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I have a friend who has original Medicare, but, is in desperate need of a Supplemental Health insurance to help pay the additional 20% of health care. She was told by a representative from Humana that due to her existing health condition it maybe hard for her to qualify for supplemental insurance. She has kidney disease (dialysis every 3 days of week), heart disease (bypass heart surgery), and diabetes.
My questions are: Does anyone know if there any hope of her getting Supplemental Health insurance with the existing health condition she has? If so, do you know the names of the Health agencies?


Any assistance you can provide me will be greatly appreciated.


Thanks.


Ann

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I must add just about anyone can get an advantage plan but it's nearly impossible to get a supplement plan when you already have health issues. You have to gualify and there are a ton of questions they ask. When I had one I changed companies every time they increased. It finally got too expensive, the reason I enrolled in an advantage plan.
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The Affordable Care Act (Obamacare) made it unlawful to discriminate against people with pre-existing illnesses.

I hope Trump hasn't totally wrecked the Act -- as he has removed the mantatory insurance coverage which made this possible.

Are you near a Kaiser Permanente?

Or, call AARP. You must've gotten many ads in the mail these past weeks.
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worriedinCali Nov 2019
Its a supplemental insurance he’s looking for though so the ACA doesn’t apply and he can be denied because if his pre-existing conditions.
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Go to the medicare website for answers:
https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap
These are plans which are defined by Medicare, not the insurers. If a person wants everything covered with no deductible and no co-pay, choose a plan F supplement. Mine is through BCBS and have used it through 2 knee replacements and a couple of smaller issues without paying an additional penny. There were no health questions and no medical exams to get the coverage.

My husband and I pay about $300 per month for this coverage, another plan for drug coverage, and his Medicare part B (my Medicare part B comes from my SS check). This is less than the deductible that my sister has on her advantage plan. I figure that I would rather pay on a regular basis and not worry when I get sick. She likes to think that if she manages to get through the year without having to pay the whole deductible she saves money. It is a matter of preference.

As to pre-existing conditions, that was not an issue in the past for the medi-gap plans, but I haven't read all the information on the new rules for 2020.

I would recommend that you or your friend start with the Medicare site and get some solid information before talking to insurance companies. Remember who pays the insurance company "assistant" who you might talk to on an insurance site. I have been lied to or misled more than once by what are really just sales people.
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BettyMG Nov 2019
Littleorchid, I've had Medgap/supplement insurance for 14 years and I changed companies several times when they increased my rates and NO insurance company will accept anyone without going thru underwriting. The ONLY exemption is first time when you turn 65. No insurer will insure just anyone with certain medical conditions. This is not so with advantage plans. It's misleading to suggest to people on this site that anyone can get a Medigap policy. It's just not so.
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She needs to call an agent. I was told by Medicare that the best way to get Supplemental Insurance is through an Agent - and my agent has found me insurance and even suggested me changing to another company for a better rate.

There are plenty of companies that will take her with existing health conditions. She also might be eligible for Medicaid as well as Medicare.
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Llamalover47 Nov 2019
RayLin: Yes, that is the route to take for sure.
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Well....I don’t think we can give a yes or no answer to this question. If your friend is in VA then unfortunately they can be denied a supplemental policy because of their pre-existing conditions. Only 4 states require medigap policies to give policies to people with pre-existing conditions. So in a yes the Humana person is right, she may be denied coverage because of her pre-existing conditions.
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Try finding an agent working for an independent insurance firm. They handle policies from several different companies and have a better chance finding an acceptable policy.
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Every dialysis center certified by Medicare is required to have a licensed clinical social worker (LCSW) on staff. Ask them for ideas. Some states (like mine, Maryland) have a Kidney Commission (MKF) that can assist with co-pays for secondary coverage. One must apply and meet eligibility requirements as well.
The LCSW knows the dialysis center wants to bill that 20% for payment to the dialysis company thus have a vested interest in helping patients find secondary coverage to help the dialysis company get paid additionally because the Medicare reimbursement rate for dialysis treatments is close to nothing (in 2010 it was $131 a treatment). I’ve been out of that field since then.
I think no matter who you find to cover her, the premiums, deductibles and co-pays will be high due to her pre-existing conditions but not insurmountable if mom can pay.
Good luck!
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Kidney dialysis should qualify a person for automatic disability and Medicaid (once financial criteria is met).
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anonymous972110 Nov 2019
I am on dialysis and I do not qualify for disability or Medicaid. I still work and pay my own expenses.
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Even with supplemental, she will still have expenses. She needs to talk to the social worker if she goes to a dialysis center. Peritoneal dialysis is the cheapest option.
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Find a medicare specialist BROKER.

Humana is trash and they want everyone in an advantage plan because they are getting rich off of them.

A broker will be able to look at all companies and tell your friend what the options are. She may have to go through underwriting and then she may or may not be accepted, do the math and see what makes better sense.

If she doesn't qualify can she put a set amount aside monthly to cover her copays until the deductibles are met? I would encourage her to do that.
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