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    Medicare?

    Hi,
    I got my medicare package in the mail today. They automatically enrolled me in Part A and Part B. I am covered under my husbands insurance and I have my Indian card as back up. Fortunately, i have never had to use my indian card but I certainly apprecaite the peace of mind from having it just in case. My Medicare package said there is no cost for Part A so I figure I might as well keep it as a back up in case I'm am not covered by insurance for some reason. I don't want to pay the part B part since I am very pleased with my current insurance coverage.

    My question is.....If I decline part B, will I have a difficult time enrolling in it at a later date if I need it down the road?
    DFW TEXAS- T-10 since March 20th, 1994

    #2
    If you enroll later, they will charge you more than the $99.90 currently that we are paying.

    http://www.medicare.gov/MedicareElig...nguage=English

    Important: The cost of Medicare Part B will go up 10% for each full 12-month period that you could have had Medicare Part B but didn’t take it, except in special cases. You will have to pay this penalty as long as you have Medicare Part B.
    The only way you can drop it and get back on it without being penalized is being covered by your insurance plan while working.

    It is such a PITA.

    I hope this helps.
    T12-L2; Burst fracture L1: Incomplete walking with AFO's and cane since 1989

    My goal in life is to be as good of a person my dog already thinks I am. ~Author Unknown

    Comment


      #3
      One thing to consider is if a Medicare recipient is eligible for Medicaid, the part B premiums are usually paid by Medicaid. What we did when Ry became eligible was enroll him in a drug plan that would cover the co-pays for his meds. The co-pays had been covered by the state (Medicaid) until he became eligible for Medicare. The state pays the premiums for his Medicare and his drug plan. I know this is based on the fact that the only income he has is social security based on a part time job (injured at 17).

      The point is there are many variables in this. Even excellent group health coverage can fall far short when you need it most. I know. My husband work for a defense contractor and the medical expenses before the Medicaid and then Medicare kicked in caused us to make a serious dent in his college fund as well as our retirement savings. This will be the first year that Ry has had all three and the first year we did not have at least 30k of a medical expense deduction (I do scrounge every available deduction).

      If the premium gets you access to a drug plan that will pay your copays (all your office visit co-pays, deductibles, and co-insurance will also be covered by Medicare B), this may very well add up to more than the premium. It really did for us.--eak
      Elizabeth A. Kephart, PHR
      mom/caregiver to Ryan-age 21
      Incomplete C-2 with TBI since 3/09

      Comment


        #4
        Thank you guys for the valuable information. Does it matter if I'm married and covered by my spouses insurance? Will HIS salary make a difference in what is covered or not covered? I don't want to pay the monthly fee if they are just going to kick it over to insurance anyway.
        DFW TEXAS- T-10 since March 20th, 1994

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          #5
          no, or not that i know of, but his ins will become the secondary and pay the last 20% that medicare doesn't...

          Comment


            #6
            If you are getting SSI or Medicaid now, it definitely makes a difference, as your husband's income gets counted into your household income then. It is a common way that PWD loose those benefits, and a common reason for people to decide to NOT get married but instead just live together. If you make it legal, it counts (and you can't get divorced on paper only....they will consider it fraud if you divorce and continue to live together in order to maintain or get benefits). It does not make a difference for Medicare, which is not based on income, but as above, it may be considered the secondary to his coverage (rather than primary). Remember that Medicare rarely pays more than 80% too.

            You can only add Medicare B back during a Medicare "open season", so if you find you need it and don't have it, then you may have to wait months to sign up. Remember that Medicare A essentially pays only for hospitalization, not for doctors office visits, PT, OT, home care skilled nursing, etc which is covered under Medicare B only. I believe DME is also under Medicare B.

            You can find a ton of information about Medicare here: http://www.medicare.gov


            (KLD)
            The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

            Comment


              #7
              i didn't think about income affecting Medicaid, yeah that will sure take Medicaid go away......

