How do you apply for Medicare?

I need to apply for medicare and I’m not sure what to do. Do I just apply for Original Medicare parts A,B, and D or should I get the Medicare advantage? I was on my husbands plan through his work and I had just met my out-of pocket cost. He’s losing his coverage and he is going on COBRA until he can find something else. I can’t go on COBRA it’s way too expensive and again I had already met my out-of pocket for this year. It’s so frustrating. Here I am with RA, have already met an out-of-pocket this year and now I am forced to start over. Money is a real issue at this point. Any suggestions? I’m due for my biologic in a few weeks. It’s so scary.


Community Answers
  • RubyRoses
    2 weeks ago

    I'm 58 and on disability and medicare. I sat with an advisor to go through my options when I signed up. You are way better off going with the seperate plans then the advantage plan. I have plan G for my supplemental.
    For drugs...The advisor found me a huge discount coupon for my most expensive and we just left coverage of it out of my drug plan. This kept the drug plan resonable priced. To get manufacturer help, find the manufacturer of your drug online. Then search for their cost help. They will have an application for you to fill out. Some have your doc also fill out part of form, others just want license and contact info for doc.
    Good luck.

  • KerryW author
    2 weeks ago

    Hi RubyRoses,
    First, thank you so much for responding. I too sat down with an advisor to go through my options. I live in Virginia and unfortunately my only options are Medicare A/B and D or the Advantage Plan due to current Virginia laws. Apparently each state is different when it comes to disabled and under 65. I sent emails to both Senators to no avail. I'm assuming you live in a state where laws help us who are under 65 and disabled. I wish I did. I will keep in mind your advise about the medications hoping it can help me. Thank you so much.

  • Carla Kienast
    3 weeks ago

    Kerry: There have been some great answers, but let me add a bit more information. I am assuming that you've been on SS disability for the allotted time before you're eligible for Medicare, so I won't go there. Medicare Advantage Plans are similar to regular HMO's in that you can only see certain doctors. That is the reason why I went with traditional Medicare. I also invested in a supplemental plan that will pick up the 20% that Medicare doesn't pay. These premiums are fairly reasonable and much less expensive than paying 20% for many medical tests. One thing about Part D. Part D applies to drugs that you get from a pharmacy and administer yourself -- such as pills or injections. And you're right, these can be expensive. HOWEVER, Medicare will cover medications administered at a medical facility -- so it covers infusions. With my Medicare plan and my supplement, I pay $0 out of pocket for my infusions. I hate infusions, but I hate paying $$$ even worse. You might talk to your rheumatologist about switching to an infused treatment. I wrote an article that explains this further: https://rheumatoidarthritis.net/living/how-you-receive-your-treatment-affects-you-financially/ Good luck!

  • KerryW author
    3 weeks ago

    Hi Carla,
    Thank you for responding. Unfortunately, because I am under the age of 65, there is no Medigap Supplement plan available to me in my area. Also there is only one Medicare Advantage Plan available which is a terrible plan. I have been disabled for quite some time but was on my husband's work insurance plan until he lost it. Now I am on COBRA trying to figure out what to do. I have been getting infusions for quite some time and yes I found out that Medicare covers the infusion but as we all know, with Original Medicare I will be responsible for the 20% of every doctor, hospital, and Specialist visit etc... plus premiums and deductibles. Part D will be a whole different ballgame as I am on several different medications. I just don't know what to do. I am not eligible for Medicaid so I'm stuck between a rock and a very hard place.

  • KerryW author
    3 weeks ago

    I honestly cannot believe how medicare works for us who are under 65 and disabled. I will have to pay 20% of the medicare allowed amount for every office, hospital, specialist bill.
    The prescription part D plan alone will break me as I need many medications, my biologic being one of them and we all know the price of that drug. My only other option is to try the only ONE Medicare Advantage plan available in my area and it's no better (probably worse). I did everything right in life, worked for over 30 years before getting sick and now I am being punished. I am not rich and I am not super poor, I am in the middle class about to lose everything and end up on MEDICAID. I even read in the medicare booklet that if I need inpatient care in a hospital then I'm not allowed television, a phone, or any personal care items such as no slip socks, I also have to stay in a semi private room. This floors me! Convicted prisoners living in a correctional facility are allowed television, cable, computers, health care etc.. all pay for by our tax money. A lot of the people on Medicaid are single women who are having children. They are perfectly capable of working, they don't get married because if they do they will lose their Medicaid. The system is broke! And I will soon be broke too.

