need advice on the wonderful world of insurance

S

Shaunessy

New member
Hey everyone! I'm looking for some advice regarding the wonderful world of insurance. <img src="i/expressions/face-icon-small-wink.gif" border="0">

Currently, my husband is covered by Medicaid through SSI and Medicare through SSDI. I'm working part-time and have insurance through my employer. I will be graduating this May and would really like to begin working full-time. Jake has been hospitalized 4-5 times a year lately (hopefully he gets back to 2-3!) so we need to have good coverage.

How do I find out how Medicare and my employer-based insurance would interact? I am able to see the co-pays my insurance charges for his prescriptions and the yearly max out-of-pocket online. My insurance company told me they are unable to tell me what would be covered/denied for Jake's hospitalizations until they get a bill. <img src="i/expressions/face-icon-small-tongue.gif" border="0">

Medicare is very confusing to me... As far as I understand, he would still be covered by Medicare part A once we pass the income limits for Medicaid. I logged onto the MyMedicare site to check it out and they have a screwy payment policy based on the number of days he's hospitalized. The lady I spoke to on the Medicare 1-800 number said that we might have to pay a monthly premium for the prescription coverage, Medicare part B. The prescription coverage has high co-pays and a huge coverage gap... so I don't know if it would help much? Does anybody actually use this?

Also, two other companies I'm considering applying for have Regence Blue Cross Blue Shield insurance. Does anyone have any good or bad experiences with them? Problems with coverage? These jobs pay slightly higher wages and BCBS is in-network for the hospital and clinic Jake goes to.

I'd love to learn from your mistakes or good decisions on this issue. I really want to start working full-time but I don't want to dig us into a health insurance hole. Are there any easy to understand websites on the subject? Perhaps "Health Insurance for Dummies"? <img src="i/expressions/face-icon-small-confused.gif" border="0">
 
S

Shaunessy

New member
Hey everyone! I'm looking for some advice regarding the wonderful world of insurance. <img src="i/expressions/face-icon-small-wink.gif" border="0">

Currently, my husband is covered by Medicaid through SSI and Medicare through SSDI. I'm working part-time and have insurance through my employer. I will be graduating this May and would really like to begin working full-time. Jake has been hospitalized 4-5 times a year lately (hopefully he gets back to 2-3!) so we need to have good coverage.

How do I find out how Medicare and my employer-based insurance would interact? I am able to see the co-pays my insurance charges for his prescriptions and the yearly max out-of-pocket online. My insurance company told me they are unable to tell me what would be covered/denied for Jake's hospitalizations until they get a bill. <img src="i/expressions/face-icon-small-tongue.gif" border="0">

Medicare is very confusing to me... As far as I understand, he would still be covered by Medicare part A once we pass the income limits for Medicaid. I logged onto the MyMedicare site to check it out and they have a screwy payment policy based on the number of days he's hospitalized. The lady I spoke to on the Medicare 1-800 number said that we might have to pay a monthly premium for the prescription coverage, Medicare part B. The prescription coverage has high co-pays and a huge coverage gap... so I don't know if it would help much? Does anybody actually use this?

Also, two other companies I'm considering applying for have Regence Blue Cross Blue Shield insurance. Does anyone have any good or bad experiences with them? Problems with coverage? These jobs pay slightly higher wages and BCBS is in-network for the hospital and clinic Jake goes to.

I'd love to learn from your mistakes or good decisions on this issue. I really want to start working full-time but I don't want to dig us into a health insurance hole. Are there any easy to understand websites on the subject? Perhaps "Health Insurance for Dummies"? <img src="i/expressions/face-icon-small-confused.gif" border="0">
 
S

Shaunessy

New member
Hey everyone! I'm looking for some advice regarding the wonderful world of insurance. <img src="i/expressions/face-icon-small-wink.gif" border="0">

Currently, my husband is covered by Medicaid through SSI and Medicare through SSDI. I'm working part-time and have insurance through my employer. I will be graduating this May and would really like to begin working full-time. Jake has been hospitalized 4-5 times a year lately (hopefully he gets back to 2-3!) so we need to have good coverage.

