Questions on Medicare and employer insurance

[cattlekid]

I am trying to get ready for open enrollment for 2013 and am struggling to find an answer to some questions I have about Medicare as secondary with my employer’s insurance.

Here’s the situation:

Medicare will be secondary until October of 2013.  My employer insurance has a $250 deductible, and a $2000 OOP maximum. 

Here are my questions:

1.    Once I hit my OOP maximum, I assume that my employer insurance will pay 100% until October.  Correct?
2.   Will Medicare pay the employer insurance deductible and copays or will I still be responsible for those amounts?

Basically, I’m trying to understand if I need to put the $2000 in my FSA account for 2013 or if Medicare will pick up those amounts. 

[Sydnee]

In the same boat. Would like to know also.
I know that once you meet the OOP the insurance will cover the rest. You have nice insurance. Our OOP is $7,500. 

[amanda100wilson]

my understanding is that you are responsible for your  Medicare deductibles etc.  your employer insurance should pay at 100% once you have met the out of pocket ex.

[smcd23]

From the Medicare webpage:
What it means to pay primary/secondary

    The insurance that pays first (primary payer) pays up to the limits of its coverage.
    The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover.
    The secondary payer (which may be Medicare) may not pay all the uncovered costs.
    If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay.

Paying "first" means paying the whole bill up to the limits of the coverage. It doesn't always mean the primary payer pays first in time. If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should've made.

So from what I gather reading that, you insurance will continue to pay what it does now, and then Medicare *may* pick up some or all of the leftover amount. On the page it says if you have additional questions to contact the Medicare COB contractor. So you may want to give Medicare a call and see if they can give you more precise information.

In my experience, when Medicare becomes primary, you should have little to no OOP costs. Since my husband came on my insurance, my insurance has been paying 100% of what Medicare doesn't, up to the allowable amount. We've paid nothing on any of his claims. We still may hit our $5000 OOP though with all of our counseling appointments (which get billed through just my insurance) and the other stuff me and the kid have done this year. I only put $1000 in my FSA too Going to have to rethink that for next year I guess.