "Extra Help.")

Here's another thing to remember: If your only income is SSDI or SSI, that income cannot be garnished. If all you have is that income and not much in the way of assets, then you are what is called "judgement proof." That is to say: you have nothing anyone can sue you for. Keep that in mind if you ever rack up hospital bills. Whatever their website might say, they are going to write off your bill because there is nothing else they can do. If you ever have to call an ambulance, the same thing applies. They really don't have a way to collect anything from you, if you simply say, "Sorry, but I can't afford to pay." Just remember not to call an ambulance merely for transportation, if a taxi is really all you need.

I'll bet that woman who is paying $5 per month doesn't even have to pay that. The main reason they want that five bucks a month is to prevent the statute of limitations from running out on collecting the debt. That way, if she wins big in the Lottery, they can come after the winnings to pay the debt.

If you are depriving yourself of dental care in order to be able to pay for your Medigap policy, that is probably not the wisest use of your money. Look into the Humana Advantage plans for your area. You might have to switch some doctors, but I would do that to save $4000 per year.

Perna, Sorry I didn't catch your reply.... It took me a while to do my last post, which is why I didn't see yours. I'm glad you're going to be able to cut your expenses back! I have a few more years before I can get the lower priced Medigap.

Rose, thanx for more info. That's funny that they offer free contraception to someone who's post-menopausal.

Thankfully, I do get the Extra Help.

That info about why the hospital is accepting $5/month was eye-opening. Yesterday, when I was talking to the lady at the physical therapy place, I found out how much was billed for last month. It was $1600. That's the full, non-Medicare-adjusted amount. The Medicare approved amount will be much less. Even if I had to pay the 20% copay of the full amount, it would still be less than my premium.

I have a car, so the only reason I would call an ambulance would be in an emergency when I couldn't drive myself and my neighbors were out

One thing I do wonder about is my home. My brothers and I inherited our parents' house. For now, I live here rent-free (I love my brothers), but pay the bills and part of the yearly costs. Could my portion of the house be taken from me? I would probably end up needing frequent hospitalizations, both psych and medical, if I lived in town.

I better go. Have to get ready for an appointment with my PDoc.

I do think that's exactly the way you need to reason it out. Those premiums are a very high cost just to preserve a wider array of options that may be wider than what you require. Also, I wonder just how much wider that array is. For instance: if you needed some complicated, dangerous surgery, I wonder if having Medigap would mean you are free to travel to any hospital in the country, like maybe someplace really prestigious, and you will be covered? Also, you have to ask yourself if that's something you would ever reasonably want to do, as it would entail other costs of travel and lodging that might be beyond your means.

Regarding ambulances, this has come up in threads before. If you can't drive and there is no one to take you AND you don't need the attention of EMTs/paramedics, then it is more appropriate to call a taxi for transportation. Of course, that can depend on the availability of taxi service in the area where you live.

The issue about you co-owning a valuable asset, like the home you live in, is a great question and beyond what I know much about. (I rent.) If I were in your shoes, I would think about scheduling a visit to a lawyer to discuss the implications of home ownership in my life. If you are near a big town, there may be free legal consultation available, like LegalAid for low income persons. Alternatively, one of your brothers may have a relationship with an attorney who could be asked about this.

The fact that you live in this house affords you some protection while you are alive and still living in it. Be aware that Medicaid sometimes comes after things like houses, after you die, to recover some of what they spent on you, while you were alive. It's called: "Medicaid Right of Recovery" or "Medicaid Estate Recovery." Google that for yourself. From what I've read, it's mostly only used to go after property of people who ended up living in nursing homes on Medicaid. I haven't read that it is used to recover expenditures to help you with things like paying part B Medicare premiums or out-patient care . . . or even in-patient care.

The next question is whether the house can be gone after by hospitals, doctors, etc. I doubt that they can, while you are living in it. But I would love to know what a lawyer would say, especially about what could happen, if you were to pass away owing a lot of money. Your brothers might want to ask one of their own lawyers about that. You probably already realize that, if your brothers ever buy you out, you will need to be very careful what you do with the money, while you are getting any form of Medicaid.

Never let it make you feel disturbed, if any medical bills you ever rack up get turned over to a collection agency. That is often done automatically and sometimes doesn't mean a blessed thing in terms of putting you in any greater danger, financially. Know that you are never legally obligated to talk to anyone on the phone about anything.

Regarding the lady above who pays five dollars per month: married people do share joint liability for certain things. If she owns property, it may be prudent for her to make the small monthly payments. Also, it sounds like she has an income that is not "judgement-proof," as Social Security is. I do think it is wise to know the Statute of Limitations for debt collections in your state. That can never kick in, while you are making any payments on a debt, which is why debt collectors so badly want you to pay "even a few dollars now and then." Sometimes, that is not so much a case of them "working with" you, as it is a case of them keeping you from availing yourself of debt relief to which you are legally entitled.

Part of my feelings about the house are that I'll cross that bridge when I and if I come to it. I don't have any children, so anything Medicaid might take won't really affect anyone, except possibly, slightly, my niece and nephew. I know if we sell the house, I'd have 30 days to use my portion of the money before it starts affecting benefits.

I did once have a hospital bill turned over to collection. They got very nasty about it. Ironically, it was the hospital that insisted I not work again. I finally got them to put the bill through Hill Burton funding.

I'll keep the taxi option in my head. Hopefully. There have been a couple of taxi companies brave enough to operate in this area. (There are a lot of roads here that probably wouldn't even qualify as tertiary. ) I also recently started talking to one of my neighbors who is retired. He told me to let him know if I needed anything.

My brain is refusing to do any more thinking right now. Thanks for sharing your knowledge; it's quite good and helpful.

Thanx for all of the input. I cancelled my policy as of August 1.

Here are some things I'm going to use the extra money for:

Dental work. Won't be able to afford all my dental needs, but will be looking into going to a dental school to maximize my dollars.

Storm door for added insulation and so I can open things up when the weather is nice.

Using the air conditioning. I have asthma and the heat and humidity make it worse. Related to the a/c and asthma: I need a dehumidifier for the basement.

Running the heat some in the winter.

Getting the septic tank pumped out. (Sorry for the gross, but this should have been done years ago. If I don't take care of it, I could end up with a huge expense, especially if they don't grandfather the current version. The new septic systems are very expensive.)

Eventually a couple of pairs of jeans and a t-shirt or two.

I just wanted to put this list out there so it's clear that this isn't for frivolous things. Obviously, some of the money is going to a bank account for future medical copays. And obviously, this can't all be done at once. I just feel a sense of relief now that it's done. Mixed in with terror.

Again, thanx for all the input. It helped me think things through and gave me the courage to do what I should have done months ago. I'm so glad to have this community for support.