How do I find out how Medicare and my employer-based insurance would interact? I am able to see the co-pays my insurance charges for his prescriptions and the yearly max out-of-pocket online. My insurance company told me they are unable to tell me what would be covered/denied for Jake's hospitalizations until they get a bill. <img src="i/expressions/face-icon-small-tongue.gif" border="0">

Medicare is very confusing to me... As far as I understand, he would still be covered by Medicare part A once we pass the income limits for Medicaid. I logged onto the MyMedicare site to check it out and they have a screwy payment policy based on the number of days he's hospitalized. The lady I spoke to on the Medicare 1-800 number said that we might have to pay a monthly premium for the prescription coverage, Medicare part B. The prescription coverage has high co-pays and a huge coverage gap... so I don't know if it would help much? Does anybody actually use this?

Also, two other companies I'm considering applying for have Regence Blue Cross Blue Shield insurance. Does anyone have any good or bad experiences with them? Problems with coverage? These jobs pay slightly higher wages and BCBS is in-network for the hospital and clinic Jake goes to.

I'd love to learn from your mistakes or good decisions on this issue. I really want to start working full-time but I don't want to dig us into a health insurance hole. Are there any easy to understand websites on the subject? Perhaps "Health Insurance for Dummies"? <img src="i/expressions/face-icon-small-confused.gif" border="0">
 
S

Shaunessy

New member
Hey everyone! I'm looking for some advice regarding the wonderful world of insurance. <img src="i/expressions/face-icon-small-wink.gif" border="0">

Currently, my husband is covered by Medicaid through SSI and Medicare through SSDI. I'm working part-time and have insurance through my employer. I will be graduating this May and would really like to begin working full-time. Jake has been hospitalized 4-5 times a year lately (hopefully he gets back to 2-3!) so we need to have good coverage.

How do I find out how Medicare and my employer-based insurance would interact? I am able to see the co-pays my insurance charges for his prescriptions and the yearly max out-of-pocket online. My insurance company told me they are unable to tell me what would be covered/denied for Jake's hospitalizations until they get a bill. <img src="i/expressions/face-icon-small-tongue.gif" border="0">

Medicare is very confusing to me... As far as I understand, he would still be covered by Medicare part A once we pass the income limits for Medicaid. I logged onto the MyMedicare site to check it out and they have a screwy payment policy based on the number of days he's hospitalized. The lady I spoke to on the Medicare 1-800 number said that we might have to pay a monthly premium for the prescription coverage, Medicare part B. The prescription coverage has high co-pays and a huge coverage gap... so I don't know if it would help much? Does anybody actually use this?

Also, two other companies I'm considering applying for have Regence Blue Cross Blue Shield insurance. Does anyone have any good or bad experiences with them? Problems with coverage? These jobs pay slightly higher wages and BCBS is in-network for the hospital and clinic Jake goes to.

I'd love to learn from your mistakes or good decisions on this issue. I really want to start working full-time but I don't want to dig us into a health insurance hole. Are there any easy to understand websites on the subject? Perhaps "Health Insurance for Dummies"? <img src="i/expressions/face-icon-small-confused.gif" border="0">
 
