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

[Keepercjr]

Lauren
<br />
<br />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!
<br />
<br />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).
<br />
<br />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.

 

[alannae]

I work for a group of oncologists. Close to half of our patients are Medicare recipients.

PartB:
As long as your spouse is actively employed by a company that does not qualify as a 'small' employer, your Medicare will be your secondary insurance. With Medicare secondary, it will pick up (pay for) all your coinsurance/copays (what you have to pay) after the annual deductible is met (currently $135). So with your commercial policy through your spouse and Medicare you shoudl only pay $135 per year for doctor visits, labs, cultures, etc. (Watch the bills you get from your clinic/doctor to make sure that they remember to bill to Medicare after your commercial policy pays)

Part A and D - I do not work with these benefits and would be doing you a disservice to give advice on this part of it.

Part C:
From speaking with patients trying to navigate the Part C world (Medicare Advantage Plans/MEdicare replacement plans/Medicare HMO/etc), I do not think having one of these plans would benefit you unless it makes a significant difference in how your hospital or prescription coverage pays. They usually don't cover as well in a secondary situation.

Hope this helps! These are the kinds of questions I've been looking for on here, something I can answer with confidence! <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[alannae]

I work for a group of oncologists. Close to half of our patients are Medicare recipients.

PartB:
As long as your spouse is actively employed by a company that does not qualify as a 'small' employer, your Medicare will be your secondary insurance. With Medicare secondary, it will pick up (pay for) all your coinsurance/copays (what you have to pay) after the annual deductible is met (currently $135). So with your commercial policy through your spouse and Medicare you shoudl only pay $135 per year for doctor visits, labs, cultures, etc. (Watch the bills you get from your clinic/doctor to make sure that they remember to bill to Medicare after your commercial policy pays)

Part A and D - I do not work with these benefits and would be doing you a disservice to give advice on this part of it.

Part C:
From speaking with patients trying to navigate the Part C world (Medicare Advantage Plans/MEdicare replacement plans/Medicare HMO/etc), I do not think having one of these plans would benefit you unless it makes a significant difference in how your hospital or prescription coverage pays. They usually don't cover as well in a secondary situation.

Hope this helps! These are the kinds of questions I've been looking for on here, something I can answer with confidence! <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[alannae]

I work for a group of oncologists. Close to half of our patients are Medicare recipients.
<br />
<br />PartB:
<br />As long as your spouse is actively employed by a company that does not qualify as a 'small' employer, your Medicare will be your secondary insurance. With Medicare secondary, it will pick up (pay for) all your coinsurance/copays (what you have to pay) after the annual deductible is met (currently $135). So with your commercial policy through your spouse and Medicare you shoudl only pay $135 per year for doctor visits, labs, cultures, etc. (Watch the bills you get from your clinic/doctor to make sure that they remember to bill to Medicare after your commercial policy pays)
<br />
<br />Part A and D - I do not work with these benefits and would be doing you a disservice to give advice on this part of it.
<br />
<br />Part C:
<br />From speaking with patients trying to navigate the Part C world (Medicare Advantage Plans/MEdicare replacement plans/Medicare HMO/etc), I do not think having one of these plans would benefit you unless it makes a significant difference in how your hospital or prescription coverage pays. They usually don't cover as well in a secondary situation.
<br />
<br />Hope this helps! These are the kinds of questions I've been looking for on here, something I can answer with confidence! <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[ej0820]

I'm on ssdi and have medicare-that's all I have. I would accept it if I were you, just in case, because it will benefit you for whatever your regular insurance doesn't pay for, etc. That could be a huge help, even if you don't need it right now. However, if it ends up being your only source of insurance, be advised that it still leaves things pretty expensive. Medicare only pays 80% of everything. You will be responsible for the other 20%. Currently, I'm drowning in health care costs...and I thought being approved for disability would make things EASIER! I think it only made things more expensive. <img src="i/expressions/face-icon-small-sad.gif" border="0">

Good luck to you! <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[ej0820]

I'm on ssdi and have medicare-that's all I have. I would accept it if I were you, just in case, because it will benefit you for whatever your regular insurance doesn't pay for, etc. That could be a huge help, even if you don't need it right now. However, if it ends up being your only source of insurance, be advised that it still leaves things pretty expensive. Medicare only pays 80% of everything. You will be responsible for the other 20%. Currently, I'm drowning in health care costs...and I thought being approved for disability would make things EASIER! I think it only made things more expensive. <img src="i/expressions/face-icon-small-sad.gif" border="0">

Good luck to you! <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[ej0820]

