Brinsupri follow-up

@irenea8 I may not have communicated it properly or I misunderstood.
Advantage Plans are actually called Medicare Advantage Plans issued by Insurance Companies and have their own guidelines regarding medical care requirements or benefits. In a sense you leave the Original Medicare Plan when you go into an Insurance Carriers Medicare Advantage Plan. The main difference is that Medigap plans ...........offer greater provider freedom and predictability in costs by paying out-of-pocket expenses for Original Medicare........ but have higher monthly premiums. Medicare Advantage plans typically have lower premiums, bundle Part D and other benefits, but come with .......network restrictions and potentially higher out-of-pocket costs.......
The Original Medicare Plan is rolled into the Insurance Carriers Advantage Plan. These plans are allowed to put limitations on the client ......a Medigap Supplemental Plan does not put these same limitation on the client. There is more freedom of choice with the Medigap Supplemental Plan.
The Original Medicare Plan with a Supplemental Plan allows you to choose a Plan D drug plan along side your Supplemental Medigap Plan giving more choice. Under Original Medicare Plans with most Medigap Supplemental Plans you can change to another Plan D each open enrollment period if you find one D Plan does not have your medications and another does in their list of med's covered the way you need them to etc. etc.
Yes it is my understanding you can change easily from one Advantage Plan to another. Their is underwriting required if you want to go from one Supplement Plan to another. If you have an Original Medicare Plan with a Medigap Supplemental Plan and a separate chosen Plan D plan you have a plan that is easier to understand and you have predictable costs.
Hope this makes sense. It can be very confusing to many because of the lack of up front explanations and information given or withheld by the insurance brokers who tend to 'push' people into the Medicare Advantage Plans.
Sorry for the long explanation if you knew all this. For some it can be so confusing and not easy to fully understand unless you do much reading and research.
Barbara

@irenea8 I may not have communicated it properly or I misunderstood.
Advantage Plans are actually called Medicare Advantage Plans issued by Insurance Companies and have their own guidelines regarding medical care requirements or benefits. In a sense you leave the Original Medicare Plan when you go into an Insurance Carriers Medicare Advantage Plan. The main difference is that Medigap plans ...........offer greater provider freedom and predictability in costs by paying out-of-pocket expenses for Original Medicare........ but have higher monthly premiums. Medicare Advantage plans typically have lower premiums, bundle Part D and other benefits, but come with .......network restrictions and potentially higher out-of-pocket costs.......
The Original Medicare Plan is rolled into the Insurance Carriers Advantage Plan. These plans are allowed to put limitations on the client ......a Medigap Supplemental Plan does not put these same limitation on the client. There is more freedom of choice with the Medigap Supplemental Plan.
The Original Medicare Plan with a Supplemental Plan allows you to choose a Plan D drug plan along side your Supplemental Medigap Plan giving more choice. Under Original Medicare Plans with most Medigap Supplemental Plans you can change to another Plan D each open enrollment period if you find one D Plan does not have your medications and another does in their list of med's covered the way you need them to etc. etc.
Yes it is my understanding you can change easily from one Advantage Plan to another. Their is underwriting required if you want to go from one Supplement Plan to another. If you have an Original Medicare Plan with a Medigap Supplemental Plan and a separate chosen Plan D plan you have a plan that is easier to understand and you have predictable costs.
Hope this makes sense. It can be very confusing to many because of the lack of up front explanations and information given or withheld by the insurance brokers who tend to 'push' people into the Medicare Advantage Plans.
Sorry for the long explanation if you knew all this. For some it can be so confusing and not easy to fully understand unless you do much reading and research.
Barbara

@sueinmn I may have over generalized. That said, I have noticed there are better insurance plans out there for Federal employees, Military, and of course our politicians. My current plan only pays 60% for Tier 4 and 0% for any tier 5 medications. I may look at supplement plans again, but my situation is different from most: I am a single parent to my adult son with Down Syndrome, and we get 0 support from his father-hasn't seen him in 20 years-not a penny sent his way. Most people don't get that it's almost impossible for someone to even have a job in my situation, particularly since he has had health problems. Fortunately, I was able to do self-employment. The bad news is my work has most likely been the cause of me contracting both BE and MABC. So, consider yourself extremely fortunate.

@kathyjjb Even with government plans there are huge differences in coverage and co-pays depending on which you choose and the premiums you are willing/able to pay. We had the same plan for many years, but once on Medicare it was lousy. We changed to a large national plan, and it covers care much better. We almost always get a "yes" right away on medical care. I'm not sure what Tier 5 is, our pharmacy only lists through Tier 4. But you can petition for coverage to specialty drugs and sometimes get them. My brother has been successful, my sister-in-law has not . We think it might be who the Pharmacy Benefit Manager is in their separate states.

That's a good primer @blm1007blm1007 !

@irenea8 There's a resource in Iowa to help you decide and tease part various Medicare options. They offer 1-1 counseling for Medicare decisions. https://shiip.iowa.gov

I have had bronchiectasis and MAC for 10 years. I failed 2 attempts of treatment due to side effects. I’m not feeling well and when I messaged my pulmo at MGH in Boston he stated I wasn’t a candidate? I’m bewildered, I have no co-morbidities.
He stated I would have to wait for my next appointment if I had any questions.
Any insights would be appreciated greatly!!
Thank you!
Deidre

@sueinmn My ID doctor and NJH have appealed numerous decisions and Humana did not budge. I can certainly relate to your sister-in-law's experiences.
After some thought, I remember my insurance broker told me that I would need to disclose my current health issues to change from my Medicare Advantage to a Medigap Supplement form-so best to just stay on what I have.

@sueinmn My ID doctor and NJH have appealed numerous decisions and Humana did not budge. I can certainly relate to your sister-in-law's experiences.
After some thought, I remember my insurance broker told me that I would need to disclose my current health issues to change from my Medicare Advantage to a Medigap Supplement form-so best to just stay on what I have.

@dstella Are you seeing a bronchiectasis specialist at MGH? If so, ask for a virtual appointment or a call back from a nurse or NP from the practice. If not, get an appointment with the bronchiectasis specialists there. I see they are on the list of centers: https://www.bronchiectasisandntminitiative.org/Find-Care/Care-Center-Network/Find-a-Center