S

Shaunessy

New member
Hey everyone! I'm looking for some advice regarding the wonderful world of insurance. <img src="i/expressions/face-icon-small-wink.gif" border="0">
<br />
<br />Currently, my husband is covered by Medicaid through SSI and Medicare through SSDI. I'm working part-time and have insurance through my employer. I will be graduating this May and would really like to begin working full-time. Jake has been hospitalized 4-5 times a year lately (hopefully he gets back to 2-3!) so we need to have good coverage.
<br />
<br />How do I find out how Medicare and my employer-based insurance would interact? I am able to see the co-pays my insurance charges for his prescriptions and the yearly max out-of-pocket online. My insurance company told me they are unable to tell me what would be covered/denied for Jake's hospitalizations until they get a bill. <img src="i/expressions/face-icon-small-tongue.gif" border="0">
<br />
<br />Medicare is very confusing to me... As far as I understand, he would still be covered by Medicare part A once we pass the income limits for Medicaid. I logged onto the MyMedicare site to check it out and they have a screwy payment policy based on the number of days he's hospitalized. The lady I spoke to on the Medicare 1-800 number said that we might have to pay a monthly premium for the prescription coverage, Medicare part B. The prescription coverage has high co-pays and a huge coverage gap... so I don't know if it would help much? Does anybody actually use this?
<br />
<br />Also, two other companies I'm considering applying for have Regence Blue Cross Blue Shield insurance. Does anyone have any good or bad experiences with them? Problems with coverage? These jobs pay slightly higher wages and BCBS is in-network for the hospital and clinic Jake goes to.
<br />
<br />I'd love to learn from your mistakes or good decisions on this issue. I really want to start working full-time but I don't want to dig us into a health insurance hole. Are there any easy to understand websites on the subject? Perhaps "Health Insurance for Dummies"? <img src="i/expressions/face-icon-small-confused.gif" border="0">
 
B

bagged2drag

Active member
As far as Blue Cross goes, I can't help. I would take a close look at the insurance policy at your job. Figure out what deductibles and max out of pocket are. It is probably a good idea to stay on the Medicare, as it can work as a supplemental insurance. People will often find that private insurance will do what it can to not pay large bills. If your husband is hospitalized numerous times a year, it is probably very easy to run costs to 150,000 or 200,000 a year after meds. Many insurance companies have a lifetime maximum coverage, usually 1 million dollars, sometimes 2 million, but I have only seen 2 million dollars a couple times. At that, you are looking at insurance to cover your husband for approximately 5 years before the insurance is exhausted. This is why it is important (in my opinion) to keep the second insurance. Also, if you put him on your policy, they may try putting a pre-existing clause on the policy. Even though you have medicare, they may not count it as credible coverage. This could easily leave you hanging. I had that happen with my old insurance company. I had state insurance, thought it would be good. I went into the hospital, ended up having to pick up a 25,000 tab.

Good luck.
 
B

bagged2drag

Active member
As far as Blue Cross goes, I can't help. I would take a close look at the insurance policy at your job. Figure out what deductibles and max out of pocket are. It is probably a good idea to stay on the Medicare, as it can work as a supplemental insurance. People will often find that private insurance will do what it can to not pay large bills. If your husband is hospitalized numerous times a year, it is probably very easy to run costs to 150,000 or 200,000 a year after meds. Many insurance companies have a lifetime maximum coverage, usually 1 million dollars, sometimes 2 million, but I have only seen 2 million dollars a couple times. At that, you are looking at insurance to cover your husband for approximately 5 years before the insurance is exhausted. This is why it is important (in my opinion) to keep the second insurance. Also, if you put him on your policy, they may try putting a pre-existing clause on the policy. Even though you have medicare, they may not count it as credible coverage. This could easily leave you hanging. I had that happen with my old insurance company. I had state insurance, thought it would be good. I went into the hospital, ended up having to pick up a 25,000 tab.

Good luck.
 
B

bagged2drag

Active member
As far as Blue Cross goes, I can't help. I would take a close look at the insurance policy at your job. Figure out what deductibles and max out of pocket are. It is probably a good idea to stay on the Medicare, as it can work as a supplemental insurance. People will often find that private insurance will do what it can to not pay large bills. If your husband is hospitalized numerous times a year, it is probably very easy to run costs to 150,000 or 200,000 a year after meds. Many insurance companies have a lifetime maximum coverage, usually 1 million dollars, sometimes 2 million, but I have only seen 2 million dollars a couple times. At that, you are looking at insurance to cover your husband for approximately 5 years before the insurance is exhausted. This is why it is important (in my opinion) to keep the second insurance. Also, if you put him on your policy, they may try putting a pre-existing clause on the policy. Even though you have medicare, they may not count it as credible coverage. This could easily leave you hanging. I had that happen with my old insurance company. I had state insurance, thought it would be good. I went into the hospital, ended up having to pick up a 25,000 tab.