I'm on ssdi and have medicare-that's all I have. I would accept it if I were you, just in case, because it will benefit you for whatever your regular insurance doesn't pay for, etc. That could be a huge help, even if you don't need it right now. However, if it ends up being your only source of insurance, be advised that it still leaves things pretty expensive. Medicare only pays 80% of everything. You will be responsible for the other 20%. Currently, I'm drowning in health care costs...and I thought being approved for disability would make things EASIER! I think it only made things more expensive. <img src="i/expressions/face-icon-small-sad.gif" border="0">
<br />
<br />Good luck to you! <img src="i/expressions/face-icon-small-smile.gif" border="0">

 

[LouLou]

Erin, What did you have before Medicare..when you weren't on disability? What you are describing is exactly what I don't want to have happen...end up worse off than I am now somehow. Lauren

 

[LouLou]

Erin, What did you have before Medicare..when you weren't on disability? What you are describing is exactly what I don't want to have happen...end up worse off than I am now somehow. Lauren

 

[LouLou]

Erin, What did you have before Medicare..when you weren't on disability? What you are describing is exactly what I don't want to have happen...end up worse off than I am now somehow. Lauren

 

[PinkPigg]

Hey Lauren,

You might want to run this one by Beth Sufian too. I know when I qualified for SSDI she said to take Medicare when I'm eligible because of the penalties you would have to pay to enroll late. Unfortunately I don't remember the specifics as two years seems so far off at the time.

Peace,
Steph

 

[PinkPigg]

Hey Lauren,

You might want to run this one by Beth Sufian too. I know when I qualified for SSDI she said to take Medicare when I'm eligible because of the penalties you would have to pay to enroll late. Unfortunately I don't remember the specifics as two years seems so far off at the time.

Peace,
Steph

 

[PinkPigg]

Hey Lauren,
<br />
<br />You might want to run this one by Beth Sufian too. I know when I qualified for SSDI she said to take Medicare when I'm eligible because of the penalties you would have to pay to enroll late. Unfortunately I don't remember the specifics as two years seems so far off at the time.
<br />
<br />Peace,
<br />Steph

 

[blindhearted]

I have Medicare Pt A & B, as well as a PPO. At one point I had 2 PPOs as well as Medicare. You would need to find out who is primary payer vs secondary or you will end up with a lot of headaches. If you get Medicare it may pay for something your other insurance wont cover. It never hurts to have more than one insurance if it is avalable to you. And I do believe that you have to enroll when it's offered or you might get a penality or declined later if you apply but I would get in contact with Beth to make sure. Also think about if your spouse is laid off, then you will be given a certain amount of time before you loose ur insurance (usually a few months) to find something else. If he doesnt get another job, or one that offers worse health coverage, then you are in a pickle. He could always purchase insurance for himself if that happened and put u on it, but the premiums would be sky high & may have a grace period before covering you, if they agree to cover you at all. If you get Medicare, then you would still have something to at least to cover the cost of hospital stays. Make sure if you get Medicare Pt D doesnt interfer with you insurance prescription coverage. I had an insurance company tell me if I signed up for Pt D they would no longer cover prescription cost so I turned down Pt D because it would have cost me more in the long run.

 

[blindhearted]

I have Medicare Pt A & B, as well as a PPO. At one point I had 2 PPOs as well as Medicare. You would need to find out who is primary payer vs secondary or you will end up with a lot of headaches. If you get Medicare it may pay for something your other insurance wont cover. It never hurts to have more than one insurance if it is avalable to you. And I do believe that you have to enroll when it's offered or you might get a penality or declined later if you apply but I would get in contact with Beth to make sure. Also think about if your spouse is laid off, then you will be given a certain amount of time before you loose ur insurance (usually a few months) to find something else. If he doesnt get another job, or one that offers worse health coverage, then you are in a pickle. He could always purchase insurance for himself if that happened and put u on it, but the premiums would be sky high & may have a grace period before covering you, if they agree to cover you at all. If you get Medicare, then you would still have something to at least to cover the cost of hospital stays. Make sure if you get Medicare Pt D doesnt interfer with you insurance prescription coverage. I had an insurance company tell me if I signed up for Pt D they would no longer cover prescription cost so I turned down Pt D because it would have cost me more in the long run.

 

[blindhearted]

I have Medicare Pt A & B, as well as a PPO. At one point I had 2 PPOs as well as Medicare. You would need to find out who is primary payer vs secondary or you will end up with a lot of headaches. If you get Medicare it may pay for something your other insurance wont cover. It never hurts to have more than one insurance if it is avalable to you. And I do believe that you have to enroll when it's offered or you might get a penality or declined later if you apply but I would get in contact with Beth to make sure. Also think about if your spouse is laid off, then you will be given a certain amount of time before you loose ur insurance (usually a few months) to find something else. If he doesnt get another job, or one that offers worse health coverage, then you are in a pickle. He could always purchase insurance for himself if that happened and put u on it, but the premiums would be sky high & may have a grace period before covering you, if they agree to cover you at all. If you get Medicare, then you would still have something to at least to cover the cost of hospital stays. Make sure if you get Medicare Pt D doesnt interfer with you insurance prescription coverage. I had an insurance company tell me if I signed up for Pt D they would no longer cover prescription cost so I turned down Pt D because it would have cost me more in the long run.

