I was hoping for help here. I work full time and have medical benefits so hubs is currently covered under my benefits. We just got the info that he now qualifies for Medicare. It's been 2 years since he applied for SSD. ( he was diagnosed with EOAD at age 46) My question is should I take it since he is currently covered. Our employer does not require us to take the services of Part B. We will take the Part A. It looks like since I work and provide benefits we can delay enrolling with out a penalty. Am I missing anything??? We also have 2 children ages 18 and 16 so I pay for the family plan, so it really doesn't seem to pay to take him off of the current plan and switch to Medicare. I would appreciate your thoughts in how to proceed in these uncharted waters. Thanks
samismom22-- His Medicare would be primary for him and your coverage would be secondary. That should just about cover him fully--no copays, or deductibles leftover for you to pick up. I am surprised your Insurance hasn't told you this. When we both worked, we cross covered and when I went on Disability and got Medicare that's what happened.
Also, check thoroughly about Prescription coverage. You do not wanxt to skip it unl;ess your coverage is equal or better than Medirze Pat D. Late enrollees pay a penalty that doesn't go away.
Thanks Carosi I don't think I would have to pay the penalty for late enrollment since it says in the brochure, if you have a spouse who works it is an exemption for late enrollment with NO Penalty. I also have really good benefits right now, so that wouldn't change if I pick up Medicare as primary and my coverage as secondary? I wouldn't have to switch doctors or anything?? I just talked to my employer about it, I will call the insurance company directly good idea. Thanks so much for any help. Hubs used to take care of all this stuff.......I miss him doing it!
samismom22, not much to add except sending my love. Yes the paperwork is monumental, for me, wow.....I am actually feeling the system is really working. You have to work it though.
Yes, Carosi2* is right. Sid was covered under my insurance - co-pays, partial payments, money out of pocket everywhere. When he went on Medicare, Medicare covers 80% and my insurance became the secondary. My premiums were reduced because he wasn't on as a full member. Now what Medicare doesn't cover, my insurance picks up.
Drug coverage is a different story. My insurance has an excellent drug coverage program. 3 months supply of non-generic for $50. 3 months supply of generic for anywhere from $5-20, depending upon the drug. If your insurance has a good drug coverage, I would keep it, and not get involved in Medicare's convoluted, confusing, expensive drug coverage.
Hi samismom, I am a retired HR Director and have familiarity with benefits plans. MOST companies require that once you or a family member become eligible for Medicare (Parts A & B), that the Medicare eligible person enroll in both A&B and Medicare will become the primary health insurance and the companies plan will become secondary.. This means that all claims have to be processed through Medicare first and any unpaid balance will be subject to payment by the company plan. IT IS CRITICAL THAT YOU GET IN WRITING FROM EITHER THE COMPANY OR INSURANCE COMPANY THAT YOU ARE NOT REQUIRED TO ENROLL HIM IN MEDICARE ONCE HE'S ELIGIBE AND THE COMPANY PLAN WILL CONTINUE TO COVER HIM BEFORE YOU DECLINE ENROLLMENT IN MEDICARE. If you have the summary plan description or the benefit plan document it should be stated in there.
There are several provisions you should be aware of.
First, Medicare Part B has a monthly premium of $104.00 which will be taken directly from your husband's SS payment if he enrolls. Both Medicare parts A& B have deductibles which must be met before they pay anything on a claim. Any deductibles which have been met under the company insurance will not count towards medicare deductible.
Most physcians/health care practitioners will take Medicare, however unless they agree to take the Medicare assignment, most likely there will be a balance which needs to be paid. The company insurance will process the unpaid balance and pay whatever percentage the plan pays IF THE DR/PROVIDER is an IN-NETWORK PROVIDER. So when your husband is covered by Medicare with the company insurance as the secondary insurer/payor, you should check that the provider is in-network otherwise you will be responsible for paying the balance not paid by Medicare.
It is particularly important to make sure the physcian is in-network if you husband is seeing a mental health practioner because many company insurance plans have limited mental health networks. In our case, DH's psychiatrist are all out of network so we have to pay the balance not covered by Medicare. He sees a psychiatrist for the antipsychotic meds he needs to control his agitation/aggression.
I apologize if you already know this but I wanted to make sure you had the correct info to make your decision. In our case with Part D we still have the company's plan (they don't require you to take Part D) because it pays better than part D.
I think the whole thing is much too complicated and confusing for the average person to wade thru. Thank you LFL for your explanations - which I tried to follow, most of us don't have your background in the subject. In fact, I think the world today is full of too much info, too many options, too many rules & regulations, people sitting in the same room talking to their hands instead of to each other. Or maybe I'm just getting old and grumpy.