Good luck.
 
B

bagged2drag

Active member
As far as Blue Cross goes, I can't help. I would take a close look at the insurance policy at your job. Figure out what deductibles and max out of pocket are. It is probably a good idea to stay on the Medicare, as it can work as a supplemental insurance. People will often find that private insurance will do what it can to not pay large bills. If your husband is hospitalized numerous times a year, it is probably very easy to run costs to 150,000 or 200,000 a year after meds. Many insurance companies have a lifetime maximum coverage, usually 1 million dollars, sometimes 2 million, but I have only seen 2 million dollars a couple times. At that, you are looking at insurance to cover your husband for approximately 5 years before the insurance is exhausted. This is why it is important (in my opinion) to keep the second insurance. Also, if you put him on your policy, they may try putting a pre-existing clause on the policy. Even though you have medicare, they may not count it as credible coverage. This could easily leave you hanging. I had that happen with my old insurance company. I had state insurance, thought it would be good. I went into the hospital, ended up having to pick up a 25,000 tab.

Good luck.
 
B

bagged2drag

Active member
As far as Blue Cross goes, I can't help. I would take a close look at the insurance policy at your job. Figure out what deductibles and max out of pocket are. It is probably a good idea to stay on the Medicare, as it can work as a supplemental insurance. People will often find that private insurance will do what it can to not pay large bills. If your husband is hospitalized numerous times a year, it is probably very easy to run costs to 150,000 or 200,000 a year after meds. Many insurance companies have a lifetime maximum coverage, usually 1 million dollars, sometimes 2 million, but I have only seen 2 million dollars a couple times. At that, you are looking at insurance to cover your husband for approximately 5 years before the insurance is exhausted. This is why it is important (in my opinion) to keep the second insurance. Also, if you put him on your policy, they may try putting a pre-existing clause on the policy. Even though you have medicare, they may not count it as credible coverage. This could easily leave you hanging. I had that happen with my old insurance company. I had state insurance, thought it would be good. I went into the hospital, ended up having to pick up a 25,000 tab.
<br />
<br />Good luck.
 
S

Skye

New member
I agree that you need to definitely find out what the lifetime max is on your company insurance. The good ones have an unlimited lifetime max. Also, find out what your out-of-poocket maximums are and your in-network and out-of-network deductibles. A very important question is whether the companies you are considering have more than 50 employees. If they have more than 50 and are relatively large than the company would be your primary insurance. If they are smaller than that than medicare would be your primary coverage.
 
S

Skye

New member
I agree that you need to definitely find out what the lifetime max is on your company insurance. The good ones have an unlimited lifetime max. Also, find out what your out-of-poocket maximums are and your in-network and out-of-network deductibles. A very important question is whether the companies you are considering have more than 50 employees. If they have more than 50 and are relatively large than the company would be your primary insurance. If they are smaller than that than medicare would be your primary coverage.
 
S

Skye

New member
I agree that you need to definitely find out what the lifetime max is on your company insurance. The good ones have an unlimited lifetime max. Also, find out what your out-of-poocket maximums are and your in-network and out-of-network deductibles. A very important question is whether the companies you are considering have more than 50 employees. If they have more than 50 and are relatively large than the company would be your primary insurance. If they are smaller than that than medicare would be your primary coverage.
 
S

Skye

New member
I agree that you need to definitely find out what the lifetime max is on your company insurance. The good ones have an unlimited lifetime max. Also, find out what your out-of-poocket maximums are and your in-network and out-of-network deductibles. A very important question is whether the companies you are considering have more than 50 employees. If they have more than 50 and are relatively large than the company would be your primary insurance. If they are smaller than that than medicare would be your primary coverage.
 
