Employer Insurance primary, Medicare secondary

[Kansas75]

I need your help to figure out this insurance mess I find myself in.  I am insured via my employer (larger than 100 employees) with a UHC plan that allows for HSA.  The family deductible is a whopping $3,000 and the in-network OOP is $6,200.  As soon as there are more than 2 people on the plan, only the family maximums matter, not the half the ammount individual caps, so because I have kids, I am running with the $3,000.  If I were to get Medicare how do they coordinate?  Do they help picking up the tap before or after I have met my primary deductible?  I have been told by my Davita insurance person it’s after, however patients on various internet forums say that they owe nothing because Medicare picks up where the primary doens’t pay, incl. the deductible, albeit at 80% after their $183 deductible.  Which one is true?  Would I get hammered with a $4,000 plus bill for January mit UHC alone, or would Medicare ease that burden once I paid their premium and deductible?
I only started dialysis in December so I have tet to see a bill, but I am extremely worried about the ammount that I will have to pay out of pocket and how Medicare can help.
Oh....I would only get Medicare because of ESRD, not age, and I am still working with what I perceive a nice income above any poverty lines quoted.  So, I don’t think I am eligble for any financial assistance.
Thanks so much for helping me figure this crap out (because I have no other things to worry about  )

[Michael Murphy]

I had my wife’s employee insurance and Medicare for the first 6 months of 2017. I was responsible for the first 3000 dollars of the 20 percent Medicare didn’t cover.  In June my wife retired and was eligible to keep her insurance instead of Medicare.  To make it my wife’s benefit to switch to Medicare they offered a ehhanced Medicare hmo package.  Now I pay nothing. And my wife’s employer saves a bundle.  My dialysis treatment was 1500 a session while I was on private insurance it’s now 340.

[iolaire]

Make sure you look at the Medicare income related rates:
https://www.medicare.gov/your-medicare-costs/part-b-costs/part-b-costs.html

If you have a high enough income it might be best to wait until the end of the coordination period to sign up.

I will say I never saw a bill for copays from Davita prior to Medicare becaming primary. Probably because Medicare would not pay the copays on what they billed insurance (it was far above the Medicare rate) and my insurance paid so much they were happy to eat the copays.

[cattlekid]

It is nearly impossible for us to give you concrete advice because every employer group health plan coordinates differently with Medicare.  For example, my employer health plan did not pick up the 20% of what Medicare did not pay, I still had to pay it but it did go against my deductible and OOP maximum.  I had a very low OOP maximum ($2000 per person calculated separately) so I waited until the very last moment to sign up for Medicare because I was not paying anything except my premiums after about mid-February for the two years I was on dialysis.

But this could be totally different for you, it all depends.  Probably best to talk with your individual insurance customer service to see how they coordinate with Medicare and go from there.

[Cowdog]

Hi Kansas75,
My situation was similar to yours when I started D over 9 years ago.

Employer Insurance was primary, I went ahead and started Medicare as secondary.
Medicare paid nothing for the 30 month coordination period BUT there was a benefit to having Medicare. If the healthcare provider accepted Medicare and the 80% paid by the Primary insurance was equal to or greater than the Medicare allowed amount the provider can not back bill you for the 20% not paid by the insurance company. I had to make some providers aware of this rule.

With Private Insurance (from Employer) you are a CASH COW  to Davita for the next 30 months.  They are going to make so much money from your treatments that I suspect you deductibles and OOP with get absorbed. Talk to your Social Worker at the clinic.
I never saw an invoice from Fresenius for the first 7 years. BUT with the advent of Obama Care my company insurance has covered less every year with higher premiums & deductibles and higher OOP I now have to pay the 20% not paid by Medicare until my OOP of $6500 is met. My deductible for 2018 is $1500 up from $500 last year. In 2016 max OOP was $2000. Fresenius absorbed all these expenses until the $$$ got bigger due to my employer insurance changes.

BTW - My employer insurance customer service and HR dept were useless, could not get their mind around the 30 month coordination period. When the 30 months was up and Medicare became primary my work HR sent a Gofer in the dept to ask me if I had stopped taking Dialysis. Said my ins claims had gone to practically nothing and they couldn't understand.

[Simon Dog]

With Private Insurance (from Employer) you are a CASH COW  to Davita for the next 30 months. 

It can be even worse if you go out of area.  When I was on employer insurance, it paid $5050 *per treatment* when I traveled and used a DaVita clinic.

For that price, there should have been a happy ending.