LFL - good info. My husband gets his medical through the VA. In the Portland VA system they do not deal with medicare. We are in the Reno area and I had to take him last week. He enrolled as a visitor with them but was also told they do bill Medicare. Legally they can't keep the funds so they put it in a fund for the Veterans to be used for buying and maintaining the vans that transport the veterans and other things to benefit Veterans. If this is the case, any amount they bill will be applied towards any deductible from what you say. He only has part A & B cause his meds through the VA are cheaper than outside. This is the first time he will have used his Medicare since he became eligible 2+ years ago.
My husband's carrier, a major defense contractor, insisted that he take parts A and B. Then they paid as secondary. We were warned that if we did not do so we risked losing coverage. We still use the insurance company's pharmacy benefits. I had planned to do what you plan to do, but was told "no way."
I am in a similar situation. My wife has one doctor who only takes Medicare, no other insurance. My insurance has very good coverage and excellent drug benefits. It costs me about $100/month to have my wife on my insurance. My insurance does not require me to put my wife on Medicare B.
So I did the math. Take her off of my insurance and put her on Medicare B would cost around the same but much worse benefits.
To add her to Medicare B and keep my insurance would cost me over $1,200/year and get around $400 in benefits.
So we are skipping Medicare B. It is nice to know it is there in case I lose my job.
apple,table,.penny raises a valid point-many company insurances which require you to enroll in Medicare A&B when eligible will reduce benefits the company plan will pay if you do not enroll in Medicare.
paulc, Medicare is often not the best/most cost effective coverage if you have other insurance, unfortunately most private plans require that once you are Medicare eligible you must enroll. Good for you that your company doesn't mandate enrollment upon eligibility.
My husband has a retiree plan that didn't mandate medicare, and I also could have put him on my plan (which already covers our kids). But in our system, when he went on medicare and his retiree plan become secondary, it started picking up everything medicare doesn't pay. We have encountered some situations that medicare doesn't cover, particularly enough physical therapy (he hits the annual limit). But overall, it is a big benefit to the budget that we now pay nothing for most of his doctor's visits, instead of our previous situation where the insurance paid 80% and we paid 20%.
When we became eligible for Medicare, BS/BC became our secondary insurance. It pays 100% of what Medicare doesn't pay which includes the medicare yearly deductible and the 20% copay Medicare doesn't cover. Claude was covered under both for 17 years, had multiple surgeries and hospitalizations other than alzheimer related, and the only thing we paid out of pocket were perscription copays.
I also have both. I pay out close to $300 per month in premiums. It's expensive, but it's worth it to me as I have health issues and won't be faced with horrendous medical bills if I really got sick.
My sister only has Medicare. We all tried to talk to her about getting a supplemental policy but "I never get sick and it would be a waste of money". Last summer she had to have emergency surgery and was in the hospital and rehab for several weeks. After Medicare paid, she was faced with close to $100,000 in bills. She is set financially so she can pay it, but most of us would be up the proverbial creek.
Well this was all so helpful!! Thanks everyone! I knew I could count on this site to get some guidance.
LFL if in fact I do not have to take Medicare, there is something that says since I work I can enroll later with no penalty. I would get it in writing like you said. I am a teacher and work for a school district. Also, here is the thing, Alzheimer's aside my husband is really healthy and has very few health issues. So we rarely see a Dr for much except 6 month neuro visits and occasional GP visit. It just doesn't seem worth it to pay the monthly amount for medicare on top of what I already pay. Remember my kids are still on the plan so I pay a nice monthly premium already.
samismom22---I may be confused, but only your DH would be going on Medicare now---you and the kids stay covered the same as now. You wouldn't start Medicare foryourself unil you hit retirement age. Also, you should be receiving checks for your children, as dependents of your husband (just like child support in the case of divorce), until they're 18 or graduate High School, whichever comes later. Those are about 1/2 size to his check. Please remember, unfortunately, with AD, things can change in the blink of an eye. The $104 premium out of his SS would be nothing if he had a major decline requiring an in-hospital med. evaluation and change. There's no way the money would be wasted if that ever happened.
Samismom22--Because I'm a fed gov't retiree, my husband is covered under my Blue Cross insurance (includes good drug coverage). When he became entitled to Medicare, I was asking the same question you did. What basically convinced me to enroll him in Medicare was a study that was done by the Alzheimer's Association. They compared hospital stays for the identical illness for a dementia patient vs a patient the same age who didn't have dementia. Costs and complications were much higher for the person with dementia. Although our existing insurance didn't require me to sign him up for Medicare, the results of that study convinced me to.
I think it was a good decision because of several things that occurred. First, he was hospitalized (twice) for inpatient medication adjustments to control behaviors/symptoms of AD. The duration added up to 7 weeks; total costs were over $1,000/day. Second, once I moved him to an ALF, he has been seen much more regularly by the psychiatrist, geriatrician, and podiatrist (on a weekly basis by the first two). His insurances have picked up all costs for the inpatient stay and the for docs/podiatrist that see him at the ALF.