S

Skye

New member
I agree that you need to definitely find out what the lifetime max is on your company insurance. The good ones have an unlimited lifetime max. Also, find out what your out-of-poocket maximums are and your in-network and out-of-network deductibles. A very important question is whether the companies you are considering have more than 50 employees. If they have more than 50 and are relatively large than the company would be your primary insurance. If they are smaller than that than medicare would be your primary coverage.
 
A

Alyssa

New member
The Blue Cross question is more of a question for the individual policy -- the better the plan is, the better they cover things -- so that would be determined by how good of a plan the employer has picked out. People have both good and bad things to say about BCBS but it doesn't usually have anything to do with them as a whole...it has more to do with the limitations and/or benifits of the individual policy that is purchase.

Generally speaking .... go for the larger employers...they have more buying power with the insurance companies and can generally provide a better policy for their employees than a small employer can.

The most important thing to find out is who is going to be primary coverage... generally speaking private health insurance comes first and Medicaid will always come in last... what I'm not 100% sure about is where Medicare will fall if he is on it due to disability -- that may make the coverage primary for him if he has no employer.... but again, try to get the answer to that piece first, because from there you can tell who will pay out on things first, then tell what will be paid out after that....again, very generally speaking dual coverage is a pretty good thing because what the primary company doesn't cover, the secondary does -- the only tricky thing is satisfying deductibles and co-insurance for both companies at the right time...check to see if they both operate on a calendar year or fiscal year plan...I have had experience with a person who had dual insurance but primary had a calendar year for deductible and secondary had fiscal year...so typically she satisfied her deductible for the primary coverage in January of each year and because she was still running on the 2nd half of the year for the fiscal year for secondary insurance they would pick up every thing....but come July the secondary insurance fiscal year started over and she would have to satisfy the deductible there again before secondary paid everything. Does that make sense? hopefully it was not just more confusion to add :)
 
A

Alyssa

New member
The Blue Cross question is more of a question for the individual policy -- the better the plan is, the better they cover things -- so that would be determined by how good of a plan the employer has picked out. People have both good and bad things to say about BCBS but it doesn't usually have anything to do with them as a whole...it has more to do with the limitations and/or benifits of the individual policy that is purchase.

Generally speaking .... go for the larger employers...they have more buying power with the insurance companies and can generally provide a better policy for their employees than a small employer can.

The most important thing to find out is who is going to be primary coverage... generally speaking private health insurance comes first and Medicaid will always come in last... what I'm not 100% sure about is where Medicare will fall if he is on it due to disability -- that may make the coverage primary for him if he has no employer.... but again, try to get the answer to that piece first, because from there you can tell who will pay out on things first, then tell what will be paid out after that....again, very generally speaking dual coverage is a pretty good thing because what the primary company doesn't cover, the secondary does -- the only tricky thing is satisfying deductibles and co-insurance for both companies at the right time...check to see if they both operate on a calendar year or fiscal year plan...I have had experience with a person who had dual insurance but primary had a calendar year for deductible and secondary had fiscal year...so typically she satisfied her deductible for the primary coverage in January of each year and because she was still running on the 2nd half of the year for the fiscal year for secondary insurance they would pick up every thing....but come July the secondary insurance fiscal year started over and she would have to satisfy the deductible there again before secondary paid everything. Does that make sense? hopefully it was not just more confusion to add :)
 
A

Alyssa

New member
The Blue Cross question is more of a question for the individual policy -- the better the plan is, the better they cover things -- so that would be determined by how good of a plan the employer has picked out. People have both good and bad things to say about BCBS but it doesn't usually have anything to do with them as a whole...it has more to do with the limitations and/or benifits of the individual policy that is purchase.

Generally speaking .... go for the larger employers...they have more buying power with the insurance companies and can generally provide a better policy for their employees than a small employer can.