 

[Landy]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>alannae</b></i>

I work for a group of oncologists. Close to half of our patients are Medicare recipients.



PartB:

As long as your spouse is actively employed by a company that does not qualify as a 'small' employer, your Medicare will be your secondary insurance. With Medicare secondary, it will pick up (pay for) all your coinsurance/copays (what you have to pay) after the annual deductible is met (currently $135). So with your commercial policy through your spouse and Medicare you shoudl only pay $135 per year for doctor visits, labs, cultures, etc. (Watch the bills you get from your clinic/doctor to make sure that they remember to bill to Medicare after your commercial policy pays)



Part A and D - I do not work with these benefits and would be doing you a disservice to give advice on this part of it.

<img src=""></end quote></div>

I have ins thru my husband's employer as primary & medicare A&B as secondary. Alanna said it perfectly! The only thing(s) I would add is: medicare won't pay a penny on home IVs and they will only pick up my co-pays on certain nebulized meds, but not on pills.
So basically, my medical out-of-pocket expenses consist of my 20% copays for home IVs (ouch!) and copays on drugs that my primary covered.

 

[Landy]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>alannae</b></i>

I work for a group of oncologists. Close to half of our patients are Medicare recipients.



PartB:

As long as your spouse is actively employed by a company that does not qualify as a 'small' employer, your Medicare will be your secondary insurance. With Medicare secondary, it will pick up (pay for) all your coinsurance/copays (what you have to pay) after the annual deductible is met (currently $135). So with your commercial policy through your spouse and Medicare you shoudl only pay $135 per year for doctor visits, labs, cultures, etc. (Watch the bills you get from your clinic/doctor to make sure that they remember to bill to Medicare after your commercial policy pays)



Part A and D - I do not work with these benefits and would be doing you a disservice to give advice on this part of it.

<img src=""></end quote>

I have ins thru my husband's employer as primary & medicare A&B as secondary. Alanna said it perfectly! The only thing(s) I would add is: medicare won't pay a penny on home IVs and they will only pick up my co-pays on certain nebulized meds, but not on pills.
So basically, my medical out-of-pocket expenses consist of my 20% copays for home IVs (ouch!) and copays on drugs that my primary covered.

 

[Landy]

<div class="FTQUOTE"><begin quote><i>Originally posted by: <b>alannae</b></i>
<br />
<br />I work for a group of oncologists. Close to half of our patients are Medicare recipients.
<br />
<br />
<br />
<br />PartB:
<br />
<br />As long as your spouse is actively employed by a company that does not qualify as a 'small' employer, your Medicare will be your secondary insurance. With Medicare secondary, it will pick up (pay for) all your coinsurance/copays (what you have to pay) after the annual deductible is met (currently $135). So with your commercial policy through your spouse and Medicare you shoudl only pay $135 per year for doctor visits, labs, cultures, etc. (Watch the bills you get from your clinic/doctor to make sure that they remember to bill to Medicare after your commercial policy pays)
<br />
<br />
<br />
<br />Part A and D - I do not work with these benefits and would be doing you a disservice to give advice on this part of it.
<br />
<br /><img src=""></end quote>
<br />
<br />I have ins thru my husband's employer as primary & medicare A&B as secondary. Alanna said it perfectly! The only thing(s) I would add is: medicare won't pay a penny on home IVs and they will only pick up my co-pays on certain nebulized meds, but not on pills.
<br />So basically, my medical out-of-pocket expenses consist of my 20% copays for home IVs (ouch!) and copays on drugs that my primary covered.

 

[ej0820]

Lauren,

before I got the medicare/ssdi, I was on medicaid, as I was approved for ssi. The medicaid was GREAT. Once I started getting ssdi payments though, I was told I make too much money to qualify for medicaid anymore. The only medicaid program I qualify for now is the medicaid spenddown-which means I would pay the amount for medicaid that the state seems to think I can afford. Right now, they think I can afford to pay $500 a month for medicaid. That's ridiculous. I can't even afford half of that a month, so I'm left with just medicare. I also get qmb, where medicaid pays the medicare premium, but that feels like such a lousy coverage...almost unnecessary. I mean, if you think I can afford $500 a month, why are you paying my $110 a month premium??

Ugh. Good luck to you.