Kimberly Jones is Group Manager of Reimbursement for Baxter BioScience, Department of Healthcare Economics (HCE).
If you are newly enrolled in Medicare, you are guaranteed the ability to purchase a Medigap policy. During this open enrollment period, there is no medical underwriting. To find policies sold in your area visit www.medicare.gov. Click on “search tools” and then on “compare health plans in your area.”
To help with your decision making, the Department of Health and Human Services offers a guide to Choosing a Medigap Policy (PDF).
Depending on which state you reside in, there have been some legislative changes that impact the age category your daughter falls into. About one half of the states have enacted legislation that expands dependent coverage up to, in some cases, 30 years of age. Requirements vary by state, but most only require that the dependent be unmarried. The Kaiser Family Foundation State Health Facts website offers a page that lists definition of dependency by age if you would like to research the requirements in your state.
Other options that you may have are dependent on whether your daughter is considered disabled. A disabled dependent can have special status on your insurance policy. I recommend that you contact the PSI ACCESS Program at 1-888-700-7010. This group provides help for primary immune deficient patients in need of assistance with Social Disability information.
This can be an overwhelming task. Our recommendation is that you use a binder system that has pocket folders inside to organize and keep track of your paperwork.
It is important to review each Explanation of Benefits (EOB) that comes to you from your insurer and match the EOB with each associated provider statement or bill. It is good to staple or paperclip these together. Insurers can make errors, so it’s important to assure that in-network benefits are paid appropriately. You will also need to assure the amount you are being charged by the provider is the amount that your insurer has designated as your responsibility.
There are definitely benefits to each plan individually. HMO plans are more restrictive. Some of your preferred physicians, as well as your pharmacy, may not be in the network. HMOs also require a referral to specialists by the primary care physician. HMOs do have, in general, less out-of-pocket expenses.
PPO plans give you a choice of physicians and pharmacies without a referral. PPO plans also have deductible and out-of-pocket expenses until you have reached a maximum, at which time the benefit level converts to 100% in most cases.
HSAs, or Health Savings Accounts, are not good for persons with a chronic illness. These plans are geared toward very healthy individuals that can pay out general claims from a savings account.