Medicare/Insurance Question

[BattleScars]

I've been covered by my wife's private insurance for almost 2 years and been on disability for about a year and a half. Today I noticed over $100 was missing from my social security payment so I called Social Security and the lady told me they started taking out the premium for Medicare because my insurance opted me in. OK, so this is my understanding but please correct me if I'm wrong, my insurance now pays for 20% and Medicare covers the other 80%. But I still have to pay for all my medicine co-pays (very expensive) and doctor visit co-pays and now this Medicare premium. I get that my insurance wants to save money but what's in it for me? I mean I can't afford the extra $100 to be take out every month.

I also read somewhere that if I decline Medicare that my insurance can drop me and/or my wife so I don't want to take that chance. If I go back to work full-time I believe Social Security will kick me off Medicare and my insurance will be responsible for the 100% again since I will no longer be considered "disabled" and I'm under the age of 65? My only other option is to divorce my wife and get off her insurance completely. As drastic as this sounds it would save us a lot of money every month. After all it's just a piece of paper.

Anyone that's had any experience with this, any help understanding what to do would be greatly appreciated.

[cattlekid]

Not sure exactly what advice to give you, but the one thing I can tell you is that you definitely qualify for Medicare regardless of age as long as you have a diagnosis of ESRD.    Personally, I am still in the coordination period so my employer insurance is primary and Medicare is secondary.  It sucks to have to pay the Medicare premium out of pocket but it does help limit the amount that your providers can charge your employer insurance, which is probably why they are making you do it. 

Even if your wife drops you from her private insurance, you will still be responsible for the 20% that Medicare doesn't cover so it does behoove you to keep that secondary coverage. 

[MooseMom]

I have found it best to call your private insurance company directly.

I'm under 65.  I am covered by my husband's private insurance company via his employer.  I qualify for Medicare parts A and B because and only because of my diagnosis of ESRD (I got a pre-emptive tx so am only now dealing with the Medicare behemoth), and I got all kinds of conflicting advice from the tx center.  My husband pays monthly premiums via deductions from his paycheck, so if we paid for Part B, we'd be paying for two insurance policies.  The monthly premium we'd be paying for Part B would be MORE than what I pay monthly for my tx meds co-pay (Part B wouldn't be covering my non-tx meds).  I wanted to make sure that the ins co was aware that I was eligible for Medicare, so my husband called them directly, explained the situation, and they (BCBS of Illinois) advised us to opt out of Part B at this time.

What I am confused about, though, is this thirty month "coordination period".  If our tx meds are covered by Medicare B for only 36 months, and if the coordination period is 30 months, then what are we supposed to do for that 6 month hole?  I think we might have to call BCBS at that time to see what they cover/don't cover during those 6 months.

Anyway, BattleScars, I'd suggest you contact the insurance company directly.

[Sydnee]

My hubby is on PD, under 65 and works full time he has to pay Medicare for basically no coverage.

My advice is to check with your social worker see if there is some organization that will help cover your Medicare premiums. Our state has a end stage renal disease program. Which will pay for anything connected to dialysis. But it's actually a reimbursement program. If we pay it they will pay us back.
Social services may have help too.

[frankswife]

We went through a somewhat similar situation. I cover Frank through my employer's insurance. We really didnt understand the coordination thing, Parts A and B, or even that we had to pay for anything. The dialysis SW applied for Frank but explained nothing. She applied in Sept. and said he was covered by Medicare effective Dec.1. We never got a card, a letter, nothing. We never even knew we had it until we got a letter in February stating that they were going to withhold nearly half of Frank's first SSDI check in March for "past due Medicare premiums". I about lost my friggin mind. Here we had to pay for something we didn't want, didnt ask for, didnt know we had, and never used. I want that money back but apparently I'm SOL. We did opt out of Part B but I guess if he doesnt pick it back up at he correct time after the coordination period Frank can be penalized 10% for every 12 months he could have had Part B but didnt, or some nonsense like that. All I know is they have thier hands in our pockets again.

[MooseMom]

Frankswife, that's outrageous!

[BattleScars]

We went through a somewhat similar situation. I cover Frank through my employer's insurance. We really didnt understand the coordination thing, Parts A and B, or even that we had to pay for anything. The dialysis SW applied for Frank but explained nothing. She applied in Sept. and said he was covered by Medicare effective Dec.1. We never got a card, a letter, nothing. We never even knew we had it until we got a letter in February stating that they were going to withhold nearly half of Frank's first SSDI check in March for "past due Medicare premiums". I about lost my friggin mind. Here we had to pay for something we didn't want, didnt ask for, didnt know we had, and never used. I want that money back but apparently I'm SOL. We did opt out of Part B but I guess if he doesnt pick it back up at he correct time after the coordination period Frank can be penalized 10% for every 12 months he could have had Part B but didnt, or some nonsense like that. All I know is they have thier hands in our pockets again.

