Hi all. I'm hoping someone can shed some light on this issue for me. My husband is currently trying to find a different job. He has a potential prospect, but I don't know anything about it or the insurance yet. I do know that Medicare would become primary for me because they employ less than 100 people. I currently have coverage through my husband's insurance and Medicare A&B secondary. If Medicare were primary, would the secondary insurance cover prescriptions? Would the secondary also pick up anything this is denied by Medicare or would they deny it also? Or is that something that differs from insurance to insurance? I haven't really been able to find any info on this, especially regarding scripts. I'm just trying to get ahead of the game here and know what lies ahead if this should happen. Honestly, I'm terrified to have Medicare as primary. We have really good insurance right now and I'm not real fond of Medicare. Thanks for any info you can provide.
Question about Medicare as primary & coverage of meds
- Thread starter Allisa35
- Start date
Hi Allisa!
I *think* I can shed a little light on this issue for you as I went through the exact same thing a couple years ago! I was scared to death just as you are! Maybe even more so because I was pregnant and had a baby while Medicare was my primary!
So, I'll start by saying everything turned out FINE!
I had to go on COBRA while my husband was between jobs a couple years ago, and with COBRA, Medicare becomes primary. I only had Medicare as primary for a few months until my husband started a new job and I got on his employers group plan and that became primary. But I think I can still help you out!
Nothing much changed in terms of prescription coverage. I continued to fill my prescriptions under Blue Cross/Blue Shield since I didn't have a Part D plan. The only prescription that did change was Pulmozyme, because Medicare part B covers Pulmozyme. In that case, your secondary plan should pick up whatever medicare doesn't cover, just leaving you with your regular copay. So in order for this not to become confusing, what I did was fill all my regular prescriptions at Walgreens through my secondary and gave them no Medicare info (since it didn't apply to prescriptions) and then filled my Pulmozyme through CF Services, where they billed Medicare as primary and then my secondary. It worked pretty darn smooth.
So to answer your question, YES, your secondary would cover your prescriptions since you do not have a Part D plan.
As far as your secondary picking up what Medicare doesn't pay..... Yes, sometimes it will. If it is something that is a COVERED service under the terms of your secondary insurance, and it is NOT a covered service by Medicare, your secondary has to pay if Medicare denies it. Or, if Medicare pays less than what your secondary would have paid if they were your primary, then they will pick up the difference. Basically the secondary looks at the claim and figures out what they would have paid on the claim if they were your primary, then they will pay up to that amount if a balance remains after Medicare pays.
Also, Medicare is cut throat when it comes to negotiating rates with hospitals. So usually for me, by the time the hospital gave me the Medicare rate, and Medicare paid whatever it paid, it was less than what my secondary would have paid. So my secondary ended up not having to pay much if anything.
For me, for the most part having Medicare as primary worked out pretty well. I didn't pay much out of pocket at all. I really think you'd be fine with it as your primary, as long as your husband's potential employer has a decent prescription plan.
I realize that a lot of what I wrote may be hard to understand as I had a hard time trying to explain it! Please let me know if you need clarification or have more questions!
Take Care,
Autumn 32 w/CF
I *think* I can shed a little light on this issue for you as I went through the exact same thing a couple years ago! I was scared to death just as you are! Maybe even more so because I was pregnant and had a baby while Medicare was my primary!
So, I'll start by saying everything turned out FINE!I had to go on COBRA while my husband was between jobs a couple years ago, and with COBRA, Medicare becomes primary. I only had Medicare as primary for a few months until my husband started a new job and I got on his employers group plan and that became primary. But I think I can still help you out!
Nothing much changed in terms of prescription coverage. I continued to fill my prescriptions under Blue Cross/Blue Shield since I didn't have a Part D plan. The only prescription that did change was Pulmozyme, because Medicare part B covers Pulmozyme. In that case, your secondary plan should pick up whatever medicare doesn't cover, just leaving you with your regular copay. So in order for this not to become confusing, what I did was fill all my regular prescriptions at Walgreens through my secondary and gave them no Medicare info (since it didn't apply to prescriptions) and then filled my Pulmozyme through CF Services, where they billed Medicare as primary and then my secondary. It worked pretty darn smooth.
So to answer your question, YES, your secondary would cover your prescriptions since you do not have a Part D plan.
As far as your secondary picking up what Medicare doesn't pay..... Yes, sometimes it will. If it is something that is a COVERED service under the terms of your secondary insurance, and it is NOT a covered service by Medicare, your secondary has to pay if Medicare denies it. Or, if Medicare pays less than what your secondary would have paid if they were your primary, then they will pick up the difference. Basically the secondary looks at the claim and figures out what they would have paid on the claim if they were your primary, then they will pay up to that amount if a balance remains after Medicare pays.
Also, Medicare is cut throat when it comes to negotiating rates with hospitals. So usually for me, by the time the hospital gave me the Medicare rate, and Medicare paid whatever it paid, it was less than what my secondary would have paid. So my secondary ended up not having to pay much if anything.
For me, for the most part having Medicare as primary worked out pretty well. I didn't pay much out of pocket at all. I really think you'd be fine with it as your primary, as long as your husband's potential employer has a decent prescription plan.
I realize that a lot of what I wrote may be hard to understand as I had a hard time trying to explain it! Please let me know if you need clarification or have more questions!
Take Care,
Autumn 32 w/CF
Thanks Autumn. That helps a lot. The insurance we have right now has paid for everything that I've had to have. They pay 100% of labs, x-ray's, etc. I think the only thing the I've had to have Medicare pick up is the dr. office co-pay which is $20. So that is why I'm really nervous to go to Medicare primary. They don't seem to have a very good track record My husband may not find anything else anyway, so I many just be getting ahead of myself, but I wanted to know what to expect. Thanks for the info. It does put me at ease a little bit knowing the insurance would still pick up scripts.
My husband may not find anything else anyway, so I many just be getting ahead of myself, but I wanted to know what to expect. Thanks for the info. It does put me at ease a little bit knowing the insurance would still pick up scripts.The level of benefits provided by secondary insurance will depend on what your husbands employer has purchased. Each employer can buy different levels of coverage, so your co-pays or deductibles after Medicare could change. If they make him a job offer they should be able to provide a summary of the coverage so you can compare it.
Thanks Jet. Yeah, I know the insurance will vary from place to place. We've gone through this before when he was looking into another job. We always have to check on the prescription part of the insurance cause that is the biggest issue for me. I've been very blessed that I haven't had to be admitted for IV's since I was in high school (part of it at my own doing), but I know it won't stay that way forever. I always check the deductibles, co-pays, and out-of-pocket. Thanks!!