Question benefit max denial/ supplemental

herrera4

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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

Networker
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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.
 
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