Yeah that is outrageous. It sounds very similar to my situation. I never applied for Medicare, as a matter in fact I had an appointment with Social Security about a year ago and my caseworker advised me to not apply for Medicare since I was already covered by my wife's insurance. He said it would be redundant. Well here I am today and I was enrolled in something I never asked for. Here's the kicker. My wife called our insurance today after my previous post and they said I'm still covered 100% by Blue Cross and they never enrolled me. So now I'm even more confused. Medicare is charging me but not covering anything! I'm having them mail me the paperwork so I can get opt out ASAP.

I would be livid if they just took half my check without expecting it. Even if Medicare makes a mistake I know they are slow as molasses refunding the money or correcting the problem. It sounds like Medicare is automatically enrolling ESRD patients and not being honest. I'm not one to believe everything is a conspiracy but something just isn't right about this. Especially when private insurance is still paying 100%.   

[Rerun]

MM the 30 months is when you are on dialysis.  You never were.  You just get the 36 month anti-rejection drug coverage by Medicare.
Having said that I do not know who is primary.  Oh, must be 30 months your husbands and six months flipped where Medicare is primary and hubbys is secondary. 

Most of us on dialysis need Medicare.  There is something about a penalty if you don't sign up right away which makes no sense.  Why sign up until you need it.   

[amanda100wilson]

i didn't know that I would be eligible for Medicare because of the length of the time that we had lived in the US.  my husband's employer cganged insurance providers, and he insurance company insisted that I contacted Medicare to find out if I was eligible.  It turns out that I did and had been for some time based on the 30 month co-ordination period.  however, because of the amount that my husband earns, Medicare sends me an invoice several times a year.  I think that I pay about 2k a year, this on top of my husband's employer insurance premiums.  my understanding that what ou pay for premiums is a comletely separate isdue from any co-pays

[KarenInWA]

All I know is that since I've had Medicare, I don't pay a co-pay anymore for anything. Sure, at times it may seem like a waste of money, but I'd rather have it than not. I don't trust insurance companies, and I feel that they'd just sock it to me later if I didn't sign up for it, especially since they kept sending me letters a few months after starting dialysis in 2011. I do know of a pre-emptive tx patient who was dealing with bills despite having "good" insurance, so I informed his wife about his eligibility for Medicare, and they were thankful.

Having said all that, I pay for Medicare premiums as a tx patient, and my Rx coverage and Medicare don't play well together. So for now, my Rx plan covers my drugs, and I pay a co-pay. But, I do believe that having Medicare in the equation makes it easier on my insurance company, so hopefully they leave me alone and just pay my bills.

KarenInWA

[jeannea]

For those of you who say you never signed up: As soon as private insurance starts getting bills for dialysis, THEY will call Medicare and start the process. You can't avoid it. And yes if you do refuse the Medicare completely the private insurance can drop you. (None of this applies if like MooseMom you get a pre-emptive transplant. My mom gave me my first kidney and I never had Medicare but I also didn't do dialysis.) then you really do have to start paying Part B. otherwise, if you need it in the future it will cost more and you'll have to wait months for it to start.

If you are unhappy with paying the copays on drugs or doctor visits with the coordinating private insurance, you can look into getting your own Part C supplemental and Part D prescription. You will probably find that even with the "wasted" money on Part B you come out ahead.

I pay $100 for Part B, $285 for Part C, and $100 for Part D every month. Then I still have some significant drug copays along with paying straight through the donut hole. I also still have a few other charges. I have no eye or dental insurance.

Just do the numbers.

[Sydnee]

The first day Ed went to the dialysis center back in January of 2012 the nurse had him sign a bunch of forms (10-15) signatures. I felt horribly pressured but she wouldn't let Ed get dialysis until all the forms were signed  (or so she said). So Ed quickly signed the forms.  When we were told to to get medicare from the social worker we had to get a form signed by the dr. After a long run around (no one knew what form) then the dr went a got the forms Ed first filled out that very first day. The dr signed it and gave it to us, Ed had signed it a month and a half earlier that first day.

So I wonder how many people sign it with out knowing it and their dialysis sends it in for them?

[Bill Peckham]

For those of you who say you never signed up: As soon as private insurance starts getting bills for dialysis, THEY will call Medicare and start the process. You can't avoid it. And yes if you do refuse the Medicare completely the private insurance can drop you. (None of this applies if like MooseMom you get a pre-emptive transplant. My mom gave me my first kidney and I never had Medicare but I also didn't do dialysis.) then you really do have to start paying Part B. otherwise, if you need it in the future it will cost more and you'll have to wait months for it to start.

If you are unhappy with paying the copays on drugs or doctor visits with the coordinating private insurance, you can look into getting your own Part C supplemental and Part D prescription. You will probably find that even with the "wasted" money on Part B you come out ahead.

I pay $100 for Part B, $285 for Part C, and $100 for Part D every month. Then I still have some significant drug copays along with paying straight through the donut hole. I also still have a few other charges. I have no eye or dental insurance.

Just do the numbers.

Were you on Part C aka Medicare Advantage prior to starting dialysis? My understanding is that Medicare Advantage is not an option for those already using dialysis.

