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gizmo

Medicare Question

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I am on SSDI, benefits started paying February 09. I am covered, at no cost, by my husband's generous health insurance plan. Our whole family is. For free. Great copays.

August 2010 (I think, two years after qualification, right?), I will be eligible for Medicare. I do not want to go on Medicare. I don't want to pay the high premium, I don't want the donut hole, I don't want the doctor restrictions.

I've been told (gossip by the water cooler type stuff) that my insurance company will drop me once they find out I am eligible for Medicare, or charge a huge premium for me to the company.

I don't want this to happen. The company saves us several hundred dollars a month in insurance premiums. I don't want Medicare knocking on their fucking door and specifically pointing out my husband.

So how does this stuff all work?

ETA: Clarification

Edited by gizmo

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I don't know how this is supposed to work, but I'm covered under my parents insurance, currently eligible for medicare and on ssdi.

I opted out of medicare and my insurance rates didn't change.

I can opt into medicare at any time, is what I was told.

That's all I can tell you for now.

There's just no reason for medicare to waste their time and/or money to research your or your husband's insurance situation and then to go further and disrupt that. What would be the gain for them?

I don't know, but it doesn't make sense, ya know?

But maybe someone ele who knows for sure can tell you for certain.

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I don't think you need to worry. Using my parents as an example, Dad was disabled long before retirement age. He stayed on her (better than Medicare) insurance until this year when she retires and they both will be on Medicare.

I agree with Luna that it doesn't make much sense and sounds like too much work for the feds to bother.

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i am fairly certain that when, in a couple of years, I hit 65 my private medical insurance will drop me. i am a bit lazy right about now so i don't want to dig out the old contract for terms and regulations but i do believe that is what the scheme is.

at 65 i get on medicare and try to figure out the scores of supplemental plans. another reason not to want any more life.

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Your private insurer often has no incentive whatsoever to drop you.

Here's the thing - and I'm assuming no one here is on dialysis, rules are different there. If someone who's more intimately involved in reimbursement knows differently and can provide citations, please do so; I'm writing from a public health system financing perspective, and as someone who looks at barriers to care faced by people on Medicare.

Medicare is almost always the primary payer - UNLESS your other insurance comes from someone's employment and it is a large group plan (the employer has >100 employees.)

If you have a private pay plan: Medicare is the primary payer. If you or your spouse or your parent work for a small group: Medicare is the primary payer. If you receive Medicaid and Medicare, Medicare is the primary payer.

If you receive health benefits from your own (or your spouse's/parent's) employment at a large group, then Medicare becomes secondary. There are also some issues around dialysis that can bump Medicare around in the payer ranking - and that is the only ever disincentive. But let's not go there right now.

Because here is why your insurance plans should be fucking thrilled that you're on Medicare, with the exception of the large group: As soon as Medicare becomes primary, then the Medicare rates, which are between 20-30% of usual, apply. And your insurance only ever pays the 20% (50% for psych) copay. And it's 20% of the Medicare rate. So the psych visit that might have cost $150 before to Aetna can not cost more than, say, $60 to Medicare, and Aetna now only pays $30.

Of course, you then may have some real problems accessing care. But that is also another issue.

Now - your private insurer may want to switch you to a supplemental plan - partly because of the dialysis reasons - and Medicare does one sweet, sweet job of covering dialysis, so, fine. (Consider your risks of dialysis, perhaps, in this analysis. Remember that your private plan will have a lifetime maximum. Remember that dialysis can get you there.) Also, those supplemental plans are usually significantly less expensive.

However, for anyone out there who has the option of continuing large-group coverage that's secondary to active employment (not retirement) in addition to Medicare - I'd really recommend you think about this if you can afford it.

Or, if you're on the fence - call your doctors' office managers and ask them if they take Medicare and if they will continue on with you if you're a Medicare patient, and what your community situation is for Medicare patients. In some parts of the country (like mine), it's really, really grim. In others, with a higher percentage of retirees, everyone takes Medicare, and it works well.

And the whole situation may change radically, of course, in the next few years.

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Here's my situation, if this applies to anyone. Baboo has a pretty good health insurance plan because he is retired from a school system. I am also covered.

However, the day he turned 65, he was booted from the plan and Medicare became his primary insurer.

That sounds terrible, but the reality isn't so bad. What Medicare doesn't cover, his insurance company (now the secondary provider) pretty much picks up. In this area, and I don't know if it's because I'm in NY state, all of the doctors we have take Medicare. (As Silver said, this varies from state to state). We have a GP, a podiatrist, an ophthalmologist, and Baboo has seen other specialists like urologists and all of that has been paid for by Medicare and our insurance.

Neither of us sees a pdoc, so I don't know about that. Our state has passed that equity law for mental health care, so I think the coverage is equal.

Gizmo, I think you're wise to investigate this in advance. Talk to your doctors' office managers, as Silver suggested. We happen to have really nice people in our local Social Security office, so Baboo has been in to see them several times and got the answers to his questions. But I understand that some offices are sucky.

olga

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some insurers have started doing this. for instance, General Motors was covering retirees with their (primo) insurance plan as part of the negotiated benefits to which they are entitled. when the shit hit the fan, they dropped everyone who was eligible for medicare. I've heard similar stories for other companies and agencies, including a place I used to work.

Might be a good idea to just call the insurance company and ask what their policy is on this issue.

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Been looking around - my state doesn't allow insurers to drop you when you are eligible for Medicare, if you're in a small business or large group plan. Looking through the regs and when that one was put into place, it was in response to the crunch in availability.

So that probably varies by state, I'm guessing...

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