SIGforum.com    Main Page  Hop To Forum Categories  The Lounge    Medicare, How Does It Work? Help Please
Page 1 2 
Go
New
Find
Notify
Tools
Reply
  
Medicare, How Does It Work? Help Please Login/Join 
Member
posted Hide Post
My previous post didnt quite answer the question I think you were asking, but I wont delete it. It might have some info useful to others. I think you're looking for this:

Coordination of benefits
If you have Medicare and other health coverage, you may have questions
about how Medicare works with your other insurance and who pays your
bills first. Each type of coverage is called a “payer.” When there’s more
than one payer, “coordination of benefits” rules decide who pays first. The
“primary payer” pays what it owes on your bills first, then you or your health
care provider sends the rest to the “secondary payer” (supplemental payer)
to pay. In some rare cases, there may also be a “third payer.”
Whether Medicare pays first depends on a number of things, including the
situations listed in the chart on the next 3 pages. However, this chart doesn’t
cover every situation. Be sure to tell your doctor and other providers if you
have health coverage in addition to Medicare. This will help them send your
bills to the correct payer to avoid delays.
Where to go with questions
If you have questions about who pays first, or if your coverage
changes, call the Benefits Coordination & Recovery Center (BCRC) tollfree at 1-855-798-2627. TTY users can call 1-855-797-2627.
The BCRC is the contractor that acts on behalf of Medicare to collect and
manage information on other types of insurance or coverage that a person
with Medicare may have, and determines whether the coverage pays before
or after Medicare. This contractor also acts on behalf of Medicare to get
repayment when Medicare makes a conditional payment, and another payer
is determined to be primary.
When you call the BCRC, have your Medicare Number ready—you can find
it on your red, white, and blue Medicare card. The BCRC may also ask for
information like your Social Security Number (SSN), your address, the date
you were first eligible for Medicare, and whether you have Medicare Part A
(Hospital Insurance) and/or Medicare Part B (Medical Insurance).
6 Section 1: When you have other health coverage
How Medicare works with other coverage–find your situation
Find your situation on pages 6 through 8 to see which payer generally pays first for
Medicare-covered items and services, and which page to visit for more details.
You can also get this information by visiting Medicare.gov.
I’ve got Medicaid (page 11)
Medicare pays first, and Medicaid pays second.
I’m 65 or older and have group health plan coverage based on my own
current employment status or the current employment status of my spouse
(pages 11–13).
• If the employer has 20 or more employees, then the group health plan pays first,
and Medicare pays second.
• If the employer has less than 20 employees and isn’t part of a multi-employer or
multiple employer group health plan (see page 18), then Medicare pays first

Here is the link that explains who pays first in detail: https://www.medicare.gov/Pubs/...n-benefits-payer.pdf
 
Posts: 1074 | Location: New Jersey  | Registered: May 03, 2019Reply With QuoteReport This Post
Member
posted Hide Post
quote:
Originally posted by sig2392:
Be aware there is a penalty on part B late enrollment.

It is a lifetime penalty.

https://www.medicare.gov/your-...e-enrollment-penalty.

Be sure to do this right or it can cost you a penalty for as long as you have part B.

I am not an expert but this is what I was told at the SS office when I went to sign up.


This is correct. This is one of the biggest problems I ran into when I was working at SSA. If you don't sign up during your initial enrollment period, you better be sure that either: 1. you don't need it - 0R - 2. you will be able to enroll during a special enrollment period when you retire.
 
Posts: 1074 | Location: New Jersey  | Registered: May 03, 2019Reply With QuoteReport This Post
Member
posted Hide Post
Thank you Fed161!
 
Posts: 7721 | Registered: October 31, 2008Reply With QuoteReport This Post
Member
Picture of az4783054
posted Hide Post
If you have a doctor you like, you might have to consider paying out of pocket for you medical exams and use medicare for your labs. That's what we found in our rural area. Doctors here do not want to deal with the added costs to deal with medicare. The only doctors that take medicare patients here are associated with the regional hospital and there's not many of them. Getting appointments and followup from tests was beyond frustrating. It's not feasible to drive 100+ miles to metro Phoenix.

We got tired of it and decided to pay out of pocket to keep our small practice doctor who refused to accept medicare. Then a medicare accepting conglomerate bought out her practice.
 
Posts: 11202 | Location: Somewhere north of a hot humid hell in the summer | Registered: January 09, 2009Reply With QuoteReport This Post
Member
Picture of Krazeehorse
posted Hide Post
I just have part A. Stayed on my wife's insurance for part B. Her employer changed providers January 1. Hope I chose wisely.


_____________________

Be careful what you tolerate. You are teaching people how to treat you.
 
Posts: 5734 | Location: Ohio | Registered: December 27, 2008Reply With QuoteReport This Post
Member
posted Hide Post
quote:
Originally posted by Krazeehorse:
I just have part A. Stayed on my wife's insurance for part B. Her employer changed providers January 1. Hope I chose wisely.


When your wife retires (I'm assuming she is working) your special enrollment period for part B begins. It's your only chance to enroll in part B without a permanent life time penalty (if you decide to enroll later). Just be aware of that. You will be fine as long as you keep that in mind. In your case not taking part B makes sense.
 
