Thursday, January 30, 2014

Medicare for Young Folks: A Case Study

A friend of mine recently reached out to me for some advice about his disabled daughter. Years ago, while an Honor Student at a prestigious Midwestern university, she needed emergency surgery, and while under anesthesia, an accident occurred: oxygen was cut off to her brain for many minutes, resulting in permanent brain damage.

She is still able to converse for brief periods of time, but unable to earn a living or live on her own. Even though she's only in her early 30's, she does qualify for Medicare and for the "Extra Help" program that substantially reduced her out-of-pocket for necessary medications.

Her father - my friend - is retiring soon, and asked for my help in researching health insurance alternatives for his daughter. What he was looking for would be a pre-65 Medicare supplement (MedSupp) for her. He already knew of one potential source: for a monthly premium of $300, he could add her to his post-retirement health plan (provided by a former employer). He asked me if there were others, and I agreed to research this (mostly because I think this is a very interesting scenario, plus I get to help a friend).

I identified several potential avenues, and began to determine their viability:

First, I recalled that - years ago - the 'Medicare And You booklet' put out by our state Department of Insurance (DOI) used to include a list of the handful of carriers that sold pre-65 MedSupps. I clicked over to the site and downloaded the latest version, and began to search through it for that list.

It was nowhere to be found.

So I called the DOI to see if I was just looking past it, and was told that it wasn't me: there are currently no longer any carriers that market these plans (at least not here in the Buckeye State). So much for that.

But the nice gentleman at the DOI did mention that Medicare Advantage plans are available to serve this market, although the young lady would have to be in an Open Enrollment period. I turned to my own Medicare Advantage guru, Roger D (I long-ago decided against selling these myself), who kindly offered his expertise. One thing he suggested I do is to determine whether or not the young lady was participating in the Extra Help program.

Extra Help enables qualifying Medicare beneficiaries to purchase their meds at greatly reduced prices, with the government (well, fellow tax-payers) picking up the cost. According to the Social Security Administration (which oversees the program), Extra Help "is estimated to be worth about $4,000 peryear." Nice!

I also started looking into whether or not she could buy an ACA-plan from the Exchange.

In Part 2, we discuss the results.
blog comments powered by Disqus