Wiki benefit max denial/ supplemental

[herrera4]

Hi we have a patient who has maxed out of her lifetime benefit for pulmonary therapy. is there supplemental insurance that would cover this denial from medicare? (patient is not eligible for state insurance)

 

[sls314]

A true Medicare supplement (Medigap) policy typically only covers what Medicare covers. They pick up the deductible/coinsurance after Medicare covered services, and deny when Medicare denies. You could check, but I'd be surprised if any Medigap policies would cover a service that had hit a lifetime max on Original Medicare.

I'm not sure how it would be handled with a Medicare Advantage plan - it could be worth investigating whether a MA plan would provide coverage even though the benefit has maxed under Original Medicare.

They could look into private insurance too. It's already past open enrollment for the ACA plans. I don't know if they could get a special enrollment period due to the circumstances of maxing the benefit under Medicare.

Those are the ideas I have off the top of my head - hopefully someone else has additional/better suggestions.