[BattleScars]

I think I'm more confused than when I first started this post. Part A, Part B, Part C, Part D, Part XYZ. Who can keep up? All I know is my situation is unusual because they are making me pay for Part B even though my private insurance is covering 100% and never sent anything in. So Medicare is taking their cut but not paying for anything. Something isn't right about that. I'm going to cancel it at least until the day my insurance makes me get on Medicare. As long as I'm paying the co-pays for Blue Cross there's no good reason for me to be paying for Medicare too.

[BattleScars]

Oh and btw, my social worker at MGH is a complete idiot. She has no clue when it comes to anything. I dread asking her anything because she just doesn't have any answers. I know next to nothing about any of these insurance issues but still know more than she does.

[Sydnee]

I think that is how social workers are. Ours is the same.

Every time we make her help us at the end she says "I learned something from this". Evidently Ed was the first person she had to work with that had private insurance through his work. (I don't believe it) She has been a social worker 8 years in Wyoming and Northern Colorado FMC dialysis centers.     

[cattlekid]

Actually, I don't think this is,out of the realm of possibility, I know on my in-center shift, out of about 20 patients, only two of us were still working and the other girl got a transplant about four months after I started. They made me fill out the Medicare form when I started but I told them in no uncertain terms that they were not to send it in to Medicare because I didn't want to waste the money on the Part B premiums. I only signed myself up for Medicare last year because I thought that I was getting close to transplant and I wanted to have all my ducks in a row.

I think that is how social workers are. Ours is the same.

Every time we make her help us at the end she says "I learned something from this". Evidently Ed was the first person she had to work with that had private insurance through his work. (I don't believe it) She has been a social worker 8 years in Wyoming and Northern Colorado FMC dialysis centers.   

[smcd23]

Oh and btw, my social worker at MGH is a complete idiot. She has no clue when it comes to anything. I dread asking her anything because she just doesn't have any answers. I know next to nothing about any of these insurance issues but still know more than she does.

   When we were at MGH they wanted us to either move to MA so my husband could get in MassHealth (he doesn't qualify in NH because before we were married we lived together and had a kid so for the state, that was good enough to count my income) or for us to get married. And financially his meds and stuff were cheaper when he was on a Medicare Drug plan because he got subsidy.

Anyway, to answer your question (I work for SSA)

If you just got enrolled in Medicare now, 2 years after you went on disability, you were enrolled under the disability rules. Everyone on disability gets enrolled in Medicare automatically after 2 years. To enroll under ESRD your dialysis center or transplant center has to send in a form to the local SSA office for processing (we call it the blue form, but I think the official form # is CMS-2728 or something like that).

The 30 month coordination of benefit period.... let the fun begin!
The 30 months starts with transplant, month of starting home dialysis treatment or 3 months after hemo treatment. The purpose of the period is so that private insurance isn't stuck footing the bill for dialysis forever. When one is on Medicare for any other reason besides ESRD (old age, disability) and they or their spouse is working, Medicare is secondary to the insurance through the employer. So where you and my husband are relatively young, your private insurance could essentially be paying for dialysis for several years, not to mention the transplant etc.
So, for ESRD patients ONLY, during the first 30 months of eligibility to Medicare, Medicare is secondary to the private insurance. Then at 30 months it switches so Medicare is footing the majority of the bill, and the group health insurance through work is secondary. This applies to ESRD patients only, so if you got automatically enrolled after 2 years, you wouldn't be enrolled properly (technically).
You can opt out of Part B if you want, but check with your group health insurance first. I know with my insurance, as long as my husband is on Medicare, he pays $0 in doctors copayments. They pick up the rest of whatever Medicare doesn't cover, and we don't get any bills for his treatment. It's not required that he take Medicare, but since we pay nothing the $100 out of his check each month is worth it.

The copayments on his meds now... that is another story...

Does that help answer your question?

[jeannea]

Part C is not the same as Medicare Advantage. We are not eligible for Medicare Advantage. We are eligible for Medicare supplement plans since with Part A and Part B you still have to pay 20% of everything. I had to buy Part C and Part D or be homeless.

[Bill Peckham]

Part C is not the same as Medicare Advantage. We are not eligible for Medicare Advantage. We are eligible for Medicare supplement plans since with Part A and Part B you still have to pay 20% of everything. I had to buy Part C and Part D or be homeless.

http://ssa-custhelp.ssa.gov/app/answers/detail/a_id/167/~/differences-between-medicare-parts-a,-b,-c-and-d



...
Part C (Medicare Advantage) plans allow you to choose to receive all of your health care services through a provider organization.  These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee.  You must have both Parts A and B to enroll in Part C.
...

[jeannea]

As usual, the government is not careful with their terms. If you are under 65 and receiving Medicare for ESRD you are not eligible for Medicare Advantage plans. You are eligible for Part C Supplemental Insurance.

[Bill Peckham]

Eligibility for Medicare supplemental plans vary state to state for those that have Medicare due to disability or ESRD. They are supplemental to Medicare, they are not provided by Medicare, so they aren't Part anything.