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  • Medicare part B?

    I'm working with good insurance; is there any advantage to getting Medicare part B? Will it cover deductibles on my employer plan?
    T3 complete since Sept 2015.

  • #2
    Originally posted by Mize View Post
    I'm working with good insurance; is there any advantage to getting Medicare part B? Will it cover deductibles on my employer plan?
    If you are eligible to begin receiving Medicare Part B (Medical Insurance) and delay taking it you will pay a 10% penalty for every 12 month period that you could have had Part B. You will pay the higher premium for all of the time you do have Part B. There are some exceptions called SEPs or Special Enrollment Periods. See the following link for qualifications: https://www.medicarerights.org/PartB...ent-Period.pdf

    This article seems to be right on point to your question:
    How does Medicare work with my current employer insurance? https://blog.medicarerights.org/medicare-work-current-employer-insurance/

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    • #3
      Medicare A only covers inpatient hospitalization and care. Medicare B covers outpatient care (doctors visits, PT, OT, home health care, etc.). Medicare D is drug coverage, which you are also required to have when signing up for Medicare at age 65. Some Medicare B plans include Medicare D. I assume your employer's insurance covers what Medicare B covers, right? If so, even when you turn 65 you don't have to sign up for Medicare B or C or D until you retire.

      If you are covered by insurance through your employer (and they employ more than 20 employees), that insurance is your primary, and Medicare is your secondary insurance. Once you retire, then you have the option, in most situations, to convert your employer's insurance to a Medicare B or Medicare Advantage (HMO) plan.

      https://www.mymedicarematters.org/20...edicare-guide/

      https://www.fool.com/retirement/2017...ll-workin.aspx

      (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.

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      • #4
        It says I can delay so long as I have employer (large) coverage without penalty and I understand it would be secondary insurance, but I don't understand the value of secondary insurance. What does it pay?
        T3 complete since Sept 2015.

        Comment


        • #5
          Medicare pays (usually) 80%, and your secondary insurance usually covers the 20%. As above, Medicare A only covers inpatient care, not outpatient. Medicare also does not pay for eye glasses, dental, or hearing aides, which may be covered under your employer's (secondary) insurance.

          (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


          • #6
            Originally posted by Mize View Post
            It says I can delay so long as I have employer (large) coverage without penalty and I understand it would be secondary insurance, but I don't understand the value of secondary insurance. What does it pay?
            Just recapping what I think you are looking for.

            You are still employed and have good insurance from your employer.
            You are eligible to sign up for Medicare.
            However, you will be using your employer's health insurance plan as Primary Payer.
            The Medicare coverage you sign up for will be the Secondary Payer.
            You are looking for how much (probably a % number) Medicare will pay toward doctor's visits, procedures, tests etc.

            I believe the answer is, it depends on how Medicare COB (Coordination of Benefits) are applied and computed. Instead of trying to explain all of the conditions here, take at look at this Medicare documentation and an article by Cornell Law School.

            https://www.cms.gov/Medicare/Coordin...-Benefits.html

            https://www.law.cornell.edu/cfr/text/42/411.33

            Comment


            • #7
              There is a difference between secondary insurance and supplemental insurance. You want both.

              Supplemental insurance only pays your private insurance's copay. Secondary is a different policy with it's own guidelines.

              How Medicare and your private insurance interact is complicated. I think Medicare is in 1st place and your private insurance comes in 2nd place (but not necessarily). Question is does your private insurance act as a supplement, a secondary, or both? Ideally it's both: 1) They pay the Medicare copay, 2) they offer additional coverage not offered by Medicare.

              I would ask both Medicare and HR how this works to see if you get the same answer.
              Last edited by August West; 10-20-2018, 08:05 PM.

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              • #8
                A few definitions:

                MEDICARE SECONDARY PAYER
                Medicare Secondary Payer or MSP refers to Medicare Benenfits when Medicare is not the primary insurance. Medicare requires all health care providers to know how to determine when Medicare is the primary or secondary insurance for their Medicare patients. Medicare is primary when the patient is:
                1. 65 or older and has a small group health plan through their own current employer or through their spouse's current employer
                2. 65 or older with insurance through a retirement plan
                3. Disabled and has a small group health plan through their own current employer or through their spouse's current employer

                In instances that the primary insurance denies the claim, Medicare may pay only in certain situations.