As you mentioned, my husband is also very healthy aside from the AD--is 68, very ambulatory and has only high BP controlled by meds. However, the examples I gave above show you how AD alone can cause significant medical expenses. Hope this helps.
I went for it because for my husband the penalty to wait until he was 65, which was just 2 years, would have made the premium much higher. Definitely sign up for part A since it does not cost. If you can wait without penalty and you insurance if good coverage, then consider waiting. I would think a lot depends on your husband's age too. Once they reach 65 I would not hesitate the part B.
samismom, as Carosi* writes, only your husband is becoming Medicare eligible, not you so there should be no penalty to you at all since you're not eligible now. As you can see from the above posts, everyone's insurance situation is different and their companies may pay at different rates (80%, 90% etc.)for the balance not paid by Medicare. Just make sure you have a full understanding of your health plan benefits, what it will/will not pay and when. It would be prudent to have a copy of the summary plan description which highlights the plans provisions and a copy of the entire plan (which is the legal document).
Also, if you sign him up for Part A (hospitalization) how will the private insurance pay? Will it then require that Mediacre pays first or will the private plan pay first? I ask because there is a $1000+ deductible under the Medicare Part A plan which must be met before Medicare pays for hospital costs.
Also check if your private plan has a lifetime maximum payout (typically $1M or $2M). With the passing of the Affordable healthcare act (Obamacare) private insurers can no longer have lifetime maximums but I'm not sure if that provision is in effect now or in 2014.
When DW got her SS disabilty it of course came with medicare. I saw the information about the penalty and not having the time to study things at that moment I went ahead and took part B (at whatever the current cost is) That was 5(?) years ago.
Through my job I have (very good) Kaiser insurance (the original HMO?) this whole time and have never formally told them about the medicare. . . . . ? I got something recently that seemed like a routine annual survey from Kaiser asking about any other coverage either wife or I had. I did tell them she has medicare but didnt list any numbers or anything (they didnt ask)
So far Kaiser has been covering whatever is needed without question (mostly just medications right now) because at 62 she is (still) perfectly healthy. MAYBE I should call Kaiser and make sure everything is OK? or maybe I should just let sleeping dogs lie? Hummmmmm . . . .
m-mman, I would ask you to do the same thing-check the summary plan description for your plan and see if you are required to notify them that your wife has Medicare and if she has it does that mean Medicare pays first? In our case DH was 60 when he became Medicare eligible and Medicare notified our company insurance about 3 months prior to his eligibility. I don't recall how they knew what coverage he had but I suspect I had to include that in the application for SSD.
Since you are only using your Kaiser plan for drug coverage and you have not signed up for Part D, Kaiser might not know about the Medicare. Or perhaps your Kaiser plan falls under a Medicare Advantage plan in which case they won't care if she's signed up for Medicare because she is on a Medicare Advantage Plan? I doubt the latter is true but thought I might include it in case.
That's what's so confusing...each private plan is different.....
Sorry m-mman, unfortunately with health care (as you know) the devil is in the details. You have no idea how many people have been denied coverage because they didn't read/understand their health plan provisions!
Thanks again LFL and Carosi2! I got it that it's only hubs that is medicare eligible the kids and I are not covered. Heck I am "just" 48 not thinking medicare at this point. And hubs is also 48 who would have thought I would have this problem to think about. I did think about upcoming possible expenses, who knows what this disease will bring, he has progressed very rapidly already. It has just been 2 years and he no longer drives or can even dress himself. So that is something big to think about, the costs down the road. And I will go back and look very carefully at my current plan and see what it says. This is a good point I also had not thought about - "Also, if you sign him up for Part A (hospitalization) how will the private insurance pay? Will it then require that Mediacre pays first or will the private plan pay first? I ask because there is a $1000+ deductible under the Medicare Part A plan which must be met before Medicare pays for hospital costs."
So glad I asked here at this site, no one I knew really had any idea. Most of my friends are still in their 40's and just aren't walking this road yet
Oh and yes the kids to receive a payment each month from SS....so helpful!
When we renew our BCBS every year the form asks if anyone is on Medicare, and if so, are they on Medicare B. so I L goes to the hospital BCBS knows that Medicare is the primary. L was automatically put on Medicare A, no choice but no premium. I had to notify SSA that we were declining Medicare B.
Of course my situation can change any year. With every new policy the rules can change. I am lucky that my office is dedicated to quality insurance, including mental health care. Wish my retirement benefits were as good (they aren't very good)
My sister has Kaiser and Medicare. She is always fighting with Kaiser cause they don't want to cover what medicare did not. This started when she turned 65 and has not gotten any better in the last 7 years.
Hi Jane, glad to see you on line again too! OMG, to be praised by the guru of social security and medicare-that my info is correct is so exciting! But no one is better than you!