Offered Medicare as part of SSDI benefits - should I decline it?

[LouLou]

As part of SSDI benefits I was sent the paperwork for Medicare Health Insurance. I have great insurance through my spouse's employer. Yes, we pay a small amt each month pre-tax to have it for me and I spend about $2500-4000 on medical related expenses a year.

Can you see any advantage to also having Medicare? Or will it just confuse the situation? Right now my insurance pays for everything 100% after I pay the initial 20% with a cap of $2500 and then pharmacy benefits are reasonable copays $30 for 90 day supply with a cap of $1000 after which all drugs are free. If I decline it but then want it years down the road can I opt to get it?

With home IVs in the first couple of months of the year and 15 rx drugs a month I hit the caps quickly.

Please advise. Thanks!

 

[LouLou]

As part of SSDI benefits I was sent the paperwork for Medicare Health Insurance. I have great insurance through my spouse's employer. Yes, we pay a small amt each month pre-tax to have it for me and I spend about $2500-4000 on medical related expenses a year.

Can you see any advantage to also having Medicare? Or will it just confuse the situation? Right now my insurance pays for everything 100% after I pay the initial 20% with a cap of $2500 and then pharmacy benefits are reasonable copays $30 for 90 day supply with a cap of $1000 after which all drugs are free. If I decline it but then want it years down the road can I opt to get it?

With home IVs in the first couple of months of the year and 15 rx drugs a month I hit the caps quickly.

Please advise. Thanks!

 

[LouLou]

As part of SSDI benefits I was sent the paperwork for Medicare Health Insurance. I have great insurance through my spouse's employer. Yes, we pay a small amt each month pre-tax to have it for me and I spend about $2500-4000 on medical related expenses a year.
<br />
<br />Can you see any advantage to also having Medicare? Or will it just confuse the situation? Right now my insurance pays for everything 100% after I pay the initial 20% with a cap of $2500 and then pharmacy benefits are reasonable copays $30 for 90 day supply with a cap of $1000 after which all drugs are free. If I decline it but then want it years down the road can I opt to get it?
<br />
<br />With home IVs in the first couple of months of the year and 15 rx drugs a month I hit the caps quickly.
<br />
<br />Please advise. Thanks!

 

[Mommafirst]

I'm not sure how medicare works, but my daughter is insured through my group plan at work. Its good insurance with $15 copays for all specialist visits and $50 co-pays for ER visits. We pay $40 co pays for most of her meds. She also qualified for the state medical plan (Bureau for Children with Medical handicaps) and since we didn't want to give up the main insurance, we designated the state plan as our secondary insurer. It pays ALL those co-pays, so now, we never pay any cash out of pocket for doctor visits or meds.

Is it possible to accept the medicare as your secondary insurance? It will likely save you the $2500-$4000 you are paying.

 

[Mommafirst]

I'm not sure how medicare works, but my daughter is insured through my group plan at work. Its good insurance with $15 copays for all specialist visits and $50 co-pays for ER visits. We pay $40 co pays for most of her meds. She also qualified for the state medical plan (Bureau for Children with Medical handicaps) and since we didn't want to give up the main insurance, we designated the state plan as our secondary insurer. It pays ALL those co-pays, so now, we never pay any cash out of pocket for doctor visits or meds.

Is it possible to accept the medicare as your secondary insurance? It will likely save you the $2500-$4000 you are paying.

 

[Mommafirst]

I'm not sure how medicare works, but my daughter is insured through my group plan at work. Its good insurance with $15 copays for all specialist visits and $50 co-pays for ER visits. We pay $40 co pays for most of her meds. She also qualified for the state medical plan (Bureau for Children with Medical handicaps) and since we didn't want to give up the main insurance, we designated the state plan as our secondary insurer. It pays ALL those co-pays, so now, we never pay any cash out of pocket for doctor visits or meds.
<br />
<br />Is it possible to accept the medicare as your secondary insurance? It will likely save you the $2500-$4000 you are paying.

 

[Giggles]

Well I too have Medicare with my SSDI. I was told to take it cause if I was ever in a position to need a transplant then it would be good to have the Medicare cause Medicare does not care what facility you go to for the transplant where your primary group insurance may care and IF you had to you could opt out of the primary group and have the Medicare as your primary if you had to do that to get the transplant at the choice place you wanted it. So for me I thought this was good to have PLUS a big bonus for me is my primary pays first but Medicare has been picking up the rest on my hospital stays, doc visits and some inhaled drugs so for me it has been very cost effective.

PM me if you have more questions! I have A and B only

Jennifer 38 with CF and CFRD

 

[Giggles]

Well I too have Medicare with my SSDI. I was told to take it cause if I was ever in a position to need a transplant then it would be good to have the Medicare cause Medicare does not care what facility you go to for the transplant where your primary group insurance may care and IF you had to you could opt out of the primary group and have the Medicare as your primary if you had to do that to get the transplant at the choice place you wanted it. So for me I thought this was good to have PLUS a big bonus for me is my primary pays first but Medicare has been picking up the rest on my hospital stays, doc visits and some inhaled drugs so for me it has been very cost effective.