              Comment


                #8
                The group health plan is primary if they are a "large group", meaning that there are more than 100 plan members. All members do not have to participate so knowing if some one at work is covered is not necessary. If he works for a large company (with more than 100 eligible people), it is a large group and the Plan administrator can confirm this.

                The primary coverage issue is a huge consideration. You do not want to turn down part B only find out that the group is secondary because there are only 15 eligible employees. I know it is enough to make your head hurt. I am fortunate in that I have a background in HR and employee benefit plans and regulatory compliance has been my focus. If you want help, PM me.--eak
                Elizabeth A. Kephart, PHR
                mom/caregiver to Ryan-age 21
                Incomplete C-2 with TBI since 3/09

                Comment


                  #9
                  Airart1 is right, that's what happened with chad. His primary forced him to Medicare as primary and his employer as secondary eve though his employe is huge. Eak, not sure I understand how that works because they told us in no uncertain terms he had to have Medicare as primary.
                  Wife of Chad (C4/5 since 1988), mom of a great teenager

                  Comment


                    #10
                    Zilla, it is different if the group plan is the spouse's. ie If Chad were covered under a group plan where you work.

                    And, it has to do with the size of the company, as mentioned above. I am also in the situation, where my insurance through my husbands plan is primary, and medicare is secondary.
                    T7-8 since Feb 2005

                    Comment


                      #11
                      Originally posted by SCI-Nurse View Post
                      You can only add Medicare B back during a Medicare "open season", so if you find you need it and don't have it, then you may have to wait months to sign up. Remember that Medicare A essentially pays only for hospitalization, not for doctors office visits, PT, OT, home care skilled nursing, etc which is covered under Medicare B only. I believe DME is also under Medicare B.

                      You can find a ton of information about Medicare here: http://www.medicare.gov


                      (KLD)
                      I think you can also add it if you have a "qualifying" situation, ie, if your husband were to be laid off, and lost his insurance, you could pick up part B.
                      T7-8 since Feb 2005

                      Comment


                        #12
                        Originally posted by sjean423 View Post
                        Zilla, it is different if the group plan is the spouse's. ie If Chad were covered under a group plan where you work.

                        And, it has to do with the size of the company, as mentioned above. I am also in the situation, where my insurance through my husbands plan is primary, and medicare is secondary.
                        So if I covered him under my employer's plan, I could make my employer's coverage primary (my company is massive), and Medicare secondary? That would be quite advantageous potentially. Hmmmmm.
                        Wife of Chad (C4/5 since 1988), mom of a great teenager

                        Comment


                          #13
                          That was my situation, zilla. When my wife was working I was on her plan with Wyeth (now Pfizer) and my Medicare was secondary. It should work that way for you.

                          Comment


                            #14
                            Originally posted by zillazangel View Post
                            So if I covered him under my employer's plan, I could make my employer's coverage primary (my company is massive), and Medicare secondary? That would be quite advantageous potentially. Hmmmmm.
                            You don't get to "choose" who is primary, there is some rubric, but a disabled spouse covered under the plan of the non disabled spouse, who works for a big company, (not sure of the headcount, it was mentioned before) ends up with medicare secondary. Altho, you would be choosing, but switching of course.

                            It works out well for me, Cigna gets the bill first, does their reasonable and customary, in network agreement magic where they make money disappear, pays their part, and then it goes to medicare. After I hit the medicare deductible, they pick up a good part of what cigna doesn't. For instance, I just got a lab bill for $1.84.

                            If you go that way, be prepared to tell the billing peeps, over and over that medicare is secondary. They tend to mess that up a lot. And even at the eye doctor, it has to go through cigna first, and get denied, even tho we don't have vision care.
                            T7-8 since Feb 2005

                            Comment


                              #15
                              https://www.shiptalk.org/About/SHIPr...spx?mf=Display

                              Also every state has an Number where you can call with questions like this.
                              If you can't handle me at my worst, then you sure as hell don't deserve me at my best.


                              Sometimes it is easier to widen doors than it is to open minds.

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