The most important thing to find out is who is going to be primary coverage... generally speaking private health insurance comes first and Medicaid will always come in last... what I'm not 100% sure about is where Medicare will fall if he is on it due to disability -- that may make the coverage primary for him if he has no employer.... but again, try to get the answer to that piece first, because from there you can tell who will pay out on things first, then tell what will be paid out after that....again, very generally speaking dual coverage is a pretty good thing because what the primary company doesn't cover, the secondary does -- the only tricky thing is satisfying deductibles and co-insurance for both companies at the right time...check to see if they both operate on a calendar year or fiscal year plan...I have had experience with a person who had dual insurance but primary had a calendar year for deductible and secondary had fiscal year...so typically she satisfied her deductible for the primary coverage in January of each year and because she was still running on the 2nd half of the year for the fiscal year for secondary insurance they would pick up every thing....but come July the secondary insurance fiscal year started over and she would have to satisfy the deductible there again before secondary paid everything. Does that make sense? hopefully it was not just more confusion to add :)
 
A

Alyssa

New member
The Blue Cross question is more of a question for the individual policy -- the better the plan is, the better they cover things -- so that would be determined by how good of a plan the employer has picked out. People have both good and bad things to say about BCBS but it doesn't usually have anything to do with them as a whole...it has more to do with the limitations and/or benifits of the individual policy that is purchase.

Generally speaking .... go for the larger employers...they have more buying power with the insurance companies and can generally provide a better policy for their employees than a small employer can.

The most important thing to find out is who is going to be primary coverage... generally speaking private health insurance comes first and Medicaid will always come in last... what I'm not 100% sure about is where Medicare will fall if he is on it due to disability -- that may make the coverage primary for him if he has no employer.... but again, try to get the answer to that piece first, because from there you can tell who will pay out on things first, then tell what will be paid out after that....again, very generally speaking dual coverage is a pretty good thing because what the primary company doesn't cover, the secondary does -- the only tricky thing is satisfying deductibles and co-insurance for both companies at the right time...check to see if they both operate on a calendar year or fiscal year plan...I have had experience with a person who had dual insurance but primary had a calendar year for deductible and secondary had fiscal year...so typically she satisfied her deductible for the primary coverage in January of each year and because she was still running on the 2nd half of the year for the fiscal year for secondary insurance they would pick up every thing....but come July the secondary insurance fiscal year started over and she would have to satisfy the deductible there again before secondary paid everything. Does that make sense? hopefully it was not just more confusion to add :)
 
A

Alyssa

New member
The Blue Cross question is more of a question for the individual policy -- the better the plan is, the better they cover things -- so that would be determined by how good of a plan the employer has picked out. People have both good and bad things to say about BCBS but it doesn't usually have anything to do with them as a whole...it has more to do with the limitations and/or benifits of the individual policy that is purchase.
<br />
<br />Generally speaking .... go for the larger employers...they have more buying power with the insurance companies and can generally provide a better policy for their employees than a small employer can.
<br />
<br />The most important thing to find out is who is going to be primary coverage... generally speaking private health insurance comes first and Medicaid will always come in last... what I'm not 100% sure about is where Medicare will fall if he is on it due to disability -- that may make the coverage primary for him if he has no employer.... but again, try to get the answer to that piece first, because from there you can tell who will pay out on things first, then tell what will be paid out after that....again, very generally speaking dual coverage is a pretty good thing because what the primary company doesn't cover, the secondary does -- the only tricky thing is satisfying deductibles and co-insurance for both companies at the right time...check to see if they both operate on a calendar year or fiscal year plan...I have had experience with a person who had dual insurance but primary had a calendar year for deductible and secondary had fiscal year...so typically she satisfied her deductible for the primary coverage in January of each year and because she was still running on the 2nd half of the year for the fiscal year for secondary insurance they would pick up every thing....but come July the secondary insurance fiscal year started over and she would have to satisfy the deductible there again before secondary paid everything. Does that make sense? hopefully it was not just more confusion to add :)
 
You must log in or register to reply here.
Top