PM me if you have more questions! I have A and B only

Jennifer 38 with CF and CFRD

 

[Giggles]

Well I too have Medicare with my SSDI. I was told to take it cause if I was ever in a position to need a transplant then it would be good to have the Medicare cause Medicare does not care what facility you go to for the transplant where your primary group insurance may care and IF you had to you could opt out of the primary group and have the Medicare as your primary if you had to do that to get the transplant at the choice place you wanted it. So for me I thought this was good to have PLUS a big bonus for me is my primary pays first but Medicare has been picking up the rest on my hospital stays, doc visits and some inhaled drugs so for me it has been very cost effective.
<br />
<br />PM me if you have more questions! I have A and B only
<br />
<br />Jennifer 38 with CF and CFRD

 

[mamalama]

Dad and I opted for Medicare A while he has insurance through work, but not B or D. Once he no longer has his Cadillac insurance we'll be able to prove that we had continuous insurance that was at least as good as Medicare so then we'll opt for B and D (RX) which both cost. Basic A is free.

Summary...take A opt out of B.

 

[mamalama]

Dad and I opted for Medicare A while he has insurance through work, but not B or D. Once he no longer has his Cadillac insurance we'll be able to prove that we had continuous insurance that was at least as good as Medicare so then we'll opt for B and D (RX) which both cost. Basic A is free.

Summary...take A opt out of B.

 

[mamalama]

Dad and I opted for Medicare A while he has insurance through work, but not B or D. Once he no longer has his Cadillac insurance we'll be able to prove that we had continuous insurance that was at least as good as Medicare so then we'll opt for B and D (RX) which both cost. Basic A is free.
<br />
<br />Summary...take A opt out of B.

 

[tleigh]

I have Medicare and in my case it always acts as primary and then we have true secondary insurance through my husband's work. I would also recommend if you do get on it just doing A (which in my case really only covers my hospital stays and some diabetes stuff), Part B and C do cost (I think part B is 90 a month which they just take out of your SSD payment).

 

[tleigh]

I have Medicare and in my case it always acts as primary and then we have true secondary insurance through my husband's work. I would also recommend if you do get on it just doing A (which in my case really only covers my hospital stays and some diabetes stuff), Part B and C do cost (I think part B is 90 a month which they just take out of your SSD payment).

 

[tleigh]

I have Medicare and in my case it always acts as primary and then we have true secondary insurance through my husband's work. I would also recommend if you do get on it just doing A (which in my case really only covers my hospital stays and some diabetes stuff), Part B and C do cost (I think part B is 90 a month which they just take out of your SSD payment).

 

[carly23]

No they dont take that out of your pay!im myself on ssdi and recently started getting medicare a,b,,c and D! And coz my income is 705$a mnth i qualify qmb meanin the state pays my premium!no money deducted <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[carly23]

No they dont take that out of your pay!im myself on ssdi and recently started getting medicare a,b,,c and D! And coz my income is 705$a mnth i qualify qmb meanin the state pays my premium!no money deducted <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[carly23]

No they dont take that out of your pay!im myself on ssdi and recently started getting medicare a,b,,c and D! And coz my income is 705$a mnth i qualify qmb meanin the state pays my premium!no money deducted <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[Keepercjr]

Lauren

I get social security income because my mom is retired (I was previously on SSI). And I'm insured through her health insurance. In my case, I HAD to accept medicare. According to our insurance, once I became medicare eligible, I had to accept it as the insurance was only going to act as secondary. I initially declined it but was able to re-enroll at the last second once I found out that my insurance was all set to only pay 20% of everything!

I have part A and B. I declined D. Medicare is my primary and I have a great PPO as my secondary. I have not had any problems with using it (CF center, urgent care, surgery, hospital stay, other specialists).

So the moral of the story is, make sure that your insurance doesn't have any crazy rules about requiring medicare if eligible. Plus once you decline medicare, the cost goes up if you choose to re-enroll. And you can only enroll during certain parts of the year. oh and because my social security benefit is higher than some cap, I have to pay $100 each month for medicare. Most of the programs that pay for the premiums if you make over a certain amount are out of funds.

 

[Keepercjr]

Lauren

I get social security income because my mom is retired (I was previously on SSI). And I'm insured through her health insurance. In my case, I HAD to accept medicare. According to our insurance, once I became medicare eligible, I had to accept it as the insurance was only going to act as secondary. I initially declined it but was able to re-enroll at the last second once I found out that my insurance was all set to only pay 20% of everything!

I have part A and B. I declined D. Medicare is my primary and I have a great PPO as my secondary. I have not had any problems with using it (CF center, urgent care, surgery, hospital stay, other specialists).

So the moral of the story is, make sure that your insurance doesn't have any crazy rules about requiring medicare if eligible. Plus once you decline medicare, the cost goes up if you choose to re-enroll. And you can only enroll during certain parts of the year. oh and because my social security benefit is higher than some cap, I have to pay $100 each month for medicare. Most of the programs that pay for the premiums if you make over a certain amount are out of funds.