Posts: 1074 | Location: New Jersey  | Registered: May 03, 2019Reply With QuoteReport This Post
I have not yet begun
to procrastinate
posted Hide Post
quote:
One basic fact of life is that employers and employer group health plans are always looking to reduce costs

^^This^^
I’m not old enough yet but I am retired. The Public Safety Retirement System that covers me and my older friends wanted them signed up ASAP when that magic birthday hits.
(They worked side jobs that paid into SS, I just worked OT shifts for the Fire Dept)

I have no idea how this will affect me yet, I haven’t paid anything to SSA for my whole 31 yr career. The last time I paid anything was 1 quarter in 1985. I don’t know if that affects eligibility or not.


--------
After the game, the King and the pawn go into the same box.
 
Posts: 3898 | Location: Central AZ | Registered: October 26, 2006Reply With QuoteReport This Post
As Extraordinary
as Everyone Else
Picture of smlsig
posted Hide Post
I want to thank all who,have contributed to this discussion particularly Fed161.

I turned 64 last month so this is one of my big projects for this year. Like others I am retired but on my wife’s insurance policy for the next 5 years or so, so this discussion is timely.
Thank you.


------------------
Eddie

Our Founding Fathers were men who understood that the right thing is not necessarily the written thing. -kkina
 
Posts: 6483 | Location: In transit | Registered: February 19, 2013Reply With QuoteReport This Post
Admin/Odd Duck

Picture of lbj
posted Hide Post
I have been on Medicare since May of last year.
If you are turning 65, you don't need to wait for the standard enrollment dates in November and December each year.

You sign up anytime in the 60 days prior to your birthday when you are turning 65.

I have A and B as well as a part D RX plan and a supplemental plan to help cover what Medicare doesn't.

It's not really complicated and so far so good.

Be aware if picking up Part B, the premium is on a sliding scale of income.
I pay the max premium which is about $580 per month. I have a lot of income.

I am saving about 2 thousand dollars a month from my old private healthcare plan since cancelled.

Medicare is covering all my cancer care bills so far.


____________________________________________________
New and improved super concentrated me:
Proud rebel, heretic, and Oneness Apostolic Pentecostal.


There is iron in my words of death for all to see.
So there is iron in my words of life.

 
Posts: 31446 | Registered: February 20, 2000Reply With QuoteReport This Post
Member
Picture of mcrimm
posted Hide Post
Before my wife and I retired - on the same day. We found a knowledgeable person at our Council on Aging. She spent about 2 hours with us going over parts A, B, C, D and the various supplements available. She confirmed our earlier decision as to which supplement we wanted. From that point it was a simple matter of contacting our insurance guy and signing up. Incidentally, we have part G.



I'm sorry if I hurt you feelings when I called you stupid - I thought you already knew - Unknown
...................................
When you have no future, you live in the past. " Sycamore Row" by John Grisham
 
Posts: 4282 | Location: Saddlebrooke, Arizona | Registered: December 24, 2013Reply With QuoteReport This Post
Legalize the Constitution
Picture of TMats
posted Hide Post
I am retired, but my wife is 10 years younger than I. I signed up for Medicare and Part B. I have the ability to keep paying for BCBS, especially to cover my wife who is not eligible for Medicare and won’t be for several more years. Medicare automatically becomes primary, and BCBS secondary. Thus far, it has worked out great for both of us. My wife continues to have insurance and with the combination, I have nothing out of pocket—no co-pays, nothing. This summer, I had a major surgical procedure, between the two (Medicare and Blue Cross), I owe nothing. That surgery alone made the expense of carrying the BCBS for my wife, a real benefit for me.


_______________________________________________________
despite them
 
Posts: 13648 | Location: Wyoming | Registered: January 10, 2008Reply With QuoteReport This Post
Member
Picture of mikeyspizza
posted Hide Post
https://www.medicare.gov/suppl...with-other-insurance

"How Medicare coordinates with other coverage

If your questions about who pays first, or if your coverage changes, call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627"
 
Posts: 4063 | Location: North Carolina | Registered: August 16, 2003Reply With QuoteReport This Post
california
tumbles into the sea
posted Hide Post
lots of great info here. thanks.
 
Posts: 10665 | Location: NV | Registered: July 04, 2004Reply With QuoteReport This Post
Member
Picture of m1009
posted Hide Post
One more thing to consider... Medicare would be secondary ins for part b if your employer has over 100 employees, and you were working and carried your main plan. If less than 100 employees, it would become primary if you signed up for part b benefits.
I have seen at least one instance, where the person did not sign up for part b, so his main ins was the only one for dr visits, and they penalized him for not signing up. The reasoning was, they would be secondary, if he had part b, so they would only pay as if they were secondary.
Hopefully, you don’t have this issue.
 
Posts: 1159 | Registered: September 27, 2008Reply With QuoteReport This Post
Member
posted Hide Post
I signed up for Medicare when I turned 65 but remained on my employers plan at that time. I'm 67 now (waiting for my first social security check this week or next).

Although I have Part A, my wife is ~10 yrs younger than me and I'm on her benefits plan. Unless her employer forces me to drop off her plan, I'll stay on hers.
 
Posts: 1480 | Location: Western WA | Registered: September 11, 2006Reply With QuoteReport This Post
  Powered by Social Strata Page 1 2  
 

SIGforum.com    Main Page  Hop To Forum Categories  The Lounge    Medicare, How Does It Work? Help Please

© SIGforum 2024