  • marddurand
    3 weeks ago

    In some states, Medicaid is available for low-income individuals. You have a choice of either going broke by staying on Medicare alone or putting yourself into poverty as Medicaid has a $15,000 limit per individual to qualify AND you have to usually go 4 months without any insurance before Medicaid will even accept you. To me, it feels there is no choice. If you are on disability, your income is already limited-you really can’t afford these expensive medications which delete any income you receive before you can even pay rent!

    Another poster mentioned Good Rx, and I have been floored by the savings. Although, pharmacies will not allow you to use with health insurance, which can easily be remedied by going to another pharmacist that offers huge discounts, BUT DO NOT GIVE THEM YOUR INSURANCE INFO.

    Also, try calling Both Protective Social Services and Human Health Social Services.

    You can also go to churches, and see if they can provide any help.

    I wish you the best as I personally have experienced this myself.

    Good luck.

  • KerryW author
    4 weeks ago

    Thank you so much for all your responses. There are very informative. I have been on the phone with Medicare more than fives times asking as many questions as I can. I have also talked with an adviser (who didn't seem very knowledgeable) so I will be going to their office today to try and speak with another agent. It seems you get a different answer from everybody. Medicare is extremely difficult but I won't stop until I figure it all out. I believe a FLARE is on the way. It's amazing to me how difficult and expensive they make it for the Seniors and the disabled. I'm disabled and under 65 and I need many medications, so I will most likely pay a big price. So sad. Thank you, all of you. I love that I can come to this sight and share information about our illness's with hopes to help each other .
    Kerry

  • Dave
    4 weeks ago

    KerryW, You are correct when you say that the whole thing is scary! However, there are answers to be had. I don't know what area or state that you live in but in my state (NC) there are advisers who will come to you and help you to get set up with the best plans for your situation. I am on Medicare with a supplement plan "G" that pays the remaining 20% after Medicare plans A & B pays their 80%. With the plan G supplement I have a one time per year deductible of around $180. My wife has the same setup. The deductible has been the ONLY out of pocket expense that we have had to pay since we have been on Medicare insurance other than for meds. My wife was in the hospital last November and had a Pacemaker put in, we paid zero out of pocket. The premiums that we pay for plan "G" are affordable. The weak link in the whole retirement Medicare insurance setup is the prescription drug plans. As far as the biologics are concerned, they are covered by Medicare and the supplement plan G if they are administered at a hospital or infusion center (as mine are.) I have been on Orencia for an extended period of time and it is covered 100% with my setup. I hope that you get some answers soon. Dealing with RA is enough of a problem without having to worry about the insurance thing. Good luck! Dave

  • DebiSue
    4 weeks ago

    Good afternoon, Kerry! My rheumatologist reminds me that the cost of many of the expensive meds may be picked up by the pharmaceutical company itself. I'm not sure how it works, but it's worth asking about. For routine medications, it's worth checking out the GoodRx app. It's been advertised on TV, and there are no coupons required. You simply type in the meds, search pharmacies near you, and compare prices. It's actually similar to what I pay with my Caremark plan. There is only one Medicare Advantage Plan here in TN as well, and I've seen patients turned away because their physician wasn't on the plan. It is unfair!. Just remember, you can change your Medicare Advantage Plan during open enrollment from Oct 15-Dec 7th if it's not working for you. Best wishes! Debi

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  • Dave
    4 weeks ago

    DebiSue, Unfortunately, the drug company discounts on most meds only apply if you have commercial insurance. They don't apply with Medicare. That seems backwards, as I was a lot more able to afford higher costs before I retired!!! Dave

  • DebiSue
    4 weeks ago

    Hi Kerry! Are you on SS Disability? If not, you can apply for Medicare online at www.SocialSecurity.gov or at your local Social Security office. My husband just got on Medicare due to retirement, and after researching Medicare Advantage Plans, we felt that our particular physicians didn't participate in most of the plans. That made our decision for us and we researched companies for Part D coverage based on our medication costs. Hope this helps and good luck! ~DebiSue

  • KerryW author
    4 weeks ago

    Hi DebiSue,
    Yes I am on SS Disability. I checked both Medicare Advantage Plans and Medicare Part D. I agree with you, I don't like the idea of having to see particular physicians (Medicare Advantage Plans) but after talking to Medicare if I use Part D my medications (not including my biologic) add up to $3322.00 a month on the cheapest plan. I'm afraid I might be forced to use the Medicare Advantage Plan. Also, depending on your area, you only have certain Medicare Advantage Plans available and I only have one. It seems so unfair. Thank you for responding, I really appreciate it.
    Kerry

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