                Supplemental Insurance vs. Secondary Insurance

                Medicare providers and beneficiaries often confuse supplemental insurance payments with Medicare secondary insurance payments. The policies are not related to each other and are applied independently of one another to a Medicare claim.
                Supplemental Insurance

                Medicare Supplemental insurance is an insurance plan that provides additional payments for Medicare covered services after Medicare has issued payment. Medicare will pay the claim as the primary insurance and then the supplemental insurance will make payment on the remaining balance according to the benefits offered by that insurance.
                Once a claim has processed through the Medicare system and paid according to the Medicare allowed amount, the Medicare claim will then "cross over" to the supplemental insurance company through the Benefits Coordination & Recovery Center (BCRC) for the supplemental insurance payer to process the remaining balance for possible payment.
                The supplemental insurance company is responsible to set up the beneficiary information for their subscribers to their supplemental policies at the BCRC.
                Medicare as Secondary Payer on a Claim

                Medicare Secondary Payer (MSP) insurance occurs when Medicare is the next payer to another insurance company paying first or "primary." Claims must process through the beneficiary's primary insurance and then the claim may be submitted to Medicare, usually by the primary payer (or on rare occasions, by the beneficiary) for possible secondary payment.
                Part A and Part B providers must submit the claim using UB-04 or CMS-1500 claim form (or electronic equivalent) coding to report the information from the primary payer's Explanation of Benefits (EOB). Medicare will then process the claim and will pay according to the Medicare calculations for secondary payment on the remaining balance of the claim.

                https://med.noridianmedicare.com/web...dary-insurance

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                • #9
                  Thanks everyone. It's truly complicated.
                  I have large group, work-supplied insurance that's quite good. Medicare Part B would cost me something like $160/month or $1,920/year so it really comes down to whether I can recoup at least $2,000 from Medicare Part B to justify having it.

                  Sounds like the answer isn't trivial to determine. I'll read some links and see what I can figure out.

                  Thanks.
                  T3 complete since Sept 2015.

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                  • #10
                    Mize, I faced this decision when my hubby w as employed. I did not sign up for Medicare B until he retired. It was a simple process involving one document that verified I had had a private primary. Hubby retired in 2016. If you do sign up for part B you then face a complicated choice of which of many plans to choose. It is a nightmare designed to drive elderly people to despair while helping private insurers rake in dough.

                    Comment


                    • #11
                      Originally posted by Mize View Post
                      Thanks everyone. It's truly complicated.
                      I have large group, work-supplied insurance that's quite good. Medicare Part B would cost me something like $160/month or $1,920/year so it really comes down to whether I can recoup at least $2,000 from Medicare Part B to justify having it.

                      Sounds like the answer isn't trivial to determine. I'll read some links and see what I can figure out.

                      Thanks.
                      For a couple years I had medicare as secondary to my employer's insurance. I don't think it actually ever paid anything. $2000 is a lot to rack up in outpatient costs. Part A is nice because then I don't have to pay my 20% copay for expensive hospitalizations, but I think in the 2 years I had Medicare (with maybe four acute visits, a couple to my PCP a couple to urgent care, a round of a dozen or so physical therapy visits and one procedure (outpatient urologic procedure done in the hospital) Medicare might have paid a total of $300 to $400... with the added inconvenience that I had to call and spend probably a total of 50 hours on hold over that period to argue with people and tell them that Medicare was secondary when they messed up the bill... oh and it freaked out my DME to the point that it has now taken over two years to get a new chair because they told me they couldn't not bill Medicare even though it was secondary (an outright lie) and even when I got their corporate office to agree that they were not obligated to bill Medicare and I could sign a piece of paper telling them not to bill Medicare they told me that because I had medicare (even though they weren't going to be billed) I couldn't get a titanium chair.

                      If you're not getting it from the flavor of my post above, I definitely do not think it's worth paying for part B... at least in my situation.

                      For your specific situation it's going to depend on how many outpatient visits you have and how often you see your doctors. For me it's only $20 copay for my PCP and $50 for a specialist. At those rates I'd have to planning on having a doctor's appointment every week to justify paying $160 a month, and I'm just not that sick.... yet....

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                      • #12
                        Thanks funklab. I think you're correct, though I do botox injections and I "pay" 20% - but I pay from an HSA my employer fills with money, so claims to Medicare would likely be an amazing hassle.
                        T3 complete since Sept 2015.

                        Comment


                        • #13
                          Originally posted by Mize View Post
                          Thanks funklab. I think you're correct, though I do botox injections and I "pay" 20% - but I pay from an HSA my employer fills with money, so claims to Medicare would likely be an amazing hassle.
                          In this situation I assume medicare is supposed to pay 80% of the 20%, but in my experience that was rarely the case. Most often it just paid nothing. Maybe if I knew the right people to call and annoy on the telephone I would have been able to save a little more money, but medical bills are so complex I rarely know what I'm supposed to pay in any case.

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